Skip to main content

  • Nearly half of patients with POAG have OCTA-identified wedge defects

    Glaucoma

    Add to My Bookmarks

    Review of: Wedge defects on optical coherence tomography angiography of the peripapillary retina in glaucoma: Prevalence and associated clinical factors

    LeTran V, Burkemper B, O’Fee J, et al. Journal of Glaucoma, April 2022

    In this study, all patients with primary open-angle glaucoma (POAG) were found to have microvasculature loss (defects) to some degree, with disc hemorrhage contributing to an increased risk of wedge defects.

    Study design

    Researchers conducted a cross-sectional study of 278 eyes of 186 patients with mild-to-severe POAG who underwent OCTA imaging of the superficial peripapillary retina. Images were evaluated for the presence of a wedge defect; potential risk factors evaluated for development of a wedge defect included comorbid conditions such as hypertension and diabetes, untreated and treated IOP, glaucoma stage, presence of a paracentral visual field (VF) defect, and presence of disc hemorrhage.

    Outcomes

    Of the 278 eyes eligible for study inclusion, 45.3% had wedge defects, 39.2% had nonspecific defects, and 15.5% had profound loss in both hemispheres. None of the eyes had qualitatively normal OCTA. The risk of having a wedge defect was increased in eyes with a paracentral VF defect (odds ratio [OR] 4.38), a history of disc hemorrhage (OR 3.19), or a thinner retinal nerve fiber layer (OR 1.71).

    Limitations

    More than half of the eyes originally examined were excluded for comorbid pathology or poor image quality. The reproducibility of OCTA images is highly sensitive to media opacities, and different imaging platforms can produce images with significantly different vessel densities. Changes over time could not be evaluated due to the cross-sectional nature of this study.

    Clinical significance

    While ocular hypertension is the primary modifiable risk factor for glaucoma, OCTA may provide insight into independent etiologies for glaucoma progression. OCTA may become a particularly helpful tool in risk stratifying normal-tension glaucoma suspects and provide further direction for setting IOP targets for patients with POAG or normal-tension glaucoma.