title: Peripapillary Retinal Nerve Fiber Layer Vascular Microcirculation in Eyes With Glaucoma and Single-Hemifield Visual Field Loss.
abstract: 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.
  
  
  
  To investigate the changes in the microcirculation of the peripapillary RNFL of eyes with glaucoma by using optical microangiography.
  
  
  
  Eyes with glaucoma and single-hemifield VF defect and normal eyes underwent scanning using an optical microangiography system covering a 6.7 × 6.7-mm2 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.
  
  
  
  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.
  
  
  
  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] μm; 95% CI, 15.1-32.0 µm; 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] μm; 95% CI, -6.2 to 12.9 µm; P = .48). Strong correlations were found between the blood flux index and VF mean deviation (Spearman ρ = 0.44; P = .045) and RNFL thickness (Spearman ρ = 0.65; P = .001) in the normal hemisphere of the eye with glaucoma.
  
  
  
  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.
authors.affiliation: Department of Ophthalmology, University of Washington, Seattle2Department of Bioengineering, University of Washington, Seattle.
authors.forename: Chieh-Li
authors.initials: CL
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, University of Washington, Seattle.
authors.forename: Karine D
authors.initials: KD
authors.lastname: Bojikian
authors.affiliation: Department of Ophthalmology, University of Washington, Seattle.
authors.forename: Joanne C
authors.initials: JC
authors.lastname: Wen
authors.affiliation: Department of Bioengineering, University of Washington, Seattle.
authors.forename: Qinqin
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Bioengineering, University of Washington, Seattle.
authors.forename: Chen
authors.initials: C
authors.lastname: Xin
authors.affiliation: Department of Ophthalmology, University of Washington, Seattle.
authors.forename: Raghu C
authors.initials: RC
authors.lastname: Mudumbai
authors.affiliation: Department of Ophthalmology, University of Washington, Seattle.
authors.forename: Murray A
authors.initials: MA
authors.lastname: Johnstone
authors.affiliation: Department of Ophthalmology, University of Washington, Seattle.
authors.forename: Philip P
authors.initials: PP
authors.lastname: Chen
authors.affiliation: Department of Ophthalmology, University of Washington, Seattle2Department of Bioengineering, University of Washington, Seattle.
authors.forename: Ruikang K
authors.initials: RK
authors.lastname: Wang
mesh_terms: D000368:Aged; D005260:Female; D005901:Glaucoma / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D009412:Nerve Fibers / Q000473:pathology; D009898:Optic Disk / Q000098:blood supply*; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012171:Retinal Vessels / Q000000981:diagnostic imaging / Q000503:physiopathology*; D012607:Scotoma / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D041623:Tomography, Optical Coherence / Q000379:methods; D014794:Visual Fields