Optical coherence tomography angiography of optic disc perfusion in glaucoma

Ophthalmology. 2014 Jul;121(7):1322-32. doi: 10.1016/j.ophtha.2014.01.021. Epub 2014 Mar 12.


Purpose: 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.

Design: Observational, cross-sectional study.

Participants: Twenty-four normal subjects and 11 patients with glaucoma were included.

Methods: One eye of each subject was scanned by a high-speed 1050-nm-wavelength swept-source OCT instrument. The split-spectrum amplitude-decorrelation angiography (SSADA) algorithm was used to compute 3-dimensional optic disc angiography. A disc flow index was computed from 4 registered scans. Confocal scanning laser ophthalmoscopy (cSLO) was used to measure disc rim area, and stereo photography was used to evaluate cup/disc (C/D) ratios. Wide-field OCT scans over the discs were used to measure retinal nerve fiber layer (NFL) thickness.

Main outcome measures: Variability was assessed by coefficient of variation (CV). Diagnostic accuracy was assessed by sensitivity and specificity. Comparisons between glaucoma and normal groups were analyzed by Wilcoxon rank-sum test. Correlations among disc flow index, structural assessments, and visual field (VF) parameters were assessed by linear regression.

Results: In normal discs, a dense microvascular network was visible on OCT angiography. This network was visibly attenuated in subjects with glaucoma. The intra-visit repeatability, inter-visit reproducibility, and normal population variability of the optic disc flow index were 1.2%, 4.2%, and 5.0% CV, respectively. The disc flow index was reduced by 25% in the glaucoma group (P = 0.003). Sensitivity and specificity were both 100% using an optimized cutoff. The flow index was highly correlated with VF pattern standard deviation (R(2) = 0.752, P = 0.001). These correlations were significant even after accounting for age, C/D area ratio, NFL, and rim area.

Conclusions: Optical coherence tomography angiography, generated by the new SSADA, repeatably measures optic disc perfusion and may be useful in the evaluation of glaucoma and glaucoma progression.

Publication types

  • Comparative Study
  • Observational Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Aged
  • Blood Flow Velocity
  • Blood Pressure
  • Cross-Sectional Studies
  • Female
  • Fluorescein Angiography*
  • Glaucoma / classification
  • Glaucoma / physiopathology*
  • Healthy Volunteers
  • Humans
  • Imaging, Three-Dimensional
  • Intraocular Pressure
  • Laser-Doppler Flowmetry
  • Male
  • Middle Aged
  • Nerve Fibers / pathology
  • Ophthalmoscopy
  • Optic Disk / blood supply*
  • Regional Blood Flow
  • Reproducibility of Results
  • Retinal Ganglion Cells / pathology
  • Retinal Vessels / physiology*
  • Sensitivity and Specificity
  • Tomography, Optical Coherence*
  • Visual Field Tests
  • Visual Fields