Physical Activity and Macular Choroidal Circulation in Older Adults With Primary Open-Angle Glaucoma: A Swept-Source Optical Coherence Tomography Angiography Study

Purpose: To evaluate the relationship between physical activity (PA) and choroidal circulation in older adults with primary open-angle glaucoma (POAG) using swept-source optical coherence tomography angiography (SS-OCTA). Methods: This cross-sectional study included participants aged 60 years or older from the Elderly Glaucoma and Sleep Study, comprising both patients with POAG and age-matched controls. PA was assessed using the International Physical Activity Questionnaire and a wrist-worn actigraphy device worn continuously for ≥7 days. PA parameters included total PA (metabolic equivalent task minutes per week), daily step count, moderate-to-vigorous physical activity (MVPA) duration, and total energy expenditure. After the monitoring period, SS-OCTA imaging was performed on all participants using a 6-mm × 6-mm macular scan to quantify choroidal vascular volume (CVV), choroidal stromal volume, choroidal vascularity index, and choriocapillaris flow density (CC FD). Associations between PA and choroidal parameters were analyzed using multivariable linear regression. Results: Older adults with POAG engaged in substantially lower levels of PA, particularly MVPA, and showed reduced CVV and CC FD compared with age-matched controls (all P < 0.05). Among patients with POAG, longer MVPA duration was independently associated with greater CVV (β = 0.04, P = 0.021) and higher CC FD (β = 0.06, P = 0.004). Conclusions: Older adults with POAG showed reduced habitual PA levels and impaired macular choroidal circulation. Longer MVPA duration was associated with better macular choroidal circulation in older adults with POAG. Translational Relevance: MVPA may represent a modifiable factor relevant to choroidal circulation health in glaucoma.