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. 2017 May 1;135(5):461-468.
doi: 10.1001/jamaophthalmol.2017.0261.

Peripapillary Retinal Nerve Fiber Layer Vascular Microcirculation in Eyes With Glaucoma and Single-Hemifield Visual Field Loss

Chieh-Li Chen  1 , Karine D Bojikian  2 , Joanne C Wen  2 , Qinqin Zhang  3 , Chen Xin  3 , Raghu C Mudumbai  2 , Murray A Johnstone  2 , Philip P Chen  2 , Ruikang K Wang  1
Affiliations

Peripapillary Retinal Nerve Fiber Layer Vascular Microcirculation in Eyes With Glaucoma and Single-Hemifield Visual Field Loss

Chieh-Li Chen et al. JAMA Ophthalmol. .

Abstract

Importance: Understanding the differences in vascular microcirculation of the peripapillary retinal nerve fiber layer (RNFL) between the hemispheres in eyes with glaucoma with single-hemifield visual field (VF) defects may provide insight into the pathophysiology of glaucoma.

Objective: To investigate the changes in the microcirculation of the peripapillary RNFL of eyes with glaucoma by using optical microangiography.

Design, setting, and participants: Eyes with glaucoma and single-hemifield VF defect and normal eyes underwent scanning using an optical microangiography system covering a 6.7 × 6.7-mm2 area centered at the optic nerve head. The RNFL microcirculation was measured within an annulus region centered at the optic nerve head divided into superior and inferior hemispheres. Blood flux index (the mean flow signal intensity in the vessels) and vessel area density (the percentage of the detected vessels in the annulus) were measured.

Main outcomes and measures: Differences in microcirculation between the hemispheres in eyes with glaucoma and normal eyes and correlations among blood flow metrics, VF thresholds, and clinical optical coherence tomography structural measurements were assessed.

Results: Twenty-one eyes from 21 patients with glaucoma (7 men and 14 women; mean [SD] age, 63.7 [9.9] years) and 20 eyes from 20 healthy control individuals (9 men and 11 women; mean [SD] age, 68.3 [10.7] years) were studied. In eyes with glaucoma, the abnormal hemisphere showed a thinner RNFL (mean [SE] difference, 23.5 [4.5] μm; 95% CI, 15.1-32.0 µm; P < .001), lower RNFL blood flux index (mean [SE] difference, 0.04 [0.01]; 95% CI, 0.02-0.05; P < .001), and less vessel area density (mean [SE] difference, 0.08% [0.02%]; 95% CI, 0.05%-0.10%; P < .001) than did the normal hemisphere. Compared with normal eyes, reduced RNFL microcirculation was found in the normal hemisphere of eyes with glaucoma, measured by mean [SE] differences in blood flux index (0.06 [0.01]; 95% CI, 0.04-0.09; P < .001) and vessel area density (0.04% [0.02%]; 95% CI, 0.02%-0.08%; P = .003) but not in RNFL thickness (3.4 [4.7] μm; 95% CI, -6.2 to 12.9 µm; P = .48). Strong correlations were found between the blood flux index and VF mean deviation (Spearman ρ = 0.44; P = .045) and RNFL thickness (Spearman ρ = 0.65; P = .001) in the normal hemisphere of the eye with glaucoma.

Conclusions and relevance: Reduced RNFL microcirculation was detected in the normal hemisphere of eyes with glaucoma, with strong correspondence with VF loss and RNFL thinning. Although the results suggest that vascular dysfunction precedes structural changes seen in glaucoma, longitudinal studies would be needed to confirm this finding.

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Conflict of interest statement

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Wang reports research support from Carl Zeiss Meditec, Inc, and significant financial interest in the intellectual property of optical coherence tomography–based microangiography technology owned by Oregon Health & Science University. No other disclosures were reported.

Figures

Figure.
Figure.. Examples of Study Eyes
In the normal eye (top), the retinal radial peripapillary capillaries were intact and distributed densely and evenly in the superior and inferior hemispheres by subjectively qualitative evaluation and quantitative analysis. In the eye with glaucoma (bottom), reduced retinal nerve fiber layer (RNFL) thickness, fewer retinal radial peripapillary capillaries, and lower blood flow metrics were observed in the inferior hemisphere compared with the superior hemisphere, which corresponded to the glaucomatous visual field defects shown in the superior hemifield in the total and pattern deviation plots. Blood flux index is calculated as the mean flow intensity in the vessel area, where the blood flow signal was normalized to 0 to 1 by dividing by the full dynamic range of blood flow signal intensity; vessel area density, the percentage of the detected vessels within the annulus. In the Cirrus RNFL thickness deviation maps, areas with RNFL thickness thinner than the fifth percentile and the first percentile of the normative database were marked in yellow and in red, respectively. GHT indicates glaucoma hemifield test; I, inferior; MD, median deviation; N, nasal; PSD, pattern standard deviation; S, superior; T, temporal; VFI, visual field index.
See this image and copyright information in PMC

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