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Editors Selection IGR 19-3

Clinical Examination Methods: OCT-Angiography

Comment by Alon Harris on:

61541 Optical Coherence Tomography Angiography of the Peripapillary Retina in Glaucoma, Liu L; Jia Y; Takusagawa HL et al., JAMA ophthalmology, 2015; 133: 1045-1052

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Advancements in our ability to accurately quantify ocular blood flow and vascular health in ocular pathology hold great promise towards enhanced disease diagnosis and patient management. The present study seeks to utilize OCT methodologies for linking peripapillary retinal perfusion and localized vascular density to distinguish glaucoma status and alignment with visual field damage. This has been proposed previously as important,¹ as regional differences in blood flow alone were inconclusive, but when considered in proportion to the tissue bed being perfused, metabolic vulnerably was apparent. The authors' work is encouraging, as development of a technology capable of quantifying vascular density whilst simultaneously calculating the volume of perfused tissue promises new insights into the role of hemodynamics in the pathogenesis and progression of glaucoma. Specifically in the present study, peripapillary flow and vessel density were significantly lower in glaucomatous eyes than in normal eyes and were highly correlated with visual field PSD in glaucomatous eyes. The use of age-matched eyes between healthy and glaucomatous subjects is one strength of the current approach, as are the high repeatability and reproducibility numbers for the techniques implemented. An obvious limitation is the small sample of 12 eyes per comparative group, as is the presence of potentially vasoactive medication use by subjects. It also remains unclear if the selected areas for analysis represent the tissue most important in the disease process in terms of order of mechanistic vascular involvement. Important next steps should include a longitudinal study tracking and pacing the progression of changes in the described peripapillary flow and vessel density in relation to glaucomatous visual function and ocular tissue changes, to better describe the modalities' ability to describe structure/function/hemodynamics relationships and evaluate their ability to predict risk for the progression of glaucoma.

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