title: Deep Retinal Layer Microvasculature Dropout Detected by the Optical Coherence Tomography Angiography in Glaucoma.
abstract: To investigate factors associated with dropout of the parapapillary deep retinal layer microvasculature assessed by optical coherence tomography angiography (OCTA) in glaucomatous eyes.
  
  
  
  Cross-sectional study.
  
  
  
  Seventy-one eyes from 71 primary open-angle glaucoma (POAG) patients with β-zone parapapillary atrophy (βPPA) enrolled in the Diagnostic Innovations in Glaucoma Study.
  
  
  
  Parapapillary deep-layer microvasculature dropout was defined as a complete loss of the microvasculature located within the deep retinal layer of the βPPA from OCTA-derived optic nerve head vessel density maps by standardized qualitative assessment. Circumpapillary vessel density (cpVD) within the retinal nerve fiber layer (RNFL) also was calculated using OCTA. Choroidal thickness and presence of focal lamina cribrosa (LC) defects were determined using swept-source optical coherence tomography.
  
  
  
  Presence of parapapillary deep-layer microvasculature dropout. Parameters including age, systolic and diastolic blood pressure, axial length, intraocular pressure, disc hemorrhage, cpVD, visual field (VF) mean deviation (MD), focal LC defects βPPA area, and choroidal thickness were analyzed.
  
  
  
  Parapapillary deep-layer microvasculature dropout was detected in 37 POAG eyes (52.1%). Eyes with microvasculature dropout had a higher prevalence of LC defects (70.3% vs. 32.4%), lower cpVD (52.7% vs. 58.8%), worse VF MD (-9.06 dB vs. -3.83 dB), thinner total choroidal thickness (126.5 μm vs. 169.1 μm), longer axial length (24.7 mm vs. 24.0 mm), larger βPPA (1.2 mm2vs. 0.76 mm2), and lower diastolic blood pressure (74.7 mmHg vs. 81.7 mmHg) than those without dropout (P < 0.05, respectively). In the multivariate logistic regression analysis, higher prevalence of focal LC defects (odds ratio [OR], 6.27; P = 0.012), reduced cpVD (OR, 1.27; P = 0.002), worse VF MD (OR, 1.27; P = 0.001), thinner choroidal thickness (OR, 1.02; P = 0.014), and lower diastolic blood pressure (OR, 1.16; P = 0.003) were associated significantly with the dropout.
  
  
  
  Systemic and ocular factors including focal LC defects more advanced glaucoma, reduced RNFL vessel density, thinner choroidal thickness, and lower diastolic blood pressure were factors associated with the parapapillary deep-layer microvasculature dropout in glaucomatous eyes. Longitudinal studies are required to elucidate the temporal relationship between parapapillary deep-layer microvasculature dropout and systemic and ocular factors.
authors: Hamilton Glaucoma Center, Shiley Eye Institute, and the Department of Ophthalmology, University of California, San Diego, La Jolla, California; Department of Ophthalmology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea.
authors: Min Hee
authors: MH
authors: Suh
authors: Hamilton Glaucoma Center, Shiley Eye Institute, and the Department of Ophthalmology, University of California, San Diego, La Jolla, California.
authors: Linda M
authors: LM
authors: Zangwill
authors: Hamilton Glaucoma Center, Shiley Eye Institute, and the Department of Ophthalmology, University of California, San Diego, La Jolla, California.
authors: Patricia Isabel C
authors: PI
authors: Manalastas
authors: Hamilton Glaucoma Center, Shiley Eye Institute, and the Department of Ophthalmology, University of California, San Diego, La Jolla, California.
authors: Akram
authors: A
authors: Belghith
authors: Hamilton Glaucoma Center, Shiley Eye Institute, and the Department of Ophthalmology, University of California, San Diego, La Jolla, California.
authors: Adeleh
authors: A
authors: Yarmohammadi
authors: Hamilton Glaucoma Center, Shiley Eye Institute, and the Department of Ophthalmology, University of California, San Diego, La Jolla, California.
authors: Felipe A
authors: FA
authors: Medeiros
authors: Hamilton Glaucoma Center, Shiley Eye Institute, and the Department of Ophthalmology, University of California, San Diego, La Jolla, California.
authors: Alberto
authors: A
authors: Diniz-Filho
authors: Hamilton Glaucoma Center, Shiley Eye Institute, and the Department of Ophthalmology, University of California, San Diego, La Jolla, California.
authors: Luke J
authors: LJ
authors: Saunders
authors: Hamilton Glaucoma Center, Shiley Eye Institute, and the Department of Ophthalmology, University of California, San Diego, La Jolla, California. Electronic address: rweinreb@ucsd.edu.
authors: Robert N
authors: RN
authors: Weinreb
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography; D058452:Axial Length, Eye / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D005902:Glaucoma, Open-Angle / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007429:Intraocular Pressure / Q000502:physiology; D008297:Male; D055806:Microvessels; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology; D009896:Optic Atrophy / Q000473:pathology; D009898:Optic Disk / Q000098:blood supply* / Q000473:pathology; D012165:Retinal Ganglion Cells / Q000473:pathology; D012171:Retinal Vessels / Q000000981:diagnostic imaging* / Q000473:pathology*; D041623:Tomography, Optical Coherence; D014065:Tonometry, Ocular; D058609:Visual Field Tests; D014794:Visual Fields