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A comprehensive update on the use of optical coherence tomography angiography in glaucoma

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Abstract

Purpose

The primary purpose of this review is to provide a comprehensive summary on the technical principles of OCTA and to enumerate vascular parameters being explicated for glaucoma diagnosis and progression with emphasis on recent studies. In addition, the authors also summarize the future clinical potentials of OCTA in glaucoma and enumerate the limitations of this imaging modality in the present-day scenario.

Methods

The index study is a narrative review on OCTA in glaucoma. The authors searched the PubMed database using the key phrases ‘‘optical coherence tomography angiography” AND “glaucoma,’’ AND/OR “vascular parameters” AND/OR “ocular perfusion.” Being a relatively recent development in ocular imaging, studies in which OCTA imaging had been used for glaucoma evaluation since 2012 were included until March 2022. The literature search included original studies and previous review articles, while case reports were excluded. Preliminary search was based on relevant articles with search keywords in the title and abstract. The second screening was performed by reading the full text of the literature.

Results

Recent studies indicate reduction in microcirculation in glaucomatous eyes compared to the normal subjects. The area of interest for glaucoma evaluation using OCTA varies among the different studies. Based on the literature reviewed here, (1) OCTA parameters measured in the peripapillary; ONH and macular area have been shown to differentiate between glaucoma and normal eyes with a discriminatory power comparable to OCT parameters used routinely in clinics, (2) monitoring of peripapillary and macular vessel density may provide important information to the evaluation of glaucoma progression and prediction of rates of disease worsening, (3) studies suggest strong correlation between the OCTA parameters, the OCT parameters and visual function, measured by visual field testing, in glaucomatous eyes, (4) future prospects of OCTA in glaucoma evaluations using AI predicting structural and functional features and prognosis based on early vascular findings would open up scope for early detection of high-risk suspects and fast progressors in glaucoma.

Conclusion

OCTA can be useful in quantifying vascular parameters in the optic disc, peripapillary and the macular regions for glaucoma evaluation. OCTA shows potential to become a part of everyday glaucoma management.

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Authors and Affiliations

  1. Byers Eye Institute, Stanford University, Palo Alto, USA

    Suria S. Mannil

  2. Cleveland Clinic Abu Dhabi, The Eye Institute, Al Maryah Island, 112412, Abu Dhabi, United Arab Emirates

    Aniruddha Agarwal & Rajesh S. Kumar

  3. Cleveland Clinic Lerner College of Medicine, Case Western, Reserve University, Cleveland, OH, USA

    Aniruddha Agarwal & Rajesh S. Kumar

  4. Department of Ophthalmology, School of Medicine, University of Pittsburgh, Pittsburgh, USA

    Ian P. Conner

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  1. Suria S. Mannil
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  2. Aniruddha Agarwal
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  4. Rajesh S. Kumar
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Contributions

SSM (Suria S Mannil) and RSK (Rajesh S Kumar) conceived of and designed the work described here. SSM wrote the first draft of the paper. RSK and AA (Anirudda Agarwal) contributed to revision and editing and provided important intellectual content. IPC (Ian P Conner) contributed to the critical review.

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Correspondence to Rajesh S. Kumar.

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Mannil, S.S., Agarwal, A., Conner, I.P. et al. A comprehensive update on the use of optical coherence tomography angiography in glaucoma. Int Ophthalmol 43, 1785–1802 (2023). https://doi.org/10.1007/s10792-022-02574-1

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