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      Optic disc microvasculature dropout in primary open-angle glaucoma measured with optical coherence tomography angiography

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          Abstract

          Purpose

          To evaluate microvasculature dropout in the optic disc (Mvd-D) using optical coherence tomography angiography (OCTA) and investigate factors associated with Mvd-D in primary open-angle glaucoma (POAG) eyes.

          Methods

          One hundred twenty-three eyes of 123 POAG patients were included from the Diagnostic Innovations in Glaucoma Study. The 3.0×3.0-mm optic nerve head OCTA scans were acquired using a spectral-domain OCT instrument. Images with whole-signal-mode were evaluated. Eyes were classified into 3 categories (Mvd-D, pseudo-Mvd-D, and no Mvd-D). Mvd-D and pseudo-Mvd-D had complete loss of OCTA signals on the temporal side of the optic disc on the en face projection image. They were distinguished base on the visualization of the anterior lamina cribrosa in the horizontal B-scans of that area. No Mvd-D was defined when no complete signal loss of OCTA signals was observed. Covariates including focal lamina cribrosa defects assessed by swept-source OCT and microvasculature dropout in the parapapillary region (Mvd-P) were analyzed.

          Results

          Forty-two, 37, and 44 eyes were identified as having Mvd-D, pseudo-Mvd-D, and no Mvd-D, respectively. The eyes with Mvd-D showed significantly lower intraocular pressure, worse visual field mean deviation, larger cup-to-disc ratio, thinner circumpapillary retinal nerve fiber layer (cpRNFL), and lower circumpapillary vessel density within the RNFL than the eyes with pseudo-Mvd-D or the eyes without Mvd-D. Multivariable logistic regression analysis showed significant associations of Mvd-D with larger cup-to-disc ratio (OR, 1.08; P = 0.001), worse visual field mean deviation (OR, 1.09; P = 0.048), higher prevalence of focal lamina cribrosa defect (OR, 9.05; P = 0.002), and higher prevalence of Mvd-P (OR, 10.33; P <0.001).

          Conclusions

          OCTA-derived Mvd-D was strongly associated with the presences of Mvd-P and focal lamina cribrosa defects, and these 3 findings were topographically associated with each other.

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          Most cited references44

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          The impact of ocular blood flow in glaucoma.

          Two principal theories for the pathogenesis of glaucomatous optic neuropathy (GON) have been described--a mechanical and a vascular theory. Both have been defended by various research groups over the past 150 years. According to the mechanical theory, increased intraocular pressure (IOP) causes stretching of the laminar beams and damage to retinal ganglion cell axons. The vascular theory of glaucoma considers GON as a consequence of insufficient blood supply due to either increased IOP or other risk factors reducing ocular blood flow (OBF). A number of conditions such as congenital glaucoma, angle-closure glaucoma or secondary glaucomas clearly show that increased IOP is sufficient to lead to GON. However, a number of observations such as the existence of normal-tension glaucoma cannot be satisfactorily explained by a pressure theory alone. Indeed, the vast majority of published studies dealing with blood flow report a reduced ocular perfusion in glaucoma patients compared with normal subjects. The fact that the reduction of OBF often precedes the damage and blood flow can also be reduced in other parts of the body of glaucoma patients, indicate that the hemodynamic alterations may at least partially be primary. The major cause of this reduction is not atherosclerosis, but rather a vascular dysregulation, leading to both low perfusion pressure and insufficient autoregulation. This in turn may lead to unstable ocular perfusion and thereby to ischemia and reperfusion damage. This review discusses the potential role of OBF in glaucoma and how a disturbance of OBF could increase the optic nerve's sensitivity to IOP.
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            Optical coherence tomography angiography of optic disc perfusion in glaucoma.

            To compare optic disc perfusion between normal subjects and subjects with glaucoma using optical coherence tomography (OCT) angiography and to detect optic disc perfusion changes in glaucoma.
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              • Record: found
              • Abstract: found
              • Article: not found

              Optical Coherence Tomography Angiography of the Peripapillary Retina in Glaucoma.

              Vascular factors may have important roles in the pathophysiology of glaucoma. A practical method for the clinical evaluation of ocular perfusion is needed to improve glaucoma management.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: Funding acquisitionRole: InvestigationRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Validation
                Role: Data curationRole: InvestigationRole: Validation
                Role: Formal analysisRole: Validation
                Role: Data curationRole: Validation
                Role: Data curationRole: Validation
                Role: Data curationRole: Validation
                Role: ConceptualizationRole: Funding acquisitionRole: Project administrationRole: ResourcesRole: SupervisionRole: ValidationRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                7 August 2018
                2018
                : 13
                : 8
                : e0201729
                Affiliations
                [1 ] Hamilton Glaucoma Center, Shiley Eye Institute, Department of Ophthalmology, University of California San Diego, La Jolla, CA, United States of America
                [2 ] Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
                [3 ] Department of Ophthalmology, Saitama Medical University, Saitama, Japan
                [4 ] Department of Ophthalmology, Haeundae Paik Hospital, Inje University, Busan, South Korea
                Bascom Palmer Eye Institute, UNITED STATES
                Author notes

                Competing Interests: This study was funded by National Eye Institute grants: EY029058 (RNW), EY011088 (LMZ), EY014267 (LMZ), EY019689 (LMZ), Core Grant P30EY022589 (LMZ); an unrestricted grant from Research to Prevent Blindness (RNW), grants for participants’ glaucoma medications from Alcon, Allergan, Pfizer, Merck and Santen (RNW) and the John Mung Program from Kyoto University Global Frontier Project for Young Professionals (TA). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                Author information
                http://orcid.org/0000-0002-2142-3534
                http://orcid.org/0000-0001-9553-3202
                Article
                PONE-D-18-09178
                10.1371/journal.pone.0201729
                6080778
                30086177
                23d99a7d-139d-4779-92f0-77a9592aa82d
                © 2018 Akagi et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 26 March 2018
                : 21 July 2018
                Page count
                Figures: 4, Tables: 3, Pages: 17
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000053, National Eye Institute;
                Award ID: EY011008
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000053, National Eye Institute;
                Award ID: EY014267
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000053, National Eye Institute;
                Award ID: EY019869
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000053, National Eye Institute;
                Award ID: EY022589
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000053, National Eye Institute;
                Award ID: EY029058
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100001818, Research to Prevent Blindness;
                This work was supported by National Institutes of Health/National Eye Institute grants EY011008 (LMZ), EY014267 (LMZ), EY019869 (LMZ), EY029058 (RNW), core grant P30EY022589 (LMZ), https://nei.nih.gov/funding, an unrestricted grant from Research to Prevent Blindness (New York, NY) (RNW), https://www.rpbusa.org/rpb/grants-and-research/grants/overview/, grants for participants’ glaucoma medications from Alcon, Allergan, Pfizer, Merck, and Santen (RNW), the John Mung Program from Kyoto University Global Frontier Project for Young Professionals (TA), http://www.john-man.rp.kyoto-u.ac.jp/en/researcher/index.html. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
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                Biology and Life Sciences
                Anatomy
                Head
                Eyes
                Medicine and Health Sciences
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