A comparative study of structural, functional and circulatory parameters in glaucoma diagnostics

PURPOSE: To compare the diagnostic accuracy of structural parameters, vessel density (VD) measured by optical coherence tomography angiography (OCTA), and electrophysiological testing in primary open-angle glaucoma (POAG) diagnosis.

METHODS: 35 healthy participants and 90 POAG patients underwent the measurement of whole image en face (wi) VD in the disc/peripapillary region and macula, as well as the assessment of the retinal nerve fiber layer (RNFL), average thickness of ganglion cell complex (GCC), pattern electroretinograms and pattern visual evoked potentials. The area under the receiver operating characteristic curve (AUC) was assessed for each parameter to differentiate early POAG from healthy eyes and conduct a differential diagnosis between the POAG stages.

RESULTS: To distinguish early POAG from healthy eyes, the parameters with the highest AUC were detected: P50 amplitude of transient pattern electroretinogram, 1° (AUC 0.93, p=0.002), P1 component of steady-state pattern electroretinogram (AUC 0.92, p=0.003), P100 amplitude of pattern visual evoked potential, 1° (AUC 0.84, p=0.013), wiVD macula superficial (AUC 0.80, p=0.001), wiVD Disc (AUC 0.74, p=0.016), GCC (AUC 0.74, p=0.016) and to distinguish early POAG from the moderate to advanced POAG: inferotemporal peripapillary VD (AUC 0.94, p<0.0001) and focal loss volume of GCC (AUC 0.92, p<0,001).

CONCLUSIONS: Our results demonstrate the importance of measuring the microcirculation parameters in the macular area along with PERGs and PVEPs for the early detection of glaucoma. VD in the inferotemporal sector of the peripapillary retina and focal loss volume of GCC are important for monitoring of the disease. The inclusion of OCTA, PERGs and PVEPs in glaucoma diagnostics may improve its early detection and monitoring. 

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