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Pattern of peripapillary capillary density loss in ischemic optic neuropathy compared to that in primary open-angle glaucoma

<div><p>Purpose</p><p>Both non-arteritic anterior ischemic optic neuropathy (NAION) and primary open-angle glaucoma (POAG) damage retinal ganglion cell axons, which are perfused by the radial peripapillary capillaries. To evaluate the pattern of ischemia, we compared peripapillary capillary density (PCD) in NAION eyes to POAG eyes matched for visual field mean deviation and retinal nerve fiber layer thickness.</p><p>Methods</p><p>31 chronic NAION (>6 months after the acute event) and unaffected fellow eyes (31 subjects), 42 moderate and severe POAG eyes (27 subjects), and 77 control eyes (46 healthy subjects) were imaged with a commercial optical coherence tomography angiography system (AngioVue, Avanti RTVue-XR, Optovue, CA) at two academic institutions. Two concentric circles of diameters 1.95mm (inner) and 3.45mm (outer) were manually placed on images centered on the optic nerve head, producing an annular region-of-interest. Image analysis with major vessel removal was performed using a custom program. Whole-image, whole-annulus, and sectoral PCDs were measured.</p><p>Results</p><p>Whole-image and whole-annulus PCDs in NAION and moderate and severe POAG eyes were significantly decreased compared to unaffected fellow eyes and control eyes (all P<0.001). Superior and temporal PCD values were affected more than other sectors in both NAION and POAG groups compared to control group. Whole-image and whole-annulus PCDs were not statistically different between NAION and POAG eyes (both P = 0.99). However, of all peripapillary sectors, the inferior sector PCD value was less affected in POAG eyes compared to NAION eyes (P = 0.001). Univariate analysis results also revealed a significant positive correlation between superior and inferior PCDs and corresponding RNFL thicknesses. The inferior sector correlation was greater in POAG than NAION eyes.</p><p>Conclusion</p><p>While the whole PCD values were not different in chronic NAION and POAG, the greater correlation of inferior PCD with corresponding RNFL sectors in POAG compared to NAION suggests greater susceptibility of the inferior radial peripapillary capillary in the pathogenesis of POAG.</p></div

Mean and standard deviation values for OCT-A peripapillary capillary density measurements in healthy participants, primary open-angle glaucoma, and anterior ischemic optic neuropathy patients and their unaffected fellow eyes.

<p>Mean and standard deviation values for OCT-A peripapillary capillary density measurements in healthy participants, primary open-angle glaucoma, and anterior ischemic optic neuropathy patients and their unaffected fellow eyes.</p

Demographic and ocular characteristics of healthy, anterior ischemic optic neuropathy and unaffected fellow eyes, and moderate-to-severe primary open-angle glaucoma patients.

<p>Demographic and ocular characteristics of healthy, anterior ischemic optic neuropathy and unaffected fellow eyes, and moderate-to-severe primary open-angle glaucoma patients.</p

Differences of the correlations of capillary density and nerve fiber layer in two sectors in two groups of subjects.

<p>Differences of the correlations of capillary density and nerve fiber layer in two sectors in two groups of subjects.</p

Peripapillary capillary density maps.

<p>Comparisons of peripapillary capillary density maps in a normal, an anterior ischemic optic neuropathy (AION) eye with average retinal nerve fiber layer (RNFL) thickness of 54 μm and visual field mean deviation of -20.5 dB, and a severe primary open-angle glaucoma (POAG) eye with average RNFL thickness of 49 μm and mean deviation of -25.2 dB. <i>First column</i>: grayscale OCT-A images with two concentric circles with 1.95-mm (inner) and 3.45-mm (outer) diameters, <i>Second column</i>: Perfused capillary area (in <i>cyan</i>) after the removal of major blood vessels. <i>Third column</i>: corresponding color-coded perfused capillary density maps with numerical capillary density (%) in peripapillary ring in four quadrants.</p

Association between different variables using univariate analysis in study groups.

<p>Association between different variables using univariate analysis in study groups.</p

A method for age-matched OCT angiography deviation mapping in the assessment of disease- related changes to the radial peripapillary capillaries - Fig 8

<p><b>Individual RPC density mapping vs deviation mapping in A) POAG, B) PDR, C) RVO, D) SCR.</b> Deviation maps highlight the areas with RPC density below or above the age-matched group mean, allowing for the visualization and identification of focal areas of significant change. In the PDR eye, the neovascular vessels emanating from the superior-temporal aspect of the disc have been interpreted by our software as large vessels due to the dilated vessel diameter, and have been removed from the analysis (red arrows). The temporal aspect of the optic disc is to the left in all images.</p

A method for age-matched OCT angiography deviation mapping in the assessment of disease- related changes to the radial peripapillary capillaries - Fig 6

<p>A & C) Group mean RPC density and B & D) SD maps for two different age groups, the 10-19yrs and the ≥60yrs age group. Relatively lower RPC density was observed in the ≥60yrs age group. The temporal aspect of the optic disc is to the left in all images.</p