OCT angiography vessel density loss and rates of visual field progression in glaucoma and glaucoma suspects

To evaluate the relationship between rates of retinal vessel density (VD) loss and rates of central and peripheral standard automated perimetry (SAP) progression. In this prospective cohort study, 116 eyes (85 glaucoma, 31 suspects) from 60 participants (mean age 68.6 ± 7.6 years) were followed at 4-month intervals. Participants underwent comprehensive ophthalmic evaluation, blood pressure assessment, SAP, and optical coherence tomography angiography (OCTA) of the optic nerve head (ONH) and peripapillary retina. OCTA scans (4.5 × 4.5 mm) were centered on the ONH, and VD was quantified using a custom fractal analysis algorithm. Over 33.3 ± 6.6 months, eyes completed an average of 7.9 ± 2.0 SAP and OCTA exams. The median SAP MD slope was 0.19 dB/year (range –2.99 to 2.74 dB/year), with 4.3% of eyes showing moderate to fast progression (≤ –0.50 dB/year). Faster SAP deterioration, across MD, central 5°, central 10°, and peripheral MS, was significantly associated with faster RPC VD loss (β = –1.63 to –2.17%/year; all p ≤ 0.01) after adjusting for confounding factors. Rates of RPC VD loss measured by OCTA are strongly correlated with both central and peripheral SAP progression, supporting RPC VD loss as a biomarker associated with glaucomatous functional decline in this predominantly mild, slow-progressing cohort.