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Original Investigation
April 5, 2018

Association of Myopia With Peripapillary Perfused Capillary Density in Patients With GlaucomaAn Optical Coherence Tomography Angiography Study

Author Affiliations
  • 1Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York
  • 2Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  • 3Farabi Eye Hospital, Tehran, Iran
  • 4Icahn School Medicine at Mount Sinai, New York, New York
  • 5Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
JAMA Ophthalmol. Published online April 5, 2018. doi:10.1001/jamaophthalmol.2018.0776
Key Points

Question  Do patients whose eyes have myopia, open-angle glaucoma, or both exhibit decreased peripapillary perfused capillary density?

Findings  In this cross-sectional study, 87 people with myopic eyes with glaucoma, 17 patients with myopic eyes without glaucoma, 93 patients with non-myopic eyes with glaucoma, and 51 control participants were assessed for perfused capillary density via optical coherence tomography angiography and customized software. The presence of PCD was associated with a progressive decrease from control status and myopia without glaucoma to nonmyopia with glaucoma to myopia with glaucoma.

Meaning  These findings suggest that open-angle glaucoma might have a greater effect on perfused capillary density than myopia does.


Importance  This study used optical coherence tomographic angiography to assess for impaired blood flow in myopic eyes with or without open-angle glaucoma.

Objective  To compare the peripapillary perfused capillary density (PCD) between eyes with and without glaucoma.

Design, Setting, and Participants  In this cross-sectional study at a tertiary glaucoma referral practice, we recruited patients with myopic eyes of spherical equivalent of more than −3.0 diopters with and without open-angle glaucoma, patients with nonmyopic eyes with glaucoma, and patients with no disease from February 2016 to October 2016. We obtained 4.5 × 4.5-mm optical coherence tomographic angiography images of the optic nerve head and calculated PCD as the ratio of pixels associated with capillaries to the number of pixels in the region of interest after large blood vessel removal. Both eyes of each patient were used in the analysis. Continuous variables were assessed by analysis of variance and t tests. A marginal model of generalized estimating equations was performed to adjust for confounding factors and intraclass correlations.

Main Outcomes and Measures  Mean PCD.

Results  We matched 87 patients with myopic eyes with glaucoma (of whom 39 [45%] were women), 17 with myopic eyes without glaucoma (of whom 10 [59%] were women), and 93 with non-myopic eyes with glaucoma (of whom 55 [59%] were women) for visual field defects and included 51 control participants (or whom 38 [75%] were women). Mean (SD) ages were 67.5 (12.0) years for patients with myopia and glaucoma, 48.2 (19.0) years for those with myopia without glaucoma, 67.3 (11.0) years for those with glaucoma without myopia, and 64.7 (8.9) years in control participants. Global PCD demonstrated a progressive decrease from the control group (mean [SD], 41.0 [4.2]) to those with myopia without glaucoma (38.4 [5.8]) to those with glaucoma without myopia (31.9 [7.5]) to those with both (28.2 [6.0]; all P < .001). The mean difference in global PCD between the 3 groups and control group, adjusted for age and axial length, was greatest in those with myopia and glaucoma (−11.1; 95% CI, −14.0 to −8.1; P < .001), followed by those with glaucoma without myopia (−8.6; 95% CI, −10.9 to −6.3; P < .001) and those with myopia without glaucoma (−2.8; 95% CI, −6.9 to 1.2; P = .17). No interaction was found between glaucoma and myopia.

Conclusions and Relevance  These findings demonstrate peripapillary microvascular attenuation to a greater extent in open-angle glaucoma than myopia. The cross-sectional design means we cannot determine if this association is a cause and/or is associated with other confounding factors.