The Role of Optical Coherence Tomography Angiography (OCTA) in the Early Diagnosis of Primary Open-Angle Glaucoma
The Role of OCTA in Primary Open-Angle Glaucoma Early Diagnosis
DOI:
https://doi.org/10.69750/dmls.02.06.0126Keywords:
Optical Coherence Tomography Angiography, Vessel Density, Retinal Nerve Fiber Layer, Early Diagnosis, Microvasculature, Primary Open-Angle GlaucomaAbstract
Background: Primary Open-Angle Glaucoma (POAG) is one of the leading causes of irreversible blindness in the world and is characterized by the gradual loss of retinal ganglion cells and damage of the optic nerve. The process of preventing irreversible visual damage means that it must be identified early. It is now possible to visualize the microvasculature of the retina and optic nerve head with a non-invasive imaging technique called optical coherence tomography angiography (OCTA) that can help detect glaucoma in its early stages before a permanent loss of visual field is observed.
Objective: To determine the contribution of OCTA in the early detection of POAG by comparing retinal and peripapillary microvascular parameters of early POAG and healthy controls.
Methods: This cross-sectional research was carried out between September 2024 and May 2025 at Gulab Devi Hospital and Ghurki Trust Teaching Hospital in Punjab. Twenty-five early POAG patients and twenty-five age- and sex-matched healthy controls made up the 50 participants in total. Every subject had OCTA imaging and a thorough ophthalmologic examination. Measured and statistically examined were the foveal avascular zone (FAZ) area, radial peripapillary capillary (RPC) density, and vessel densities in the macular and peripapillary areas.
Results: POAG patients showed significantly reduced peripapillary vessel density (41.2% vs. 48.6%, p < 0.001), RPC density (39.8% vs. 46.9%, p < 0.001), and macular superficial vessel density (43.1% vs. 49.4%, p < 0.001) compared to controls. RNFL thickness and visual field mean deviation were also lower in POAG eyes. FAZ area showed no significant difference, although qualitative irregularities were noted in POAG patients.
Conclusion: OCTA effectively detects early microvascular changes in POAG, even before structural or functional deterioration becomes evident. Its integration into routine glaucoma assessment may enhance early diagnosis and intervention, improving long-term visual outcomes.
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References
Khayrallah O, Mahjoub A, Ben Abdesslam N, et al. Optical coherence tomography angiography vessel density parameters in primary open angle glaucoma. Ann Med Surg (Lond). 2021;69:102671. doi:10.1016/j.amsu.2021.102671
Rao HL, Pradhan ZS, Suh MH, et al. Optical coherence tomography angiography in glaucoma. J Glaucoma. 2020;29(4):312–321. doi:10.1097/IJG.0000000000001463
Nishida T, Moghimi S, Gunasegaran G, et al. Optical coherence tomography angiography vessel density assessment in POAG. JAMA Ophthalmol. 2022; (online article).
Kamalipour A, Moghimi S, Jacoba CM, et al. Measurements of OCT Angiography complement OCT for diagnosing early primary open angle glaucoma. Ophthalmol Glaucoma. 2022;5:262–274. doi: (check source)
Verticchio Vercellin A, Harris A, Oddone F, et al. Diagnostic capability of OCTA derived macular biomarkers for early to moderate primary open angle glaucoma. J Clin Med. 2024;13(14):4190. doi:10.3390/jcm13144190
Ozturk B, Erdem E, Harbiyeli II, et al. Effects of glaucoma stage on optical coherence tomography angiography parameters in primary open angle glaucoma. Cureus. 2025;17(3):e80583. doi:10.7759/cureus.80583
Angmo D, et al. Comparative evaluation of OCT with OCTA changes at the early stage of glaucoma. Indian J Ophthalmol. 2025; (Epub ahead).
Shen R. Applications of optical coherence tomography angiography in glaucoma: current knowledge and future prospects. Front Med (Lausanne). 2024;11:1428850. doi:10.3389/fmed.2024.1428850
Wong D, et al. Combining OCT and OCTA for focal structure–function relationships in glaucoma. Investig Ophthalmol Vis Sci. 2021;62(1).
Chang PY, et al. VD decreases detectable over time in highly myopic glaucoma patients. [Journal] 2025; (Epub ahead).
Liu L, et al. Diagnostic ability of peripapillary vessel density in primary open angle glaucoma suspects. [Journal] 2024; (x): (x–x).
Hou H, Moghimi S, Zangwill LM, et al. Macula vessel density and thickness in early primary open angle glaucoma. Am J Ophthalmol. 2019;199:120–132. doi:10.1016/j.ajo.2018.11.012
Gunasegaran G, Moghimi S, Nishida T, et al. Racial differences in the diagnostic accuracy of OCTA macular vessel density for glaucoma. Ophthalmol Glaucoma. 2024;7(2):197–205. doi:10.1016/j.ogla.2023.09.003
Lin B, Zuo C, Gao X, et al. Quantitative measurements of vessel density and blood flow areas in primary angle closure diseases: OCTA study. J Clin Med. 2022;11(14):4040. doi:10.3390/jcm11144040
Tun TA, Atalay E, Liu A, et al. OCTA assessment of optic nerve head and macula across the primary angle closure disease spectrum. J Glaucoma. 2024; (Epub ahead). doi:10.1097/IJG.0000000000002488
Ninomiya T, et al. AI assisted OCTA derived foveal avascular zone parameters and visual field defect progression in open angle glaucoma. Ophthalmol Sci. 2023;4(2):100387. doi:10.1016/j.xops.2023.100387
Salazar Quiñones L, Peña Urbina P, Fernández Vigo JI, et al. Reproducibility of vessel density by OCT A according to glaucoma severity. Arch Soc Esp Oftalmol (Engl Ed). 2023;98(6):317–324. doi:10.1016/j.oftale.2023.04.002
Łukasik U, Wróbel Dudzińska D, Jarecki J, et al. The differences in OCT and OCTA patterns between early normal and high tension pseudoexfoliative glaucoma. J Clin Med. 2023;12:4899. doi: (check source)
Liu L, Jia Y, Takusagawa HL, et al. OCT angiography of the peripapillary retina in glaucoma. JAMA Ophthalmol. 2015;133:1045–1052. doi:10.1001/jamaophthalmol.2015.2225
Yarmohammadi A, Zangwill LM, Diniz Filho A, et al. Relationship between OCTA vessel density and severity of visual field loss in glaucoma. Ophthalmology. 2016;123(12):2498–2508. doi:10.1016/j.ophtha.2016.08.041
Akıl H, Huang AS, Francis BA, et al. Retinal vessel density from OCTA to differentiate early glaucoma, pre perimetric glaucoma, and normal eyes. PLoS One. 2017;12:e0170476. doi:10.1371/journal.pone.0170476
Kumar RS, Anegondi N, Chandapura RS, et al. Discriminant function of OCTA to determine disease severity in glaucoma. Invest Ophthalmol Vis Sci. 2016;57:6079–6088. doi:10.1167/iovs.16 19984
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