Optic Disc Perfusion in Primary Open Angle and Normal Tension Glaucoma Eyes Using Optical Coherence Tomography-Based Microangiography.


PURPOSE: To investigate optic disc perfusion differences in normal, primary open-angle glaucoma (POAG), and normal tension glaucoma (NTG) eyes using optical microangiography (OMAG) based optical coherence tomography (OCT) angiography technique. DESIGN: Cross-sectional, observational study. SUBJECTS: Twenty-eight normal, 30 POAG, and 31 NTG subjects. METHODS: One eye from each subject was scanned with a 68 kHz Cirrus HD-OCT 5,000-based OMAG prototype system centered at the optic nerve head (ONH) (Carl Zeiss Meditec Inc, Dublin, CA). Microvascular images were generated from the OMAG dataset by detecting the differences in OCT signal between consecutive B-scans. The pre-laminar layer (preLC) was isolated by a semi-automatic segmentation program. MAIN OUTCOME MEASURES: Optic disc perfusion, quantified as flux, vessel area density, and normalized flux (flux normalized by the vessel area) within the ONH. RESULTS: Glaucomatous eyes had significantly lower optic disc perfusion in preLC in all three perfusion metrics (p<0.0001) compared to normal eyes. The visual field (VF) mean deviation (MD) and pattern standard deviation (PSD) were similar between the POAG and NTG groups, and no differences in optic disc perfusion were observed between POAG and NTG. Univariate analysis revealed significant correlation between optic disc perfusion and VF MD, VF PSD, and rim area in both POAG and NTG groups (p≤0.0288). However, normalized optic disc perfusion was correlated with some structural measures (retinal nerve fiber layer thickness and ONH cup/disc ratio) only in POAG eyes. CONCLUSIONS: Optic disc perfusion detected with OMAG was significantly reduced in POAG and NTG groups compared to normal controls, but no difference was seen between POAG and NTG groups with similar levels of VF damage. Disc perfusion was significantly correlated with VF MD, VF PSD, and rim area in glaucomatous eyes. Vascular changes at the optic disc as measured using OMAG may provide useful information for diagnosis and monitoring of glaucoma.





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Publication Info

Bojikian, Karine D, Chieh-Li Chen, Joanne C Wen, Qinqin Zhang, Chen Xin, Divakar Gupta, Raghu C Mudumbai, Murray A Johnstone, et al. (2016). Optic Disc Perfusion in Primary Open Angle and Normal Tension Glaucoma Eyes Using Optical Coherence Tomography-Based Microangiography. PLoS One, 11(5). p. e0154691. 10.1371/journal.pone.0154691 Retrieved from https://hdl.handle.net/10161/16165.

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Divakar Gupta

Associate Professor of Ophthalmology

Divakar Gupta, MD is a board certified, fellowship-trained ophthalmologist specializing in the medical and surgical treatment of glaucoma and cataracts.  He performs both traditional glaucoma surgery such as trabeculectomy and glaucoma tube shunts, as well as cutting-edge Minimally Invasive Glaucoma Surgery (MIGS).  He is trained in the latest surgical techniques of cataract and laser-assisted cataract surgery.  Dr. Gupta also offers premium intraocular lenses for cataract surgery patients interested in astigmatic correction and/or presbyopia correction.

He has a clinical and research interest in early diagnosis of glaucoma and improving treatment outcomes. His research focuses on novel ways to use optical imaging and technology to identify and manage glaucoma.  Dr. Gupta also spends time teaching and lecturing trainees and eye professionals at the Duke Eye Center and in the community.  When he is not working, he spends his time watching Duke Basketball, playing tennis, and enjoys cooking.

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