Elsevier

Ophthalmology

Volume 121, Issue 7, July 2014, Pages 1322-1332
Ophthalmology

Original article
Optical Coherence Tomography Angiography of Optic Disc Perfusion in Glaucoma

https://doi.org/10.1016/j.ophtha.2014.01.021Get rights and content

Purpose

To compare optic disc perfusion between normal subjects and subjects with glaucoma using optical coherence tomography (OCT) angiography and to detect optic disc perfusion changes in glaucoma.

Design

Observational, cross-sectional study.

Participants

Twenty-four normal subjects and 11 patients with glaucoma were included.

Methods

One eye of each subject was scanned by a high-speed 1050-nm–wavelength swept-source OCT instrument. The split-spectrum amplitude-decorrelation angiography (SSADA) algorithm was used to compute 3-dimensional optic disc angiography. A disc flow index was computed from 4 registered scans. Confocal scanning laser ophthalmoscopy (cSLO) was used to measure disc rim area, and stereo photography was used to evaluate cup/disc (C/D) ratios. Wide-field OCT scans over the discs were used to measure retinal nerve fiber layer (NFL) thickness.

Main Outcome Measures

Variability was assessed by coefficient of variation (CV). Diagnostic accuracy was assessed by sensitivity and specificity. Comparisons between glaucoma and normal groups were analyzed by Wilcoxon rank-sum test. Correlations among disc flow index, structural assessments, and visual field (VF) parameters were assessed by linear regression.

Results

In normal discs, a dense microvascular network was visible on OCT angiography. This network was visibly attenuated in subjects with glaucoma. The intra-visit repeatability, inter-visit reproducibility, and normal population variability of the optic disc flow index were 1.2%, 4.2%, and 5.0% CV, respectively. The disc flow index was reduced by 25% in the glaucoma group (P = 0.003). Sensitivity and specificity were both 100% using an optimized cutoff. The flow index was highly correlated with VF pattern standard deviation (R2 = 0.752, P = 0.001). These correlations were significant even after accounting for age, C/D area ratio, NFL, and rim area.

Conclusions

Optical coherence tomography angiography, generated by the new SSADA, repeatably measures optic disc perfusion and may be useful in the evaluation of glaucoma and glaucoma progression.

Section snippets

Study Population

This study was performed at the Casey Eye Institute at Oregon Health & Science University. The research protocols were approved by the institutional review board at Oregon Health & Science University and carried out in accordance with the tenets of the Declaration of Helsinki. Written informed consent was obtained from each subject after an explanation of the nature of the study.

The normal subjects and subjects with early glaucoma were part of the Advanced Imaging for Glaucoma study. One eye

Results

Disc perfusion was studied in 24 normal subjects and 11 subjects with glaucoma (Table 1). The mean age in the normal group, 52±10 years, was 16 years less than in the glaucoma group. The glaucoma group consisted of 8 PG and 3 PPG eyes. Most of the glaucoma group had mild disease, in which 6 of the 11 subjects had stage 0 to 1 according to Glaucoma Staging System 2.23 There were no significant differences in BMI, diabetes mellitus, systemic hypertension, or the use of systemic antihypertensive

Discussion

In this study, we reported the first use of OCT angiography to quantify human disc perfusion in glaucoma. Optical coherence tomography angiography with SSADA has many properties that make it useful for clinical evaluation. First, it is a noninvasive technique that does not require the injection of any exogenous dye or contrast agent. Second, it provides 3D visualization of the optic nerve head vasculature from the disc surface to the lamina cribrosa. Third, it provides near-automated

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    Financial Disclosure(s): The author(s) have made the following disclosure(s): Oregon Health & Science University, Y.J., and D.H. have a significant financial interest in Optovue, Inc, a company that may have a commercial interest in the results of this research and technology. These potential conflicts of interest have been reviewed and managed by Oregon Health & Science University. J.G.F. and D.H. receive royalties on an OCT patent licensed by the Massachusetts Institute of Technology to Carl Zeiss Meditec and LightLab Imaging. M.F.K. and J.G.F. receive royalties from intellectual property owned by the Massachusetts Institute of Technology and licensed to Optovue, Inc. The other authors have no proprietary or commercial interest in any materials discussed in this article.

    Supported by National Institutes of Health Grant 1R01 EY023285-01, Rosenbaum's P30EY010572, Clinical and Translational Science Award Grant UL1TR000128, an unrestricted grant from Research to Prevent Blindness, R01-EY11289-26 and Air Force Office of Scientific Research (AFOSR) FA9550-10-1-0551, German Research Foundation DFG-HO-1791/11-1, DFG-GSC80-SAOT, and DFG Training Group 1773.

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