Optical Coherence Tomography Angiography and Glaucoma

While we have a good understanding of glaucoma, there is still much that we do not know.

By: John Warren, OD

Optometric Management June 2, 2025

Clinical Scorecard: Optical Coherence Tomography Angiography and Glaucoma

Category	Detail
Condition	Glaucoma with associated structural and microvascular changes
Key Mechanisms	Intraocular pressure (IOP) elevation, retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) thinning, peripapillary perfusion loss detected by OCT-A
Target Population	Patients with glaucoma, including those with prior refractive surgery and low-tension glaucoma
Care Setting	Ophthalmology and optometry clinical practice with access to OCT-A and visual field testing

OCT-A reveals focal GCC and RNFL thinning correlating with peripapillary perfusion loss and visual field defects.
Post-refractive surgery corneal thickness affects IOP interpretation; pachymetry is important despite lack of precise adjustment formulas.
Perfusion dropout on OCT-A may indicate higher risk of glaucoma progression, especially in low-tension glaucoma patients.

Perform corneal pachymetry in patients with prior refractive surgery to contextualize IOP measurements.
Use OCT-A to assess optic nerve and macular microvascular perfusion alongside structural imaging (GCC, RNFL).
Conduct threshold visual field testing to correlate functional deficits with structural and perfusion changes.

Continue IOP-lowering therapy (e.g., latanoprost) while considering corneal thickness and perfusion status.
Schedule regular follow-up with OCT-A and visual field testing every 6 months to monitor stability or progression.

Monitor structural changes via OCT-A and OCT imaging of GCC and RNFL.
Assess visual field stability with periodic threshold visual field tests.
Observe for progression of perfusion loss as a potential indicator of disease advancement.

Patients with significant peripapillary perfusion loss may have faster glaucoma progression.
Low-tension glaucoma patients may have vascular etiologies contributing to disease independent of IOP.

Glaucoma patients including those with prior LASIK and low-tension glaucoma

Latanoprost monotherapy can maintain acceptable IOP; however, perfusion loss requires close monitoring despite stable IOP.

Incorporate corneal pachymetry in glaucoma patients with refractive surgery history to better interpret IOP.
Utilize OCT-A to detect microvascular changes that correlate with structural and functional glaucoma damage.
Maintain a combined approach of imaging and functional testing for comprehensive glaucoma monitoring.
Recognize the potential vascular component in low-tension glaucoma and adjust monitoring accordingly.
Implement a 6-month follow-up schedule with OCT-A and visual field testing for patients with perfusion loss.