ImportanceRapid initial optic nerve head capillary density loss may be used to assess the risk of glaucoma visual field progression.ObjectiveTo investigate the association between the rate of initial optic nerve head capillary density loss from optical coherence tomography angiography (OCTA) and visual field progression.Design, Setting, ParticipantsThis was a retrospective study of a longitudinal cohort at a glaucoma referral center. A total of 167 eyes (96 with primary open-angle glaucoma and 71 with glaucoma suspect) of 109 patients were monitored for a mean (SD) of 5.7 (1.4) years from January 2015 to December 2022. Data analysis was undertaken in April 2023.Main Outcomes and MeasuresThe rates of initial capillary density and average retinal nerve fiber layer loss were calculated from the first 3 optic nerve head OCTA and OCT scans, respectively, during the initial follow-up (mean [SD], 2.0 [1.0] years). Based on the median rate, eyes were categorized into fast and slow progressor groups. The association between initial capillary density change or retinal nerve fiber layer thinning and visual field progression was evaluated using linear-mixed and time-varying Cox models.ResultsA total of 167 eyes of 109 patients (mean [SD] age, 69.0 [11.1] years; 56 [51.4%] female and 53 [48.6%] male) were assessed. Eighty-three eyes were slow OCTA progressors, while 84 eyes were fast with mean capillary density loss of −0.45% per year and −1.17% per year, respectively (mean difference, −0.72%/year; 95% CI,−0.84 to −0.60; P < .001). Similarly, 83 eyes were slow OCT progressors, while 84 eyes were fast with mean retinal nerve fiber layer thinning of −0.09 μm per year and −0.60 μm per year, respectively (mean difference, −0.51 μm/year; 95% CI,−0.59 to −0.43; P < .001). The fast OCTA and OCT progressors were associated with more rapid visual field loss (mean difference, −0.18 dB/year; 95% CI,−0.30 to −0.06; P = .004 and −0.17 dB/year; 95% CI,−0.29 to −0.06; P = .002, respectively). Fast OCTA progressing eyes were more likely to have visual field progression (hazard ratio, 1.96; 95% CI, 1.04-3.69; P = .04). Seventeen of 52 eyes (32.7%; 95% CI, 32.5-32.8) with fast OCTA and OCT progression developed subsequent visual field likely progression.Conclusion and RelevanceRapid initial optic nerve head capillary density loss from OCTA was associated with a faster rate of visual field progression and a doubling of the risk of developing event progression in this study. These findings may support clinical use of OCTA and OCT optic nerve head measurements for risk assessment of glaucoma progression.

中文翻译：

---

初始视神经头毛细血管密度损失率和视野进展风险

重要性快速初始视神经头毛细血管密度损失可用于评估青光眼视野进展的风险。目的探讨光学相干断层扫描血管造影（OCTA）初始视神经头毛细血管密度损失率与视野进展之间的关联。 、环境、参与者这是一项针对青光眼转诊中心的纵向队列的回顾性研究。从 2015 年 1 月到 2022 年 12 月，对 109 名患者的 167 只眼睛（96 只原发性开角型青光眼和 71 只疑似青光眼）进行了平均 (SD) 5.7 (1.4) 年的监测。数据分析于 2023 年 4 月进行主要结果和测量初始毛细血管密度和平均视网膜神经纤维层损失率分别根据初始随访期间的前 3 次视神经乳头 OCTA 和 OCT 扫描计算（平均 [SD]，2.0 [1.0] 年） ）。根据中位速率，眼睛被分为快速进展组和慢速进展组。使用线性混合和时变 Cox 模型评估初始毛细血管密度变化或视网膜神经纤维层变薄与视野进展之间的关联。结果共有 109 名患者的 167 只眼睛（平均 [SD] 年龄，69.0 [11.1] 岁） ; 56 名女性（51.4%）和 53 名男性（48.6%）接受了评估。 83 只眼睛是缓慢的 OCTA 进展者，而 84 只眼睛是快速进展者，每年平均毛细血管密度损失分别为 -0.45% 和 -1.17%（平均差，-0.72%/年；95% CI，-0.84 至−0.60；磷< .001）。同样，83只眼睛是慢速OCT进展者，而84只眼睛是快速进展者，平均视网膜神经纤维层每年变薄分别为-0.09μm和-0.60μm（平均差异，-0.51μm/年；95％CI，- 0.59至-0.43；磷< .001）。快速 OCTA 和 OCT 进展者与更快的视野丧失相关（平均差，-0.18 dB/年；95% CI，-0.30 至 -0.06；磷= .004 和 −0.17 dB/年； 95% CI，−0.29 至−0.06；磷= .002，分别）。快速 OCTA 进展的眼睛更有可能出现视野进展（风险比，1.96；95% CI，1.04-3.69；磷= .04)。 52 只眼睛中的 17 只 (32.7%; 95% CI, 32.5-32.8) 具有快速 OCTA 和 OCT 进展，随后出现视野可能进展。结论和相关性 OCTA 导致的初始视神经乳头毛细血管密度快速丧失与视野加快速度相关本研究中发生事件进展的风险加倍。这些发现可能支持临床使用 OCTA 和 OCT 视神经乳头测量来评估青光眼进展的风险。