Central Visual Field Damage and Parapapillary Choroidal Microvasculature Dropout in Primary Open-Angle Glaucoma

Purpose: To determine whether microvasculature dropout (MvD) in the parapapillary choroid is related to the presence of central visual field defects in primary open-angle glaucoma (POAG).

Design: Cross-sectional observational study.

Participants: Thirty-two POAG patients with an initial parafoveal scotoma (IPFS) within a 10° radius in 1 hemifield and 42 POAG patients with an initial nasal step (INS) within the nasal periphery outside 10° of fixation in 1 hemifield.

Methods: The peripapillary choroidal microvasculature was evaluated on en face images obtained using swept-source OCT angiography. Microvasculature dropout was defined as a focal sectoral capillary dropout with no visible microvascular network identified in the choroidal layer. Factors associated with IPFS, compared with INS, were assessed using logistic regression analyses.

Main Outcome Measures: Factors associated with IPFS rather than INS.

Results: Microvasculature dropout was observed in 25 of 32 eyes (78.1%) in the IPFS group, but in only 1 of 42 eyes (2.4%) in the INS group (P < 0.001). In logistic regression analyses, only MvD was a significant factor influencing the presence of IPFS. Systemic risk factors such as cold extremities (P = 0.026), migraine (P = 0.044), lower mean arterial pressure (P = 0.037), and lower ocular perfusion pressure (P = 0.024) were associated significantly with the presence of MvD.

Conclusions: The presence of MvD in the parapapillary choroid was a strong predictor for IPFS.