Peripapillary Vascular Density Differentiates Glaucomatous Cupping From Physiological Cupping Using Optical Coherence Tomography Angiography.

Prcis: In glaucoma, peripapillary vascular density was reduced compared with normal eyes, with or without physiological cupping.

Purpose: To assess the ability of radial peripapillary capillaries vessel density (RPC VD) to distinguish between physiological and glaucomatous cupping using optical coherence tomography angiography (OCTA).

Patients and methods: An observational study was conducted at Ain Shams University, involving 98 eyes from 98 patients, divided into 3 groups. Group 1 included 30 eyes with primary open angle glaucoma, group 2 included 28 normal eyes with physiological cupping [vertical cup/disc ratio 0.6 or more based on structural optical coherence tomography (OCT) and no evidence of glaucoma], and group 3 included 40 age-matched normal eyes (vertical cup/disc ratio ≤0.5). Participants were subjected to ophthalmological examination, structural OCT, and OCTA of the optic disc.

Results: Group 1 exhibited significantly lower RPC VD than the other groups ( P <0.001), while no significant differences were noted between groups 2 and 3 ( P =0.559). Moderate negative correlations were observed between C/D vertical ( r =-0.556, P =0.002), and horizontal ratios ( r =-0.430, P =020), and RPC VD in glaucomatous eyes across the whole image and its 4 quadrants. No significant correlations were found between these parameters in the other groups.

Conclusion: Using OCTA, glaucomatous eyes showed reduced RPC VD compared with normal eyes, even in the presence of physiological cupping. This finding may help to differentiate between physiological and glaucomatous cupping.