Peripapillary Retinal Nerve Fiber Layer Vascular Microcirculation in Eyes With Glaucoma and Single-Hemifield Visual Field Loss

IMPORTANCE Understanding the differences in vascular microcirculation of the peripapillary retinal nerve fiber layer (RNFL) between the hemispheres in eyes with glaucoma with single-hemifield visual field (VF) defects may provide insight into the pathophysiology of glaucoma. OBJECTIVE To investigate the changes in the microcirculation of the peripapillary RNFL of eyes with glaucoma by using optical microangiography. DESIGN, SETTING, AND PARTICIPANTS Eyes with glaucoma and single-hemifield VF defect and normal eyes underwent scanning using an optical microangiography system covering a6.7 x 6.7-mm(2) area centered at the optic nerve head. The RNFL microcirculation was measured within an annulus region centered at the optic nerve head divided into superior and inferior hemispheres. Blood flux index (the mean flow signal intensity in the vessels) and vessel area density (the percentage of the detected vessels in the annulus) were measured. MAIN OUTCOMES AND MEASURES Differences in microcirculation between the hemispheres in eyes with glaucoma and normal eyes and correlations among blood flow metrics, VF thresholds, and clinical optical coherence tomography structural measurements were assessed. RESULTS Twenty-one eyes from 21 patients with glaucoma (7 men and 14 women; mean [SD] age, 63.7 [9.9] years) and 20 eyes from 20 healthy control individuals (9 men and 11 women; mean [SD] age, 68.3 [10.7] years) were studied. In eyes with glaucoma, the abnormal hemisphere showed a thinner RNFL (mean [SE] difference, 23.5 [4.5] mu m; 95% CI, 15.1-32.0 mu m; P <.001), lower RNFL blood flux index (mean [SE] difference, 0.04 [0.01]; 95% CI, 0.02-0.05; P <.001), and less vessel area density (mean [SE] difference, 0.08%[0.02%]; 95% CI, 0.05%-0.10%; P <.001) than did the normal hemisphere. Compared with normal eyes, reduced RNFL microcirculation was found in the normal hemisphere of eyes with glaucoma, measured by mean [SE] differences in blood flux index (0.06 [0.01]; 95% CI, 0.04-0.09; P <.001) and vessel area density (0.04%[0.02%]; 95% CI, 0.02%-0.08%; P =.003) but not in RNFL thickness (3.4 [4.7] mu m; 95% CI,-6.2 to 12.9 mu m; P =.48). Strong correlations were found between the blood flux index and VF mean deviation (Spearman rho = 0.44; P =.045) and RNFL thickness (Spearman rho = 0.65; P =.001) in the normal hemisphere of the eye with glaucoma. CONCLUSIONS AND RELEVANCE Reduced RNFL microcirculation was detected in the normal hemisphere of eyes with glaucoma, with strong correspondence with VF loss and RNFL thinning. Although the results suggest that vascular dysfunction precedes structural changes seen in glaucoma, longitudinal studies would be needed to confirm this finding.