Macular Perfusion Density New Adjunct Marker for Glaucoma Severity

The current study found significant reductions in macular perfusion density across all sectors from mild to severe glaucoma stages, with the outer nasal sector exhibiting the most significant decline. Photo: Lori Mandy Pennington, OD, and Brooke Smith, OD. Click image to enlarge. Ocular and intraocular blood flow systems seem to play crucial roles in the pathogenesis of glaucoma. Contemporary research further supports vascular dysregulation and ocular perfusion abnormalities as contributors to glaucomatous damage. Researchers in Japan recently explored the relationship between macular perfusion density, as seen with OCT angiography (OCT-A) and central visual field (VF) defects in patients with primary open-angle glaucoma (POAG) across its mild, moderate and advanced stages.They found that decreased outer nasal macular perfusion density correlates with worsening VF defects across all glaucoma severity levels—particularly with central 10-2 sensitivity—highlighting its potential as a critical parameter for monitoring POAG progression, including advanced stages.“By explicitly analyzing sectoral macular perfusion density in relation to central 10-2 VF sensitivity mapped to corresponding OCT-A sectors, our data indicates that vascular impairment in the outer nasal macula is closely aligned with central functional loss across severities,” the team wrote in their paper, which was published in Journal of Glaucoma.In this retrospective, cross-sectional analysis of 196 POAG eyes, OCT-A (6x6mm, superficial plexus) provided sectoral macular perfusion density. This value in each sector was then analyzed in relation to the sum of total deviation of the Humphrey Field Analyzer central 10–2 sectors mapped to OCT-A sectors. In total, 71, 65 and 60 patients were classified to have mild, moderate and severe POAG, respectively. The mean circumpapillary retinal nerve fiber layer (cpRNFL), macular ganglion cell inner plexiform layer (mGCIPL) and macular thicknesses significantly decreased with increasing glaucoma severity.Outer nasal macular perfusion density decreased stepwise from mild to moderate to severe (means: 46.7%, 42.7%, 39.6%, respectively). Outer nasal macular perfusion density correlated with central 10-2 total deviation sums within strata. In multivariable analysis for mean deviation 10-2 (complete cases), outer nasal macular perfusion density and mGCIPL thickness were independently associated, whereas cpRNFL was not.“The results highlight the potential of OCT-A for detailed assessments of glaucoma progression, even in patients with advanced disease,” the researchers noted. “The findings contribute to a comprehensive understanding of glaucoma pathophysiology.”Click here for the journal source. Inuzuka M, Matsuo M, Kubota M, et al. Relationship between macular perfusion density and central visual field loss in primary open angle glaucoma. J Glaucoma. 2026;35(1):14-22.  This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.