Utility of Lamina Cribrosa Microvasculature Determined by Swept-Source Optical Coherence Tomography Angiography in Glaucoma Diagnosis

Purpose: To evaluate the diagnostic capability of the lamina cribrosa microvasculature determined using swept-source optical coherence tomography angiography (SS-OCTA) in detecting glaucoma.Methods: Lamina cribrosa vessel density (LCVD) was quantified using a 3.0 3.0 mm optic nerve head scan obtained with SS-OCTA.The area under the receiver operating characteristic curve (AUC) was used to assess the diagnostic ability of LCVD and other structural parameters such as circumpapillary retinal nerve fiber layer (cpRNFL) and macular ganglion cell inner plexiform layer (mGCIPL) thicknesses.Patients with primary open-angle glaucoma (POAG) were divided into mild-to-moderate and advanced stages based on a visual field mean deviation (VF MD) of -10 dB, and the AUCs of LCVD in these stages were compared to evaluate the effect of glaucoma severity on the diagnostic ability of LCVD.Correlations between LCVD and other structural and functional parameters were evaluated using the Pearson correlation analysis.Results: In total, 133 patients with POAG (79 eyes with mild-to-moderate stage and 54 eyes with advanced stage), 49 with suspected glaucoma, and 43 with healthy eyes were included.POAG eyes had significantly lower LCVD (p < 0.001), cpRNFL (p < 0.001), and mGCIPL (p < 0.001) thicknesses than healthy eyes.The AUCs for LCVD, cpRNFL thickness, and mGCIPL thickness were 0.742, 0.983, and 0.932, respectively.The AUC of inferior-sector LCVD (0.789) was higher than that of the other quadrants.The AUC of LCVD in differentiating advanced stage glaucoma from healthy controls (0.823) was greater than that in differentiating all patients with POAG or those with mild-to-moderate stage from controls (0.742 and 0.688, respectively).LCVD significantly correlated with cpRNFL thickness (p < 0.001), mGCIPL thickness (p < 0.001), and VF MD (p < 0.001).Conclusions: The glaucoma diagnostic ability of LCVD was moderate and that of LCVD increased according to glaucoma severity.LCVD significantly correlated with other conventional structural and functional parameters.This reduction in LCVD could be used as an adjunct tool to detect and assess glaucomatous damage.