Journal
BRITISH JOURNAL OF OPHTHALMOLOGY
Volume 107, Issue 6, Pages 816-822Publisher
BMJ PUBLISHING GROUP
DOI: 10.1136/bjophthalmol-2021-319923
Keywords
glaucoma; macula; diagnostic tests; investigation; field of vision
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This study found that enlargement of the macular intercapillary area is closely associated with thinning of the macular ganglion cell-inner plexiform layer and decreased central visual field sensitivity in early normal tension glaucoma eyes.
Purpose To investigate the relationship of macular intercapillary area (ICA) with macular ganglion cell-inner plexiform layer (GCIPL) thickness and central visual field sensitivity (CVFS) in normal tension glaucoma (NTG). Methods Seventy-eight early NTG eyes, 33 moderate-to-severe NTG eyes and 75 normal control eyes were cross-sectional evaluated. All participants underwent swept-source optical coherence tomography angiography (OCT-A; DRI-OCT, Topcon, Tokyo, Japan). A customised MATLAB program was used to quantify macular OCT-A metrics at central 3x3 mm macular region including vascular density (VD), foveal avascular zone (FAZ) area, 10 largest ICA including FAZ area (ICA10_IncFAZ) and excluding FAZ area (ICA10_ExcFAZ). Generalised estimating equation regression models were performed to determine the relationships of OCT-A vascular metrics with GCIPL thickness in the macular region and CVFS. Results NTG eyes had lower global VD, larger ICA10_IncFAZ, and larger ICA10_ExcFAZ than normal controls (all p <= 0.016). In the multivariable analyses, decreased VD (beta=-0.304, p=0.006) and increased ICA (beta=-0.231 for ICA10_IncFAZ and beta=-0.259 for ICA10_ExcFAZ, all p <= 0.042) were significantly associated with decreased GCIPL thickness in early NTG eyes but not in moderate-to-severe NTG eyes. ICA enlargement was associated with CVFS in early NTG eyes (beta=-0.310, p=0.009), while VD was associated with CVFS in moderate-to-severe NTG eyes (beta=-0.272, p=0.038). Conclusion ICA enlargement could be a potentially important disease marker of early NTG as reflected by its association with GCIPL thinning and decrease CVFS specifically for early NTG eyes.
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