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Editors Selection IGR 23-2

Clinical Examination Methods: Optical Microangiography

Comment by Lucy Shen & Aimee C. Chang on:

99667 Optical Microangiography and Progressive Ganglion Cell-Inner Plexiform Layer Loss in Primary Open-Angle Glaucoma, Rao HL; Dasari S; Puttaiah NK et al., American Journal of Ophthalmology, 2022; 238: 36-44

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In this prospective case series, Rao and colleagues evaluated the association between optical microangiography (OMAG) measurements and progressive ganglion cell-inner plexiform layer (GCIPL) loss in Indian patients with primary open-angle glaucoma (POAG). GCIPL loss rate of superior and inferior sectors was assessed in 63 eyes of 38 patients with mild-to-moderate POAG for a follow-up duration of 3.0 ± 0.8 years and with 4.1 ± 1.1 OCT examinations. The investigators reported an association between a faster rate of sectoral GCIPL loss and lower baseline quadrant peripapillary perfusion density (PD) and vessel density (VD). Specifically, a 1% lower baseline peripapillary PD was associated with a 0.04 µm/year faster rate of GCIPL loss in the corresponding sector, and a 1 mm/mm² lower baseline peripapillary VD was associated with a 0.09 µm/year faster rate of GCIPL loss in the corresponding sector. A potentially unexpected finding was the lack of association between baseline macular OMAG measurements and GCIPL thinning rate, suggesting that macular OCTA changes may not be as informative as peripapillary OCTA changes in predicting glaucoma progression. Similar findings were reported by the same group when they assessed the association between rate of RNFL thinning and baseline OMAG measurements.¹ These findings suggest a clinical role for peripapillary OMAG measurements in predicting glaucoma progression in in patients with mild-to-moderate POAG. As noted by the authors, this study is limited by its sample size, relatively short duration and potential confounding effects when assessing two sectors of the same eye and two eyes of the same patients, although statistical adjustment for potential correlations was performed. Additional studies in different ethnic groups with case and control subjects and other OCTA software are needed to confirm the findings of the study and further establish the clinical utility of peripapillary OCTA measurements in predicting glaucoma progression.

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