Wu Jo-Hsuan, Moghimi Sasan, Nishida Takashi, Adelpour Mohsen, Kamalipour Alireza, Gunasegaran Gopikasree, Zangwill Linda M, Weinreb Robert N
Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA.
Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA.
Br J Ophthalmol. 2025 Mar 20;109(4):490-496. doi: 10.1136/bjo-2024-325746.
BACKGROUND/AIMS: To examine longitudinal optical coherence tomography angiography (OCTA) changes in macula and optic nerve head (ONH) in healthy, glaucoma suspect (GS) and primary open-angle glaucoma (POAG) eyes.
Healthy, GS and POAG eyes from Diagnostic Innovations in Glaucoma Study with ≥2 years follow-up and four visits of macular/ONH OCTA imaging were included. Rates of macular wiVD (whole-image vessel density) and ONH wiCD (whole-image capillary density) changes were calculated for each diagnosis group using join mixed-effect modelling. Differences in wiVD/wiCD change rates across diagnoses were examined through pairwise comparison. Relationships of baseline 24-2 visual field (VF) mean deviation (MD) with wiVD/wiCD change rates were evaluated for POAG eyes.
There were 36, 57 and 79 eyes (25, 38 and 50 subjects) in healthy, GS and POAG groups, respectively. Rates of wiVD (range:-0.72 to -0.92 %/year) and wiCD (range:-0.28 to -0.66 %/year) loss were different from zero in all groups (p<0.05). The rates of wiCD loss differed across all diagnosis groups (p<0.001), while wiVD change rates did not increase when comparing healthy to GS eyes (p=0.167). Baseline VF MD showed a significant but modest correlation with the rates of both wiVD and wiCD loss (p<0.05), and the correlation with wiCD change rate was slightly stronger (R=0.27 vs 0.16).
In glaucoma, there is earlier microvasculature loss in the ONH than in the macula. Moreover, ONH VD loss shows a slightly stronger association with baseline VF than macular VD. Observing ONH VD loss with OCTA may help to monitor early glaucoma, which should be confirmed by future larger studies.
背景/目的：研究健康眼、青光眼可疑（GS）眼和原发性开角型青光眼（POAG）眼中黄斑和视神经乳头（ONH）的纵向光学相干断层扫描血管造影（OCTA）变化。
纳入青光眼诊断创新研究中随访时间≥2年且进行了4次黄斑/ONH OCTA成像检查的健康眼、GS眼和POAG眼。使用联合混合效应模型计算每个诊断组黄斑全图像血管密度（wiVD）和ONH全图像毛细血管密度（wiCD）的变化率。通过两两比较检验不同诊断之间wiVD/wiCD变化率的差异。评估POAG眼中基线24-2视野（VF）平均偏差（MD）与wiVD/wiCD变化率之间的关系。
健康组、GS组和POAG组分别有36只、57只和79只眼（25名、38名和50名受试者）。所有组中wiVD（范围：-0.72至-0.92%/年）和wiCD（范围：-0.28至-0.66%/年）的损失率均不同于零（p<0.05）。所有诊断组之间wiCD损失率不同（p<0.001），而将健康眼与GS眼比较时，wiVD变化率没有增加（p=0.167）。基线VF MD与wiVD和wiCD损失率均呈显著但适度的相关性（p<0.05），且与wiCD变化率的相关性稍强（R=0.27对0.16）。
在青光眼中，ONH的微血管损失比黄斑更早。此外，ONH血管密度损失与基线VF的关联比黄斑血管密度稍强。用OCTA观察ONH血管密度损失可能有助于监测早期青光眼，这有待未来更大规模的研究证实。
