title: Optical Coherence Tomography Angiography of the Peripapillary Retina in Glaucoma.
abstract: OBJECTIVE
  Vascular factors may have important roles in the pathophysiology of glaucoma. A practical method for the clinical evaluation of ocular perfusion is needed to improve glaucoma management.
  
  
  OBJECTIVE
  To detect peripapillary retinal perfusion in glaucomatous eyes compared with normal eyes using optical coherence tomography (OCT) angiography.
  
  
  METHODS
  Prospective observational study performed from July 24, 2013, to April 17, 2014. Participants were recruited and tested at Casey Eye Institute, Oregon Health & Science University. In total, 12 glaucomatous eyes and 12 age-matched normal eyes were analyzed. The optic disc region was imaged twice using a 3 × 3-mm scan by a 70-kHz, 840-nm-wavelength spectral OCT system. The split-spectrum amplitude-decorrelation angiography algorithm was used. Peripapillary flow index was calculated as the mean decorrelation value in the peripapillary region, defined as a 700-µm-wide elliptical annulus around the disc. Peripapillary vessel density was the percentage area occupied by vessels. The data statistical analysis was performed from October 30, 2013, to May 30, 2014.
  
  
  METHODS
  Variability was assessed by the coefficient of variation. The Mann-Whitney test was used to compare the 2 groups of eyes. Correlations between vascular and visual field variables were assessed by linear regression analysis.
  
  
  RESULTS
  In 12 normal eyes, a dense microvascular network around the disc was visible on OCT angiography. In 12 glaucomatous eyes, this network was visibly attenuated globally and focally. In normal eyes, between-visit reproducibilities of peripapillary flow index and peripapillary vessel density were 4.3% and 2.7% of the coefficient of variation, respectively, while the population variabilities of peripapillary flow index and peripapillary vessel density were 8.2% and 3.0% of the coefficient of variation, respectively. Peripapillary flow index and peripapillary vessel density in glaucomatous eyes were lower than those in normal eyes (P < .001 for both). Peripapillary flow index (Pearson r = -0.808) and peripapillary vessel density (Pearson r = -0.835) were highly correlated with visual field pattern standard deviation in glaucomatous eyes (P = .001 for both). The areas under the receiver operating characteristic curve for normal vs glaucomatous eyes were 0.892 for peripapillary flow index and 0.938 for peripapillary vessel density.
  
  
  CONCLUSIONS
  Using OCT angiography, reduced peripapillary retinal perfusion in glaucomatous eyes can be visualized as focal defects and quantified as peripapillary flow index and peripapillary vessel density, with high repeatability and reproducibility. Quantitative OCT angiography may have value in future studies to determine its potential usefulness in glaucoma evaluation.
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland2Department of Ophthalmology, Peking Union Medical College Hospital, Beijing, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Liu
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland.
authors.forename: Yali
authors.initials: Y
authors.lastname: Jia
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland.
authors.forename: Hana L
authors.initials: HL
authors.lastname: Takusagawa
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland.
authors.forename: Alex D
authors.initials: AD
authors.lastname: Pechauer
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland.
authors.forename: Beth
authors.initials: B
authors.lastname: Edmunds
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland.
authors.forename: Lorinna
authors.initials: L
authors.lastname: Lombardi
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland.
authors.forename: Ellen
authors.initials: E
authors.lastname: Davis
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland.
authors.forename: John C
authors.initials: JC
authors.lastname: Morrison
authors.affiliation: Casey Eye Institute, Oregon Health & Science University, Portland.
authors.forename: David
authors.initials: D
authors.lastname: Huang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001783:Blood Flow Velocity; D001794:Blood Pressure / Q000502:physiology; D005260:Female; D005451:Fluorescein Angiography; D005902:Glaucoma, Open-Angle / Q000503:physiopathology*; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D009898:Optic Disk / Q000098:blood supply*; D011446:Prospective Studies; D012039:Regional Blood Flow; D012171:Retinal Vessels / Q000503:physiopathology*; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D014794:Visual Fields / Q000502:physiology