Factors associated with macular vessel density measured by optical coherence tomography angiography in healthy and glauc

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CLINICAL INVESTIGATION

Factors associated with macular vessel density measured by optical coherence tomography angiography in healthy and glaucomatous eyes Kwanghyun Lee1,4 · Chan Keum Park2 · Eun Woo Kim1,3 · Joo Yeon Kim1 · Heon Yang1 · Wungrak Choi1 · Sang Yeop Lee1 · Gong Je Seong1 · Chan Yun Kim1 · Hyoung Won Bae1 Received: 10 January 2020 / Accepted: 17 May 2020 © Japanese Ophthalmological Society 2020

Abstract Purpose  To investigate factors associated with macular vessel density and to analyze their effects according to glaucoma stage. Study design  Retrospective cross-sectional study. Methods  A total of 72 healthy eyes and 147 open-angle glaucomatous eyes were studied. All eyes underwent optical coherence tomography and visual field examinations. Clinical variables were compared according to the glaucoma stage. Relationships between macular vessel density (mVD) and other variables were analyzed using linear regression and segmented analyses. Results  Age (P = 0.010) and signal strength (P < 0.001) were associated with macular vessel density in healthy eyes. In glaucomatous eyes, age, signal strength, ganglion cell-inner plexiform layer (GCIPL) thickness, and mean deviation (MD) correlated with macular vessel density (all P ≤ 0.005). When analyzed by glaucoma stage, age correlated with macular vessel density in early (P = 0.017 and all P ≤ 0.012, respectively) and moderate (P = 0.002 and all P ≤ 0.001, respectively) glaucoma. Conversely, GCIPL thickness was associated with macular vessel density (P = 0.004). According to segmented analysis between MD and mVD, the MD value at the change point for mVD was −17.92 dB, which was much lower than that for GCIPL thickness (−5.83 dB). Conclusion  Signal strength was the most significant factor associated with macular vessel density in healthy and glaucomatous eyes. Other than signal strength, factors associated with macular vessel density of glaucomatous eyes vary according to the glaucoma stage. The segmented analysis suggests that mVD could be better than GCIPL thickness in predicting MD changes in moderate-to-advanced glaucoma. Keywords  Glaucoma · Macular vessel density · Optical coherence tomography angiography

Introduction Corresponding Author: Hyoung Won Bae Electronic supplementary material  The online version of this article (https​://doi.org/10.1007/s1038​4-020-00757​-w) contains supplementary material, which is available to authorized users. * Hyoung Won Bae [email protected] 1



Department of Ophthalmology, The Institute of Vision Research, Yonsei University College of Medicine, 50‑1, Yonsei‑ro, Seodaemun‑gu, Seoul 03722, South Korea



Department of Ophthalmology, Maryknoll Hospital, Busan, South Korea

2

Optical coherence tomography (OCT) is used to diagnose and monitor glaucoma, a progressive optic neuropathy characterized by loss of retinal ganglion cells and optic nerve 3



Department of Ophthalmology, Myung-Gok Eye Research Institute, Kim’s Eye Hospital, Konyang University College of Medicine, Seoul, South Korea

4



Department of Ophthal