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Precis: Choroidal microvasculature dropout (CMvD) is an independent predictor for overall and central visual field (VF) progression in open-angle glaucoma (OAG) eyes., Purpose: The purpose of this study was to investigate the impact of CMvD identified by optical coherence tomography angiography (OCT-A) at baseline on subsequent VF progression in eyes with OAG., Methods: This retrospective observational study included 80 OAG eyes with CMvD [CMvD(+)] and without CMvD [(CMvD(-)] at baseline [40 of each matched for both age (10 y and below) and baseline VF severity (≤1 dB)]. The patients were followed regularly at 6-month intervals. VF progression was defined according to the Early Manifest Glaucoma Trial criteria. Associations of overall VF progression with baseline clinical factors, including the presence of CMvD and other variables, were analyzed by logistic regression with a generalized estimating equation in the entire OAG cohort. Linear mixed models were used to determine the differences in visual field mean sensitivity (VFMS) between the CMvD(+) and CMvD(-) groups globally and regionally at each follow-up point., Results: During a mean follow-up of 35.91±2.51 months, a significant difference was evident in the VF progression rate between the CMvD(-) and CMvD(+) groups (22.5% vs. 70%, P<0.001). CMvD at baseline and a higher visit-to-visit intraocular pressure fluctuation were significant predictors of VF progression. The VFMS differed significantly between the 2 groups at the central and superior central VF regions after 2 years of follow-up., Conclusion: The presence of CMvD at baseline is an independent predictor of subsequent VF progression. CMvD(+) eyes show a faster rate of VFMS loss at the central and superior central VF regions., Competing Interests: Disclosure: The authors declare no conflict of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Precis: The prevalence of choroidal microvascular dropout (CMvD) was significantly higher in primary open-angle glaucoma (POAG) than primary angle-closure glaucoma (PACG) or pseudoexfoliation glaucoma (PXG) in the early stage. However, in the advanced stage, it did not differ among the 3 groups., Purpose: The purpose of this study was to compare the prevalence of peripapillary CMvD in POAG, PACG, and PXG., Materials and Methods: The presence of peripapillary CMvD was identified using optical coherence tomography angiography (AngioVue/RTVue-XR) imaging of the choroid in 186 eyes from 186 subjects [age and visual field (VF) mean deviation (MD) matched; 62 POAG, 62 PACG, and 62 PXG eyes]. Prevalence of CMvD was compared among glaucoma types in early and moderate to advanced disease, as divided by VF MD (-6 dB). The association between glaucoma type and presence of CMvD was evaluated using logistic regression analysis., Results: Prevalence of CMvD was significantly different between glaucoma types in early-stage disease (PACG 7.5%, PXG 25%, and POAG 46.3%, P<0.001), but it did not differ between glaucoma types in eyes with moderate to advanced disease (PACG 59.1%, PXG 68.2%, and POAG 81%; P=0.331). After adjusting for age, sex, the β-zone peripapillary atrophy/disc ratio, and glaucoma severity (VF MD), the CMvD odds ratio was 7.50 times greater in POAG than in PACG (P=0.001)., Conclusions: CMvD was more common in POAG relative to both PACG and PXG, especially in early-stage disease. This finding suggested a role for ischemic injury in the pathogenesis of POAG.

Precis: Substantial proportion of primary angle closure glaucoma (PACG) eyes showed glaucomatous worsening after successful lens extraction and intraocular pressure (IOP) control, which may suggest that an earlier intervention may be required to prevent PACG., Purpose: The purpose of this study was to investigate the longitudinal clinical course of the primary angle closure (PAC) disease spectrum, including PAC, primary angle closure suspect (PACS), and PACG patients, who underwent lens extraction., Methods: This retrospective observational study included 77 eyes from patients with PACS, PAC, and PACG who underwent lens extraction and were followed up for >2 years after surgery. The mean, peak, and fluctuation of IOP were analyzed before and after lens extraction among groups. Visual field (VF) mean deviation was compared immediately after lens extraction and the final follow-up. Postoperative glaucoma progression determined by 3 criteria (optic disc/retinal nerve fiber layer photographs, optical coherent tomography, and VF) was compared among the 3 groups., Results: Seventeen PACS, 24 PAC, and 36 PACG eyes were included. The mean and peak IOP, and IOP fluctuation IOP were significantly reduced postoperatively in all groups. Postoperative VF mean deviation was significantly aggravated only in the PACG group (from -7.26 to -8.82 dB, P<0.001). The prevalence of postoperative glaucoma progression by at least 1 criterion was significantly higher in PACG, and none of the eyes with PACS and PAC showed VF conversion (PACS, PAC, PACG; 11.8%, 12.5% vs. 61.1% in disc/retinal nerve fiber layer, 11.8%, 8.3% vs. 63.9% in optical coherent tomography, 0%, 0% vs. 33.3% in VF, all P<0.001)., Conclusions: In the PAC spectrum, lens extraction achieved significant IOP reduction. However, despite IOP control, a substantial proportion of PACG eyes showed glaucomatous progression. This result may suggest that lens extraction should be performed early to prevent PACG.

Precis: Pseudoexfoliation glaucoma eyes had a similar level of peripapillary and superficial macular vessel densities compared with primary open-angle glaucoma eyes matched for age and glaucoma severity when assessed by optical coherence tomography angiography (OCT-A)., Purpose: To compare vessel density (VD) measured by OCT-A between primary open-angle glaucoma (POAG) and pseudoexfoliation glaucoma (PXG) in the peripapillary and macular areas., Materials and Methods: The circumpapillary (cpVD), parafoveal (pfVD), and perifoveal vessel densities (perifVD) were obtained using OCT-A (AngioVue/RTVue-XR) in 98 eyes from 98 subjects [age, visual acuity, visual field (VF) mean deviation (MD) matched 49 POAG and 49 PXG eyes]. Global and 8 sectoral VDs in the peripapillary capillary layer were compared. In the macula, the superficial and deep layers of the pfVD and perifVD were analyzed globally and in 4 quadrants. Univariate and multivariate linear regression models were built using cpVD, pfVD, and perifVD as dependent variables and covariates [age, intraocular pressure (IOP), axial length, signal strength index (SSI), and retinal nerve fiber layer (RNFL) thickness] were considered independent variables., Results: In the peripapillary region, none of the VDs differed between groups both before and after adjustment. When we adjusted superficial and deep layer macular VDs for age, IOP, SSI, axial length, and RNFL thickness, all of which could affect measurements, the 2 groups did not differ in any sector. The cpVD in POAG eyes significantly correlated with VF MD and RNFL thickness, whereas IOP, VF MD, and RNFL thickness affected cpVD in PXG. The macular VD in the deep layer was associated with only SSI in both groups., Conclusions: Age-matched and glaucoma severity-matched PXG and POAG did not significantly differ in cpVD or in most of the superficial macular VD parameters.

Purpose: To investigate the hypothesis that macular structure, function, and vessel density (VD) measurements can predict foveal threshold (FT) outcomes in glaucomatous eyes., Materials and Methods: One hundred ninety-five eyes from 195 subjects (134 subjects with early-to-moderate stage open-angle glaucoma and 61 healthy controls) who underwent optical coherence tomography angiography imaging and 24-2 visual field (VF) testing with FT measurements on the same day were retrospectively enrolled in this study. The association of FT with macular structural/functional/VD measurements was evaluated using partial correlation analyses with adjustment for age and linear regression analyses., Results: FT showed significant correlations between the thickness of the macular ganglion cell-inner plexiform layer (mGCIPL) (r=0.330, P<0.001) and the mean sensitivity (MS) of the central 5 and 10 degrees VF points (r=0.448, P<0.001 and r=0.361, P<0.001). Significant correlations were also found between FT and VD measurements at the inferior and superior parafoveal sectors (r=0.455, P<0.001 and r=0.438, P<0.001). In multivariate linear regression analyses controlling the covariates, the thickness of the mGCIPL, central 5 degrees VF MS, and parafoveal VD were significantly associated with FT (all P<0.001). There was also a significant association between FT and logMAR best-corrected visual acuity (β=-5.647, P<0.001)., Conclusions: Macular VD along with mGCIPL thickness and central 5 degrees VF MS independently predict FT outcomes even in the eyes of patients with early-to-moderate stage open-angle glaucoma.