Among subjects with glaucoma, wedge-shaped defects on optical coherence tomography angiography were associated with disc hemorrhages, paracentral visual field defects, increased cup-to-disc ratio, and thinner retinal nerve fiber layer.
To examine determinants of wedge defects on peripapillary optical coherence tomography angiography (OCTA) in glaucoma.
278 eyes of 186 subjects with mild to severe primary open angle glaucoma (POAG) underwent 6×6 spectral domain-OCTA imaging of the superficial peripapillary retina from 2016-2020 at an academic practice. Wedge defects were defined as focal microvasculature loss that extends outward from the optic nerve in an arcuate, wedge shape. Logistic regression models controlling for inter-eye correlation identified variables significantly associated with wedge defects. Eyes with profound microvasculature loss in both hemispheres were excluded. Candidate variables included: age, gender, race or ethnicity, diabetes, hypertension, follow-up duration, baseline untreated intraocular pressure (IOP), IOP at time of imaging, disc hemorrhage (DH) history, paracentral visual field (VF) defects, cup-disc-ratio (CDR), central corneal thickness, spherical equivalent, VF mean deviation, retinal nerve fiber layer thickness (RNFL), and glaucoma stage.
Of 278 eyes, 126 (45.3%) had wedge defects in at least 1 hemisphere. In our multivariable logistic regression model, wedge defects were associated with DH history (odds ratio [OR] 3.19 [95% confidence interval (CI) 1.05-9.69], P=0.041), paracentral VF defects (OR 4.38 [95% CI 2.11-9.11], P<0.0001), larger CDR (OR 1.27 [95% CI 1.03-1.56], P=0.024, per 0.1 increase), and thinner RNFL (OR 1.71 [95% CI 1.25-2.34], P=0.0009, per 10 micron decrease).
DH history and paracentral VF defects were independently associated with wedge defects on OCTA, which was present in 45.3% of POAG patients. These findings may provide insight into glaucoma pathogenesis.

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