1 Department of Ophthalmology, the Second Xiangya Hospital, Central South University, Changsha 410011, China 2 Aier School of Ophthalmology, Central South University, Changsha 410015, China 3 Changsha Aier Eye Hospital, Changsha 410015, China
Abstract: Objective: To evaluate the vessel density and optic disc morphological characteristics in high myopic (HM) patients with primary open-angle glaucoma (POAG), and to investigate the association between vessel density and visual field loss. Methods: This was a cross-sectional study. A total of 24 HM patients (44 eyes) with POAG and 37 HM patients (50 eyes) without POAG (control group) were enrolled in this study. The glaucoma patients were additionally classified into a mild POAG group (13 patients, 20 eyes) and moderate and severe POAG group (15 patients, 24 eyes) according to the visual field mean deviation (MD). All patients underwent imaging using optical coherence tomography angiography (OCTA) to measure vessel density and structural parameters of the optic disc and macula, fudus photography to calculate the optic disc ovality index, and standard automated perimetry. The differences in vessel density, structural parameters and visual field variables between the groups were compared by one-way analysis and the correlation between MD and the optic disc ovality index was performed by Pearson correlation or Spearman correlation analysis. Results: Compared with the control group, the HM patients with POAG showed reduced peripapillary capillary density, deep foveal vessel density and superficial parafoveal vessel density (F=86.340, 18.620, 42.757, all P<0.001), which aggravated the progression of glaucoma. There was no significant difference in the optic disc ovality index between the mild POAG group and control group (P=0.077), while the moderate and severe POAG group showed a decreased optic disc ovality compared to the control group and mild POAG group, and the difference was significant (P<0.001, P=0.028 respectively). The parameter with the highest correlation coefficient to visual field MD was average retinal nerve fiber layer (RNFL) thickness (r=0.782, P<0.001), followed by average ganglion cell complex (GCC) thickness (r=0.621, P<0.001), superficial parafoveal vessel density (r=0.621, P<0.001), peripapillary capillary density (r=0.599, P<0.001) and deep parafoveal vessel density (r=0.420, P=0.002). The disc ovality index was positively associated with the peripapillary capillary density (r=0.318, P=0.002), disc area (r=0.405, P<0.001), average RNFL thickness (r=0.476, P<0.001) and average GCC thickness (r=0.375, P<0.001). Conclusions: In contrast to average RNFL thickness and GCC thickness, decreased vessel density in HM patients with POAG is associated less with visual field loss. The disc ovality index is correlated with a decrease in vessel density and structural damage. The OCTA can be used for early diagnosis of HM with POAG.
聂芬1 欧阳君怡2,3 罗丽佳2,3 罗金香2,3 陈晓宇1 段宣初1,2,3. OCTA评估高度近视合并原发性开角型青光眼血管密度与视野缺损的相关性[J]. 中华眼视光学与视觉科学杂志, 2020, 22(12): 881-888.
Fen Nie1,Junyi Ouyang2, 3, Lijia Luo2, 3, Jinxiang Luo2, 3, Xiaoyu Chen1,Xuanchu Duan1, 2, 3. Evaluation of the Correlation between Vessel Density and Visual Field Loss in High Myopic Patients with Primary Open-Angle Glaucoma Using OCTA. Chinese Journal of Optometry Ophthalmology and Visual science, 2020, 22(12): 881-888. DOI: 10.3760/cma.j.cn115909-20200527-00227
Kim KE, Kim MJ, Park KH, et al. Prevalence, awareness, and risk factors of primary open-angle glaucoma: Korea national health and nutrition examination survey 2008- 2011. Ophthalmology, 2016, 123(3): 532-541. DOI: 10.1016/ j.ophtha.2015.11.004.
[2]
Nagaoka N, Jonas JB, Morohoshi K, et al. Glaucomatous-type optic discs in high myopia. PLoS One, 2015, 10(10): e0138825. DOI: 10.1371/journal.pone.0138825.
[3]
Lee JE, Sung KR, Lee JY, et al. Implications of optic disc tilt in the progression of primary open-angle glaucoma. Invest Ophthalmol Vis Sci, 2015, 56(11): 6925-6931. DOI: 10.1167/ iovs.15-17892.
[4]
Seol BR, Park KH, Jeoung JW. Optic disc tilt and glaucoma progression in myopic glaucoma: A longitudinal match-pair case-control study. Invest Ophthalmol Vis Sci, 2019, 60(6): 2127-2133. DOI: 10.1167/iovs.18-25839.
[5]
Kornzweig AL, Eliasoph I, Feldstein M. Selective atrophy of the radial peripapillary capillaries in chronic glaucoma. Arch Ophthalmol, 1968, 80(6): 696-702. DOI: 10.1001/ archopht.1968.0098005069800.
[6]
Flammer J, Orgül S, Costa VP, et al. The impact of ocular blood flow in glaucoma. Prog Retin Eye Res, 2002, 21(4): 359-393. DOI: 10.1016/s1350-9462(02)00008-3.
[7]
Hodapp E, Parish II RK, Anderson DR. Clinical decisions in glaucoma. Mosby: St. Louis, 1993: 52-61.
Chen Q, He J, Yin Y, et al. Impact of the morphologic characteristics of optic disc on choroidal thickness in young myopic patients. Invest Ophthalmol Vis Sci, 2019, 60(8): 2958- 2967. DOI: 10.1167/iovs.18-26393.
[10]
Shin HY, Park HY, Park CK. The effect of myopic optic disc tilt on measurement of spectral-domain optical coherence tomography parameters. Br J Ophthalmol, 2015, 99(1): 69-74. DOI: 10.1136/bjophthalmol-2014-305259.
[11]
Lee SH, Lee EJ, Kim TW. Comparison of vascular-function and structure-function correlations in glaucomatous eyes with high myopia. Br J Ophthalmol, 2020, 104(6): 807-812. DOI: 10.1136/ bjophthalmol-2019-314430.
[12]
Yarmohammadi A, Zangwill LM, Diniz-Filho A, et al. Optical coherence tomography angiography vessel density in healthy, glaucoma suspect, and glaucoma eyes. Invest Ophthalmol Vis Sci, 2016, 57(9): 451-459. DOI: 10.1167/iovs.15-18944.
Yarmohammadi A, Zangwill LM, Diniz-Filho A, et al. Relationship between optical coherence tomography angiography vessel density and severity of visual field loss in glaucoma. Ophthalmology, 2016, 123(12): 2498-2508. DOI: 10.1016/j.ophtha.2016.08.041.
[17]
Jeon SJ, Park HL, Park CK. Effect of macular vascular density on central visual function and macular structure in glaucoma patients. Sci Rep, 2018, 8(1): 16009. DOI: 10.1038/s41598-018- 34417-4.
[18]
Wang Y, Xin C, Li M, et al. Macular vessel density versus ganglion cell complex thickness for detection of early primary open-angle glaucoma. BMC Ophthalmol, 2020, 20(1): 17. DOI: 10.1186/s12886-020-1304-x.