Optical Coherence Tomography Angiography and Visual Field Progression in Primary Angle Closure Glaucoma

Precis: Lower whole enface disc (coefficient: 0.02, P=0.03) and macular vessel densities (coefficient: 0.04, P=0.02) on optical coherence tomography angiography (OCTA) were significantly associated with faster rate of mean deviation (MD) decline. Purpose: To evaluate the association between OCTA features and prior visual field (VF) progression in primary angle closure glaucoma (PACG). Methods: In a cross-sectional study, 46 eyes of 31 PACG patients with 5 reliable VF examinations performed over >= 3 years of follow-up underwent OCTA imaging. Effect of clinical (age, sex, number of antiglaucoma medications, mean, and SD of intraocular pressure during follow-up), optical coherence tomography (average retinal nerve fiber layer and ganglion cell complex thickness) and OCTA (whole enface vessel density of disc and macular scan, deep-layer microvascular dropout) parameters on the rate of MD change was evaluated using linear mixed models. Results: Average (+/- SD) MD of the baseline VF was -7.4 +/- 7.3 dB, and rate of MD change was -0.32 +/- 0.29 dB/y. Whole enface vessel density of disc and macular scans was 39.5%+/- 8.1% and 38.7%+/- 4.4%, respectively. Microvascular dropout was noted in 33.3% of the eyes. Multivariate mixed models showed that lower whole enface disc (coefficient: 0.02, P=0.03) and macular vessel densities (coefficient: 0.04, P=0.02) were significantly associated with faster rate of MD decline. Other factors significantly associated with faster progression in multivariate models were older age (coefficient: -0.02, P<0.05) and the presence of systemic hypertension (coefficient: -0.37, P=0.01) and diabetes (coefficient: -0.28, P=0.05). Conclusions: Lower superficial vessel density measured using OCTA was significantly associated with faster VF progression in PACG. In these eyes, OCTA parameters can serve as biomarker suggestive of past VF progression.