Assessment of retinal microcirculation alterations in glaucoma by optical coherence tomography angiography

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Microcirculation alterations of the human retina are of significant relevance with glaucoma.Optical coherence tomography angiography (OCTA) is a non-invasive examination that provides signals of the retina and retinal microcirculation.It is currently widely used in research and screening for glaucoma due to its effective detection of each layer in the retinal microcirculation.Vessel density of radial peripapillary capillary (RPC) is positively correlated with the retinal nerve fiber layer thickness, which is crucial in the assessment of glaucoma.Peripapillary region and macula are regions of interest in OCTA analysis for microcirculation.Vessel density of the whole retina and RPC in the peripapillary region decreases significantly, which matches the thinned retinal fiber layer thickness and visual field defects, and is relevant to the disease severity.As for the macular region, vessel density declines while the area of the foveal avascular zone increases.Greater changes in late-stage glaucoma and normal-tension glaucoma are detected by OCTA compared with other stages and types of glaucoma.OCTA imaging may be influenced by high myopia and intraocular pressure, and the peripapillary region is of greater diagnostic value than macula in microcirculation changes.In conclusion, OCTA can serve as a new technique for the assessment of retinal microcirculation in glaucoma.This review summarized the characteristics of retinal microcirculation in OCTA images and its change in peripapillary and macular region in glaucoma eyes.Influencing factors associated with peripapillary and macular microcirculation changes in OCTA images and evaluation of peripapillary and macular microcirculation in glaucoma by OCTA and their diagnostic values were reviewed.

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