Longitudinal OCT Angiography Versus Structural OCT for Predicting Visual Field Progression in Glaucoma
In brief
Each 1%/year faster macular vessel loss predicted over twice progression hazard
Among 333 eyes with open-angle glaucoma followed for about four years, 29% showed visual-field progression. Faster loss of macular vessel density on optical coherence tomography angiography independently predicted progression; thinning on structural optical coherence tomography did not. The findings support vessel-density change as a potential monitoring signal, but the study did not formally compare the tests head to head.
- Journal
- Journal of glaucoma (Q1)
- Published
- 28 October 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Burhan Başkan, Yusuf Evcimen
- PMID
- 42956246
- DOI
- 10.1097/IJG.0000000000002798
Why clinicians should know about it
- Picked for Ophthalmology (paper of the day, 1 November 2026): Longitudinal OCT angiography predicts glaucoma visual-field progression
Abstract
PRCIS: In this longitudinal study, the rate of OCT angiography vessel density loss was an independent predictor of visual field progression in glaucoma, whereas the rate of structural OCT thinning was not. PURPOSE: To compare longitudinal OCT angiography vessel density and structural OCT changes as predictors of visual field (VF) progression in open-angle glaucoma (OAG). METHODS: This prospective study included 333 OAG eyes (110 normal-tension) followed quarterly for 4.1±0.9 years and 60 age-matched healthy controls examined at baseline and 6 months. Peripapillary capillary vessel density (pcVD), macular vessel density (mVD), peripapillary retinal nerve fibre layer thickness (pRNFLT) and macular ganglion cell-inner plexiform layer thickness (mGCIPLT) were measured. VF progression was defined by combined event- and trend-based criteria. Linear mixed-effects models compared rates of change; Cox models used cumulatively updated rates as time-dependent predictors. RESULTS: Controls showed minimal change, with small statistically detectable declines in some parameters. Ninety-eight eyes (29.4%) progressed. Progressors showed faster pcVD (-0.73 vs. -0.56%/year, P=0.022) and parafoveal mVD loss (-1.12 vs. -0.40%/year, P<0.001). In advanced glaucoma, mVD loss remained associated with progression (P<0.001), whereas mGCIPLT (P=0.104) and pRNFLT (P=0.118) changes did not. In multivariable Cox analysis, parafoveal mVD rate (HR 2.15 per 1%/year faster loss, 95% CI 1.52-3.04) and pcVD rate (HR 1.82, 95% CI 1.34-2.47) were independent predictors (both P<0.001), whereas pRNFLT (HR 1.28 per 1 μm/y, P=0.158) and mGCIPLT (HR 1.41, P=0.071) were not. CONCLUSION: Vessel density loss independently predicted VF progression, whereas structural OCT thinning was not; in advanced glaucoma, vessel density loss remained associated with progression in mixed-model analyses. Formal head-to-head comparisons were not performed.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.