Rates of Choriocapillaris Microvascular Dropout and Macular Structural Changes in Glaucomatous Optic Neuropathy With and Without Myopia

• Published in: American journal of ophthalmology 2024-11, Vol.267, p.257-270
• Main Authors: JIRAVARNSIRIKUL, ANUWAT, BELGHITH, AKRAM, REZAPOUR, JASMIN, MICHELETTI, ELEONORA, NISHIDA, TAKASHI, MOGHIMI, SASAN, SUH, MIN HEE, JONAS, JOST B., WALKER, EVAN, CHRISTOPHER, MARK, FAZIO, MASSIMO A., WEINREB, ROBERT N., ZANGWILL, LINDA M.
• Format: Article
• Language: English
• Subjects: Aged; Choroid - blood supply; Choroid - diagnostic imaging; Female; Fluorescein Angiography - methods; Follow-Up Studies; Glaucoma, Open-Angle - diagnosis; Glaucoma, Open-Angle - physiopathology; Humans; Intraocular Pressure - physiology; Macula Lutea - blood supply; Macula Lutea - diagnostic imaging; Macula Lutea - pathology; Male; Microvessels - pathology; Middle Aged; Myopia - physiopathology; Nerve Fibers - pathology; Ocular Hypertension - diagnosis; Ocular Hypertension - physiopathology; Optic Disk - blood supply; Optic Nerve Diseases - diagnosis; Optic Nerve Diseases - physiopathology; Retinal Ganglion Cells - pathology; Retinal Vessels - diagnostic imaging; Retinal Vessels - pathology; Tomography, Optical Coherence - methods; Visual Fields - physiology
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2024.06.030

To evaluate the association between rates of juxtapapillary choriocapillaris microvasculature dropout (MvD) change and rates of ganglion cell inner plexiform layer (GCIPL) loss in primary open-angle glaucoma (POAG) and glaucoma suspect eyes with and without myopia. Cohort study from clinical trial data. 238 eyes from 155 POAG and glaucoma suspect patients were stratified into no-myopia (axial length (AL) ≤ 24 mm; n = 78 eyes), mild myopia (24 mm < AL ≤ 26 mm; n = 114 eyes), and high myopia (AL > 26 mm; n = 46 eyes). Eyes with a minimum of 3 visits and 1.5 years of follow-up with both optical coherence tomography angiography (OCT-A) and OCT macula scans were included. Presence, area, and angular circumference of juxtapapillary MvD were evaluated on en face choroidal images and horizontal B-scans obtained from OCT-A imaging. Over the mean follow-up of 4.4 years, the mean MvD area rates of change (95% CI) were largest in high and mild myopia group (0.04 [0.03, 0.05] mm2/year in both groups), followed by the no-myopia group (0.03 [0.02, 0.04] mm2/year). The mean MvD angular circumference rates of change (95% CI) were highest in mild myopia group (8.7° [6.9°, 10.5°]/year) followed by the high myopia and no-myopia groups (8.1° [5.3°, 10.9°]/year, and 7.4° [5.3°, 9.6°]/year, respectively). While the mean global GCIPL thinning rates between eyes with MvD at baseline compared to eyes without were similar in all myopia groups, the rates of MvD area change were significantly faster in all myopia groups with baseline MvD (all p ≤ 0.004). Significant faster rates of MvD angular circumference change were found in the mild myopia group with baseline MvD (P < .001) only. In multivariable models, the rates of GCIPL thinning over time were significantly associated with rates of MvD angular circumference change and MvD area change (R2 = 0.33, P < .001 and R2 = 0.32, P = .006, respectively). Rates of GCIPL thinning were associated with rates of MvD area and angular circumference change over time in myopic POAG eyes. Utilizing OCT-A to detect MvD may provide an additional tool for monitoring macular structural changes in glaucomatous eyes with myopia.