Factors Associated with Progressive Peripapillary Perfusion Density Reduction on Optical Microangiography in Primary Open-angle Glaucoma

Precis: Greater baseline peripapillary perfusion density (PD; coefficient: −0.03, P <0.001) and faster retinal nerve fiber layer thinning during follow-up (coefficient: 0.06, P =0.02) are significantly associated with a faster rate of peripapillary PD loss in POAG patients. Purpose: To evaluate the factors associated with progressive peripapillary perfusion density (PD) reduction in primary open-angle glaucoma (POAG) using optical microangiography (OMAG). Methods: In a prospective study, 50 eyes of 28 POAG patients (95 hemifields) were longitudinally studied for at least 2 years and with a minimum of 3 OMAG and optical coherence tomography (OCT) examinations. Effect of clinical parameters (age, gender, presence of systemic diseases, central corneal thickness, mean, peak and fluctuation of intraocular pressure during follow-up), baseline hemifield mean deviation (MD), baseline retinal nerve fiber layer (RNFL) thickness, baseline peripapillary PD, and the rate of RNFL change on the rate of PD change was evaluated using linear mixed models. Results: Average (±SD) MD, RNFL thickness and peripapillary PD of the analyzed quadrants at baseline were −5.7±4.7 dB, 87±17 µm and 40.7±4.2% respectively. Rate of quadrant peripapillary PD and RNFL change were −0.27%/year and −1.6±0.4 µm/year respectively. Multivariate mixed models showed that greater baseline PD (coefficient: −0.03, P <0.001) and faster rate of RNFL change during follow-up (coefficient: 0.06, P =0.02) were significantly associated with faster rate of PD loss. Conclusions: Greater peripapillary PD at baseline and faster RNFL thinning during follow-up were significantly associated with a faster rate of PD loss in POAG patients. Therefore, PD at baseline should be considered while evaluating progressive PD loss in POAG patients.