The Interrelationship between Refractive Error, Blood Vessel Anatomy, and Glaucomatous Visual Field Loss

PURPOSE: We quantified the interrelationship between retinal blood vessel (BV) anatomical variation, spherical equivalent (SE) of refractive error, and functional diagnostic parameters in glaucoma to identify optimal parameters for the improvement of optical coherence tomography (OCT) retinal nerve fiber layer thickness (RNFLT) norms. METHODS: A trained observer marked the intersections of the main superior/inferior temporal arteries and veins with concentric circles around the optic nerve head (ONH) center on fundus images. The interrelationship of BV, SE, and visual field global parameters was analyzed by multivariate regression and model comparison. RESULTS: A total of 445 eyes of 445 patients in a large glaucoma practice were selected. Of all investigated BV parameters, interartery angles (IAA) between superior and inferior arteries at a radius of 1.73 mm around the ONH center demonstrated the strongest relationship to SE (Bayesian information criterion difference to null model, 11.9). SE and BV parameters are unrelated to functional parameters, including mean deviation (MD), pattern standard deviation, and glaucoma hemifield test results. CONCLUSIONS: BV locations outside the ONH are sufficiently stable over glaucoma severity to represent individual eye anatomy, and the IAA at 1.73 mm eccentricity is the optimal parameter to be considered for novel OCT RNFLT norms. TRANSLATIONAL RELEVANCE: Among a large set of BV location parameters, considering IAA may improve RNFLT norms optimally and thereby increase the accuracy of clinical glaucoma diagnosis.