A Report by the American Academy of Ophthalmology Ophthalmic Technology Assessment Committee Glaucoma Panel
Darrell WuDunn, MD, PhD,1 Hana L. Takusagawa, MD,2 Arthur J. Sit, MD,3 Julia A. Rosdahl, MD, PhD,4 Sunita Radhakrishnan, MD,5 Ambika Hoguet, MD,6 Ying Han, MD, PhD,7 Teresa C. Chen, MD8
Ophthalmology, Volume 128, 1222-1235, © 2021 by the American Academy of Ophthalmology. Click here for free access to the OTA.
Purpose: To review the current published literature on the use of OCT angiography (OCTA) to help detect changes associated with the diagnosis of primary open-angle glaucoma.
Methods: Searches of the peer-reviewed literature were conducted in March 2018, June 2018, April 2019, December 2019, and June 2020 in the PubMed and Cochrane Library databases. Abstracts of 459 articles were examined to exclude reviews and non-English articles. After inclusion and exclusion criteria were applied, 75 articles were selected and the panel methodologist rated them for strength of evidence. Three articles were rated level I and 57 articles were rated level II. The 15 level III articles were excluded.
Results: OCT angiography can detect decreased capillary vessel density within the peripapillary nerve fiber layer (level II) and macula (level I and II) in patients with suspected glaucoma, preperimetric glaucoma, and perimetric glaucoma. The degree of vessel density loss correlates significantly with glaucoma severity both overall and topographically (level II) as well as longitudinally (level I). For differentiating glaucomatous from healthy eyes, some studies found that peripapillary and macular vessel density measurements by OCTA show a diagnostic ability (area under the receiver operating characteristic curve) that is comparable with structural OCT retinal nerve fiber and ganglion cell thickness measurements, whereas other studies found that structural OCT measurements perform better. Choroidal or deep-layer microvasculature dropout as measured by OCTA is also associated with glaucoma damage (level I and II). Lower peripapillary and macular vessel density and choroidal microvasculature dropout are associated with faster rates of disease progression (level I and II).
Conclusions: Vessel density loss associated with glaucoma can be detected by OCTA. Peripapillary, macular, and choroidal vessel density parameters may complement visual field and structural OCT measurements in the diagnosis of glaucoma.
1University of Florida, College of Medicine--Jacksonville, Department of Ophthalmology, Jacksonville, Florida
2VA Eugene Healthcare Center, Eugene, Oregon, and Casey Eye Institute, Oregon Health & Sciences University, Portland, Oregon
3Mayo Clinic, Department of Ophthalmology, Rochester Minnesota
4Duke Eye Center, Durham, North Carolina
5Glaucoma Center of San Francisco, Glaucoma Research and Education Group, San Francisco, California
6Ophthalmic Consultants of Boston, Boston, Massachusetts
7UCSF Medical Center, San Francisco, California
8Harvard Medical School, Department of Ophthalmology, Massachusetts Eye & Ear, Glaucoma Service, Boston, Massachusetts