Longitudinal Choriocapillaris Vascular Density Changes in Different Types of Primary Open-Angle Glaucoma

PURPOSE: To evaluate longitudinal changes in choriocapillaris perfusion in patients with glaucoma with four phenotypes of optic disc damage and to explore associated factors with decreased choriocapillaris vessel density (CVD). METHODS: This prospective longitudinal study included 96 eyes of 96 patients with primary open-angle glaucoma (POAG). Patients with POAG was differentiated into the optic disc phenotypes of focal ischemic type (FI), myopic type (MY), senile sclerotic type (SS), and generalized enlargement type (GE). Patients were followed up every three months. Simple linear regression was used to investigate the factors associated with a reduction in CVD. RESULTS: The median follow-up time was 2.5 years (range, 2.0–3.0 years). Choriocapillaris perfusion tended to decrease over time, with CVD decreasing significantly faster in the FI type than in the other three types (P < 0.001). The percentage decrease in the FI type was 7.85%, 10.89%, and 8.88% faster than MY, SS and GE, respectively, after correcting for age, gender, axial length, intraocular pressure, mean deviation, retinal nerve fiber layer (RNFL), and image quality score. In multivariate regression, decreased CVD was independently associated with the rate of RNFL thinning. CONCLUSIONS: FI type had the fastest rate of CVD decline in the four phenotypes of optic disc damage, and decreased CVD was positively correlated with the rate of RNFL thinning. TRANSLATIONAL RELEVANCE: The role of the choriocapillaris in the pathogenesis and therapeutic potential of glaucoma require further attention to facilitate better management of glaucoma patients.