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Editors Selection IGR 16-2
Progression / Prognostic Factors: Choroidal microvasculature dropout predicts faster structural glaucoma loss
Comment by Atusya Miki on:
126596 Baseline choroidal microvasculature dropout as a predictor of rapid global structural loss in open-angle glaucoma, Lee A; Kim KE; Song WK et al., Scientific reports, 2025; 15: 5801
The relationship between parapapillary microvasculature dropout (MvD) and glaucomatous optic neuropathy has been widely reported. Studies have found MvD is associated with multiple aspects of the disease, such as worse visual field damage, reduced parapapillary circulation, parapapillary beta and gamma zones, a thinner choroid, focal defects of the lamina cribrosa, a thinner retinal nerve fiber layer, disc hemorrhage, and faster disease progression. Though the exact mechanisms behind this relationship have not been clarified, prior research suggests a correlation between circulatory disturbances and nerve fiber damage at the location of the MvD. In a study compared 51 open-angle glaucoma eyes with localized choroidal MvD (cMvD) in the inferior retina to 51 without, Lee et al. for the first time reported that eyes with inferior cMvD showed a rapid decline in both retinal sublayer thickness and vascular density, not only in the affected inferior retina but also in the unaffected superior retina. Although the mechanisms behind this relationship have not been elucidated in this study, the authors offered several hypotheses. Based on the extensive interconnection of vessels in the parapapillary choroid, the authors propose that a localized MvD could cause widespread microcirculatory impairment across the entire region. Another hypothesis given by the authors is that higher intraocular pressure in patients with MvD contributed to the faster progression in both affected and unaffected areas. If true, this would be inconsistent with the authors' assertion that MvD is an independent predictor of global glaucoma progression, suggesting it is merely a reflection of high intraocular pressure. Although further research is needed to fully understand the mechanism, this study suggests an interesting possibility: a localized MvD may reflect a more widespread vascular disturbance throughout the entire parapapillary region.
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