Association Between Parapapillary Choroidal Vessel Density Measured With Optical Coherence Tomography Angiography and Future Visual Field Progression in Patients With Glaucoma

ImportanceInvestigating the vascular risk factors of glaucoma progression is important to individualize treatment; however, few studies have investigated these factors because the available methods have proven insufficient to evaluate the vascular features of patients with glaucoma. Recently, the advent of optical coherence tomography angiography (OCT-A) allowed both qualitative and quantitative microvascular data to be obtained, to in turn evaluate the perfusion status of different retinal layers. ObjectiveTo determine whether baseline parapapillary choroidal vessel density (VD) as measured by OCT-A was associated with future glaucoma progression. Design, Setting, and ParticipantsA prospective, observational, comparative study was conducted at Seoul St Mary's Hospital of The Catholic University of Korea from March 1, 2016, to December 31, 2018, for 108 glaucomatous eyes in which the retinal nerve fiber layer thickness and mean deviation were measured by at least 5 serial OCT and visual field (VF) examinations. The participants underwent OCT-A at baseline. Vessel density was measured using the en face image of the choroidal map of OCT-A within the -zone parapapillary atrophy region. Main Outcomes and MeasuresParapapillary choroidal VD, retinal nerve fiber layer thinning rate, mean deviation rate, and progression of glaucoma as measured by OCT and VF. ResultsAmong 108 patients (74 women and 34 men; mean [SD] age, 59.2 [13.1] years), 38 (35.2%) showed progression of glaucoma as measured by OCT and 34 (31.5%) showed progression of glaucoma as measured by VF at the last follow-up. The mean (SD) follow-up duration was 2.6 [2.3] years. The presence of disc hemorrhage (odds ratio, 5.57; 95% CI, 3.18-8.29; P=.001), baseline mean deviation (odds ratio, 0.83; 95% CI, 0.71-0.97; P=.02), and parapapillary choroidal VD (odds ratio, 1.18; 95% CI, 1.09-1.28; P=.01) were associated with progression of glaucoma as measured by VF, but not with progression of glaucoma as measured by OCT. Baseline parapapillary choroidal VD (, 1.08; 95% CI, 1.02-1.13; P<.001) was associated with progression of glaucoma as measured by VF using Cox proportional hazards regression analysis. Conclusions and RelevanceThese data suggest that lower parapapillary choroidal VD within the -zone parapapillary atrophy at baseline among individuals with glaucoma could play some role in the risk of progression of glaucoma as measured by VF. The findings suggest that patients with glaucoma with lower parapapillary choroidal VD within the -zone parapapillary atrophy at baseline warrant careful monitoring for progression of glaucoma as measured by VF. This cohort study examines whether baseline parapapillary choroidal vessel density as measured by optical coherence tomography angiography is associated with future glaucoma progression. Key PointsQuestionIs parapapillary choroidal vessel density within the -zone peripapillary atrophy as measured by optical coherence tomography angiography at baseline associated with future glaucoma progression? FindingsIn this cohort study of 108 patients with open-angle glaucoma, baseline parapapillary choroidal vessel density was associated with progression of glaucoma as measured by visual field using Cox proportional hazard regression analysis, as was older age and poorer mean deviation of the visual field. MeaningThese data suggest that lower parapapillary choroidal vessel density within the -zone peripapillary atrophy at baseline among individuals with glaucoma could play a role in the risk of progression of glaucoma as measured by the visual field.