Search Results (479)

Background: Long-term stent healing after primary PCI of culprit unprotected left main (ULM) lesions is insufficiently explored. In this setting, large vessel size and bifurcation anatomy may limit angiographic stent optimization and contribute to persistent strut malapposition and incomplete coverage. Objectives: To identify OCT-derived geometric and healing parameters associated with long-term strut coverage and malapposition after angiography-guided primary PCI of culprit ULM lesions. Methods: This single-center exploratory study included 30 patients with long-term OCT follow-up after angiography-guided primary PCI of culprit ULM lesions. OCT analysis was performed separately in three prespecified subsegments: the left main (LM), polygon of confluence (POC), and distal main branch (dMB). Five predefined strut-level healing outcomes were analysed: covered struts, malapposed struts, malapposed and uncovered struts, significantly malapposed struts (>400 μm), and significantly malapposed and uncovered struts. Associations between patient-level healing outcomes and OCT-derived measures of lumen geometry, stent dimensions, neointimal response, and an exploratory lumen–stent mismatch variable were assessed using univariable and multivariable linear regression. Results: A total of 31,703 struts were analysed. Overall strut coverage was 90.7 ± 6.6%. Compared with the dMB, proximal ULM segments (LM and POC) showed lower strut coverage (82.8% and 84.2% vs. 93.9%, p < 0.001) and higher malapposition rates (17.4% and 14.2% vs. 0.4%, p < 0.001). In regression analysis, larger native lumen dimensions were associated with lower strut coverage and higher malapposition, whereas larger achieved stent area was associated with better strut healing. The exploratory lumen–stent mismatch variable in multivariable models with all five healing outcomes in multivariable models (all p < 0.01). Conclusions: After angiography-guided primary PCI of culprit unprotected left main lesions, long-term strut healing was significantly influenced by the mismatch between native reference lumen area and the achieved mean stent area. Whether intravascular imaging–guided optimization of stent sizing and expansion in large-calibre left main anatomy improves strut healing requires further investigation. Full article

Objectives: This study investigated whether visual field abnormalities are present in eyes with suspected nasal optic disc hypoplasia (NOH) by using fundus photography and optical coherence tomography (OCT). Methods: NOH was diagnosed using the following criteria: (1) small optic disc, (2) nasal optic disc pallor or optic disc margin irregularity, (3) wedge-shaped temporal visual field defects extending from Mariotte’s blind spot, and (4) reduced nasal circumpapillary retinal nerve fiber layer (cpRNFL) thickness. Eyes fulfilling criteria 1, 2, and 4 without visual field abnormalities were classified as pseudo-NOH (pNOH), whereas eyes without visual field or cpRNFL abnormalities were considered normal. Nasal cpRNFL thickness was measured using OCT, radial peripapillary capillary (RPC) density was assessed using OCT angiography (OCTA), visual field testing was performed, and optic disc blood flow velocity was evaluated using the mean blur rate (MBR) and laser speckle flowgraphy (LSFG). Results: Seven eyes with NOH, 13 eyes with pNOH, and 24 normal right eyes were included. Nasal cpRNFL thickness and MBR were significantly reduced in both the NOH and pNOH groups compared with the normal group, with no significant difference between the NOH and pNOH groups. Nasal RPC density was significantly lower in the NOH group than in both the pNOH and normal groups, and no significant difference was observed between the pNOH and normal groups. Conclusions: Even when NOH was suspected from fundus, LSFG, and OCT C-scan findings, visual field abnormalities were not consistently present. Differences in RPC density measured using OCTA may have contributed to this variability. This study examined whether suspected nasal optic disc hypoplasia (NOH) is always associated with visual field defects. Using fundus imaging, OCT, OCT angiography, and laser speckle flowgraphy, we compared eyes with NOH, pseudo-NOH, and normal eyes. Although structural changes such as reduced nasal nerve fiber layer thickness and decreased blood flow were observed in both NOH and pseudo-NOH, visual field abnormalities were not consistently present. Notably, reduced radial peripapillary capillary density was specific to NOH, suggesting that vascular differences may explain variability in visual function. These findings highlight the importance of multimodal imaging in NOH evaluation. Full article

Background and Objectives: Open-angle glaucoma subtypes share a structural phenotype but differ in pathophysiology: pseudoexfoliative glaucoma (PXG) involves vascular endothelial dysfunction associated with deposition of exfoliative material, whereas normal-tension glaucoma (NTG) reflects primary vascular dysregulation in the absence of elevated intraocular pressure. We characterized subtype-specific OCT angiography (OCTA) profiles obtained from a 3 × 3 mm macular scan and evaluated their discriminatory power for pairwise subtype classification. Materials and Methods: This was a single-center, cross-sectional study of 304 eyes: 198 glaucomatous eyes—primary open-angle glaucoma (POAG, glaucoma simplex in our clinical nomenclature), n = 102; PXG (glaucoma capsulare), n = 68; NTG (glaucoma sine tensio), n = 28—and 106 healthy controls. The Cirrus HD-OCT 5000 AngioPlex 3 × 3 mm OCTA protocol was used to assess vessel density (VD), perfusion density, foveal avascular zone (FAZ) morphology, ganglion cell complex (GCC), and retinal nerve fiber layer (RNFL) thickness. Analyses included Kruskal–Wallis tests with Bonferroni post hoc correction, ROC analysis with DeLong comparison of combined versus structural-only models, multivariate regression, and an exploratory XGBoost classifier with SHAP-based interpretation. Results: VD Inner and Perfusion Inner were lower in PXG (16.37 ± 3.33%; 0.31 ± 0.05) than in POAG (18.73 ± 3.41%; 0.34 ± 0.05; both p < 0.001); Perfusion Inner was also lower than in NTG (p < 0.05). FAZ Area was largest in NTG (0.27 ± 0.11 mm²) and greater than in PXG (0.19 ± 0.08; p < 0.01); FAZ Circularity differed across subtypes (p < 0.001). Combined OCTA–structural models outperformed structural-only models for POAG vs. PXG (DeLong p = 0.002) and for PXG vs. NTG (AUC = 0.770; p = 0.010). Sector-resolved Spearman analysis revealed subtype-specific coupling: in NTG, VD Inner and Perfusion Inner correlated with the inferior RNFL (r = 0.53 and r = 0.52; both p < 0.01); in PXG, coupling shifted nasally (r = 0.41 and r = 0.46; both p < 0.001). The exploratory XGBoost classifier separated glaucoma from controls with an internal cross-validated AUC of 0.975 ± 0.008 (5-fold CV; not externally validated); FAZ Circularity (mean |SHAP| = 0.418) and FAZ Area (0.411) were the top inter-subtype features, supported by case-level SHAP. RNFL avg and average GCC independently predicted MD across subtypes; in PXG, Perfusion Inner also predicted MD (β = −32.78; p = 0.032). Conclusions: In this single-center, cross-sectional cohort, OCTA revealed subtype-associated macular microvascular profiles that are complementary to structural OCT. Reduced vessel and perfusion density characterized PXG, whereas FAZ enlargement and reduced circularity distinguished NTG and PXG. Vascular–structural coupling was nasal-predominant in PXG and inferior-predominant in NTG. Combined multimodal models outperformed structural-only approaches. Macular perfusion additionally predicted MD in PXG. The XGBoost/SHAP analysis is exploratory; prospective and externally validated studies are required before clinical deployment. Full article

Background and Clinical Significance: Blunt ocular trauma is a significant but often underestimated cause of visual impairment, particularly among adolescents involved in high-risk activities such as horseback riding. While most equestrian injuries affect the head and extremities, ocular trauma, especially commotio retinae, can result in severe visual complications. Case Presentation: We report the case of a 15-year-old girl who sustained blunt ocular trauma to the left eye following a fall from a horse and presented with decreased visual acuity. Multimodal imaging revealed outer retinal abnormalities on spectral-domain optical coherence tomography (OCT), including ellipsoid zone irregularities. Early-phase fluorescein angiography showed central hypofluorescence in the foveal region with surrounding mild mottled hyperfluorescence, without clear vascular abnormalities. Fundus photography demonstrated subtle macular changes. Visual acuity improved significantly following treatment, with partial resolution of macular changes, although mild outer retinal irregularities persisted on follow-up imaging. Conclusions: These findings underscore the importance of early ophthalmic evaluation and advanced retinal imaging in blunt ocular trauma. Given the high risk of visual injury during equestrian activities, especially in pediatric and adolescent populations, preventive strategies such as mandatory helmet use and rider education are essential. Implementation of standardized follow-up protocols is also recommended to monitor long-term retinal changes in patients with traumatic maculopathy. Full article

Objectives: To assess the association of structural biomarkers derived from optical coherence tomography (OCT) and choriocapillaris (CC) flow information with point-wise retinal sensitivity (PWS) measured by microperimetry (MP) in intermediate age-related macular degeneration (iAMD). Methods: Patients with iAMD received imaging with spectral-domain (SD)-OCT (Spectralis, Heidelberg Engineering) and OCT-angiography (OCT-A) (PLEX Elite 9000, ZEISS). In addition, MP examinations in photopic setting (MP-3, NIDEK) and mesopic background illumination (MAIA2, ICare) were performed. The thickness of the ellipsoid-zone (EZ) and the outer nuclear layer (ONL), as well as the volume of drusen and HRF, were segmented using deep-learning (DL)-based approaches. CC flow deficit percentage (FD%) was extracted from OCT-A slabs using a novel binarization method. Semiautomatic co-registration of MP examinations, OCT-A slabs, and OCT volumes was performed. Three exploratory models were calculated using multivariable mixed-effects models: (1) structure–function (SF) using structural OCT biomarkers, (2) flow–function (FF) utilizing OCT-A derived flow information, and (3) structure–flow–function (SFF) incorporating both OCT and OCT-A data. Model performance was evaluated using AIC and BIC criterion. Results: 19 eyes of 19 patients were evaluated, totalling 3297 MP-stimuli, 1873 B-scans, and 19 OCT-A slabs. Mean (SD) age was 76 (7) years, and sensitivity was 26.0 (3.36) dB in the MP-3 and 22.42 (3.64) dB in the MAIA2. Mesopic MAIA2 examinations showed significantly lower PWS values (−3.56 to −3.63 dB; p < 0.001). Drusen and HRF volume decreased PWS (−0.6 [95% CI: −1.04; −0.16] dB/nL; p = 0.007 and −9.56 [95% CI: −12.86; −6.26] dB/nL; p < 0.001), while ONL was positively associated with PWS (0.06 [0.05; 0.07] at an eccentricity of 5.2°; p < 0.001) in the SF model. CC FD% was not significantly associated with PWS in the FF and the SFF model (p > 0.05 in both cases). In the SFF model drusen volume (−1.69 [95% CI: −2.09; −1.29] dB/nL; p < 0.001), EZ (0.04 [95% CI: 0.02; 0.06] dB/µm; p < 0.001), and ONL thickness (0.03 [95% CI: 0.02; 0.04] dB/µm; p < 0.001) were significant predictors for PWS. The SF model exhibited the lowest AIC and BIC indicating best model performance. Conclusions: Structural parameters derived from SD-OCT such as HRF, drusen volume, and outer retinal layer thickness may be more closely associated with PWS, with CC FD% as an OCT-A-derived metric contributing limited additional explanatory benefit in cross-sectional analyses. Full article

Background: Moderate-to-severe coronary calcification is associated with worse outcomes following percutaneous coronary intervention (PCI). We aimed to assess the safety and efficacy of optical coherence tomography (OCT) compared with conventional angiography in PCI guidance of moderate-to-severe calcified coronary artery lesions. Methods: Multiple databases were systematically searched for outcomes of OCT- versus angiography-guided PCI in calcified lesions. Study selection and data extraction were conducted in accordance with the PRISMA guidelines. The primary endpoint was target vessel failure (TVF), a composite of cardiac death, target vessel myocardial infarction (TV-MI), and ischemia-driven target vessel revascularization (ID-TVR). Secondary endpoints included clinical (i.e., TVF components, stent thrombosis, and 30-day major adverse cardiovascular events [MACEs]), imaging, and procedural outcomes. Results: Four randomized controlled trials involving 3186 participants were included. Compared with angiography, OCT was associated with a significant reduction in TVF (risk ratio [RR] = 0.66; 95% confidence interval [CI]: 0.52–0.82), cardiac death (RR = 0.39; 95% CI: 0.22–0.70), TV-MI (RR = 0.63; 95% CI: 0.42–0.94), and stent thrombosis (RR = 0.24; 95% CI: 0.08–0.72). However, there were no significant changes in ID-TVR (RR = 0.77; 95% CI: 0.55–1.08) or 30-day MACEs (RR = 0.50; 95% CI: 0.16–1.61). Most procedural outcomes varied across studies and showed significant heterogeneity. Conclusions: OCT-guided PCI was associated with better clinical outcomes compared with angiography-guided PCI in this patient population. However, larger randomized trials are needed to confirm these results. Full article

Background/Objectives: To evaluate the associations between corneal topographic irregularity, higher-order aberrations (HOAs), and posterior segment structural and microvascular parameters in keratoconus using optical coherence tomography (OCT) and OCT angiography (OCTA). Methods: In this cross-sectional study, 81 eyes with keratoconus and 60 healthy control eyes underwent corneal topography and wavefront analysis, spectral-domain OCT with enhanced depth imaging, and OCTA. Retinal layer thicknesses, choroidal thickness and area metrics, choroidal vascularity index (CVI), and OCTA-derived vascular parameters were analyzed. Associations were assessed using Spearman correlation analysis with false discovery rate (FDR) correction. Results: Compared with controls, keratoconus eyes showed significantly increased corneal curvature, corneal irregularity indices, and HOAs (all p < 0.001). Structural OCT analysis demonstrated preserved inner retinal layers, whereas outer nuclear layer thickness was reduced (p < 0.001) and overall outer retinal layer thickness was increased (p = 0.005). Choroidal thickness and both total and luminal choroidal areas were significantly greater in keratoconus eyes (all p ≤ 0.011), while CVI did not differ between groups (p > 0.05). OCTA revealed reduced superficial capillary plexus vessel density at the whole image and perifoveal regions (all p < 0.001), whereas deep capillary plexus and foveal avascular zone metrics were largely preserved. Correlation analyses identified only weak and inconsistent associations between corneal parameters, HOAs, and posterior segment measurements, none of which remained statistically significant after FDR correction. Conclusions: Despite pronounced anterior segment deformation and optical degradation, posterior segment structural and microvascular alterations in keratoconus are limited and weakly related to corneal disease severity. These findings support a predominantly anterior segment centered pathophysiology of keratoconus and highlight the importance of stringent multiple-comparison control in multimodal imaging studies. Full article

Background: This narrative review introduces the “From Plaque to Perfusion” framework, a clinically pragmatic approach that maps multimodality imaging technologies to critical decision points in the acute coronary syndrome (ACS) patient journey. By integrating non-invasive assessment, invasive procedural guidance, and post-event tissue characterisation, this framework provides a structured pathway for deep phenotyping of ACS. Artificial intelligence (AI) is highlighted as an essential enabling layer that enhances diagnostic precision, automates quantification, and supports scalable, data-driven care. Contemporary ACS management pathways, while effective, often leave residual clinical uncertainty. The diagnostic objective has evolved beyond confirming myocardial injury to comprehensively phenotyping the entire ACS cascade: defining the plaque substrate, identifying the culprit mechanism, and quantifying the myocardial consequence. This requires a systematic integration of advanced imaging modalities. Methods: This narrative review is based on a comprehensive literature search of major medical databases (PubMed/MEDLINE, Scopus, Embase, Google Scholar) for high-level evidence, including randomized controlled trials, meta-analyses, and international expert consensus documents published between January 2010 and February 2026. Results: The “From Plaque to Perfusion” framework consists of three core stages. First, non-invasive assessment with coronary computed tomography angiography (CCTA), fractional flow reserve (FFR-CT), and PET-CT defines plaque substrate and vascular inflammation. Second, invasive precision in the catheterization laboratory, guided by optical coherence tomography (OCT) and intravascular ultrasound (IVUS), resolves the culprit mechanism and optimizes percutaneous coronary intervention (PCI). Third, post-event tissue characterization with cardiac magnetic resonance (CMR) quantifies myocardial injury and refines prognosis. AI-driven platforms are shown to enhance each stage by automating analysis, standardizing interpretation, and providing actionable metrics for clinical decisions, including complex scenarios like Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA). Conclusions: The “From Plaque to Perfusion” framework, enabled by AI, reframes ACS imaging as an integrated, mechanism-driven pathway. This approach moves beyond isolated test interpretation toward a scalable model of precision, phenotype-led care that promises to improve diagnostic certainty and personalize patient management. Full article

Background/Objectives: This study aimed to develop a nomogram-based prediction tool to estimate visual field (VF) progression in patients with bilateral myopic normal-tension glaucoma (mNTG) by integrating key structural and vascular parameters. Methods: This retrospective cohort study included 150 eyes from 75 treatment-naïve patients with mNTG. All subjects were followed for at least five years with at least six reliable VF examinations. Key structural features, including the lamina cribrosa steepness index (LCSI) via enhanced-depth imaging optical coherence tomography (OCT) and choroidal microvascular dropout (cMvD) via OCT angiography (OCTA), were evaluated. VF progression was determined by event-based glaucoma progression analysis (GPA). To construct the predictive nomogram, clustered logistic regression with forward selection and 1000 bootstrap iterations was used to identify independent predictors. Results: Of the 150 eyes, 58 (38.7%) exhibited VF progression. Multivariable analysis identified steeper LCSI and the presence of parapapillary cMvD at baseline as significant independent predictors of progression. The resulting nomogram demonstrated excellent predictive accuracy, with an AUC of 0.922 and a C-index of approximately 0.92, indicating strong discriminative ability. Conclusions: This nomogram, incorporating structural (LCSI) and vascular (cMvD) markers, may offer a useful individualized tool for predicting VF progression in mNTG. This tool could assist in the early identification of high-risk patients and supports personalized treatment planning to optimize long-term visual outcomes. Full article

Background: Attention deficit hyperactivity disorder (ADHD) lacks objective biomarkers that may complement clinical diagnosis. Optical coherence tomography angiography (OCTA) enables non-invasive quantitative assessment of retinal microvasculature and has emerged as a potential tool to explore neurovascular features associated with neurodevelopmental disorders. The aim of this study was to comparatively evaluate macular and peripapillary OCTA parameters in individuals with ADHD and neurotypical controls. Methods: This comparative case–control study involved 200 eyes (100 from 50 patients with ADHD and 100 from 50 neurotypical controls) belonging to the same well-characterized cohort previously evaluated using structural optical coherence tomography (OCT). Macular and peripapillary OCTA scans were obtained, and quantitative parameters related to vessel density, perfusion density, and peripapillary flow metrics of the superficial retinal capillary plexus were analyzed separately for right and left eyes. Group comparisons were performed using independent-samples t-tests and analysis of covariance adjusted for age, sex, and axial length, with correction for multiple comparisons. Results: After adjustment for age, sex, and axial length, no OCTA parameter showed statistically significant between-group differences after correction for multiple comparisons. Across parameters, mean differences were small and did not provide statistical evidence of an effect under the prespecified analytical framework. Conclusions: Superficial OCTA-derived microvascular parameters did not demonstrate robust between-group differences in ADHD in this cohort. These results suggest that when restricted to the superficial capillary plexus, OCTA metrics are unlikely to serve as standalone biomarkers for ADHD. Full article

Background and Objectives: Optic disc drusen (ODD) are deposits in the optic nerve head that can look like true swelling, and in some patients, slowly damage the optic nerve and cause visual field loss. We aimed to identify which eyes are most likely to worsen over time using common clinic tests. Methods: We studied 131 adults with OCT-confirmed ODD who also had OCT-angiography (a scan that measures small blood vessels around the optic nerve) and repeated visual field tests over at least 18 months. We measured (1) the size of the drusen (maximum drusen height), (2) blood vessel density around and inside the optic nerve, and (3) change in visual field performance over time. “Fast progression” was defined as visual field worsening of ≥0.5 dB per year. Results: Eyes with superficial ODD had larger drusen than buried ODD (382.6 ± 110.9 vs. 247.2 ± 92.8 µm; p < 0.001) and more frequent visual field defects (78.6% vs. 58.7%; p = 0.02). When blood vessel density around the optic nerve was low, fast progression was much more common (52.3%) than in the middle (16.3%) or highest groups (13.6%; p < 0.001). In the adjusted model, fast progression was more likely with superficial ODD (OR 6.3) and larger drusen (OR 2.0 per 100 µm), and less likely when the vessel density was higher (OR 0.8 per 1% increase). Adding the vessel measurements improved the prediction accuracy (AUC 0.8 → 0.9; p = 0.011). Conclusions: Combining drusen size and blood vessel measurements helps identify ODD patients at higher risk of faster visual field loss and may guide closer follow-up. Full article

High myopia is increasingly prevalent and complicates glaucoma diagnosis. Axial elongation remodels the optic nerve head (ONH) and parapapillary tissues, producing structural and functional changes that mimic glaucoma—termed myopic optic neuropathy (MON). We reviewed current concepts on the MON–glaucomatous optic neuropathy (GON) spectrum and practical implications for diagnosis, monitoring, and management. A focused PubMed search targeted high/pathologic myopia, glaucoma, ONH and parapapillary anatomy, optical coherence tomography (OCT)/OCT angiography, visual fields, and progression. Major reviews, population-based studies, and longitudinal investigations were prioritized and integrated into a clinician-oriented framework. Greater myopia severity is associated with higher glaucoma risk and, in some cohorts, greater treatment burden, including surgery. Disc tilt, torsion, parapapillary atrophy, and staphyloma-related curvature complicate structural assessment and reduce reliability of single-visit OCT due to magnification and segmentation artifacts. Visual fields may be atypical, and central defects are under-sampled by standard 24-2 testing. Progression-centered strategies—combining event- and trend-based analyses and confirmation rules—distinguish MON-predominant changes from true GON or overlap and guide follow-up. In highly myopic eyes, multimodal structure–function assessment anchored on reproducible progression enhances diagnostic confidence and guides individualized intraocular pressure–lowering therapy. Standardized reporting of myopia definitions and progression criteria is recommended. Full article

Craniopharyngioma (CP) is a rare benign tumor of the sellar and suprasellar region that often compresses the optic pathways, causing significant visual impairment in both children and adults. The early detection and monitoring of optic nerve involvement are essential for preserving visual function. Optical coherence tomography (OCT) and OCT angiography (OCTA) are noninvasive, high-resolution imaging modalities that provide quantitative assessment of retinal nerve fiber layer (RNFL) thickness, ganglion cell complex (GCC), and retinal microvasculature. Thinning of the RNFL and GCC correlates with visual field defects and reduced visual acuity and may also serve as a predictor of postoperative visual recovery. OCTA reveals microvascular alterations that may precede structural damage and, together with other imaging parameters, can be used to estimate the likelihood of visual improvement after neurosurgery. This review summarizes current evidence on the use of OCT and OCTA in CP, highlighting their applications in assessment of optic pathway involvement, preoperative evaluation, postoperative monitoring, and risk stratification. Based on our clinical experience, we propose a table with recommended OCT parameters and follow-up intervals. Importantly, OCT should be interpreted alongside the visual acuity, visual field testing, and fundus examination for comprehensive assessment. Future directions include the standardization of imaging protocols and prospective multicenter studies, and integration of OCTA metrics into predictive models of visual outcomes. OCT and OCTA provide objective, reproducible biomarkers that support individualized patient care and may improve visual prognosis in CP. Full article

Background/Objectives: Anterior segment optical coherence tomography (AS-OCT) and optical coherence tomography angiography (AS-OCTA) have enhanced the evaluation of the cornea, ocular surface, and ocular surface diseases (OSD), offering high-resolution structural and anterior segment vascular imaging. This review summarizes recent advances in these modalities and their clinical applications. Methods: A comprehensive literature search was conducted using PubMed, Web of Science, and Google Scholar with the terms OCT, OCTA, anterior segment, and ocular surface disease. Studies published in the past five years were included, emphasizing more recent developments such as ultra-high-resolution AS-OCT (UHR-AS-OCT) and swept-source AS-OCTA technologies. Results: UHR-AS-OCT provides non-invasive, sub-micron imaging of the cornea and the ocular surface, including tear film morphology and epithelial thickness to correlate with clinical tests such as tear break-up time, and fluorescein staining. Advances in AS-OCTA allow dye-free, depth-resolved imaging of corneal and conjunctival vasculature. These vascular biomarkers have shown promising utility in conditions such as limbal stem cell deficiency, chemical ocular injury, and ocular surface squamous neoplasia. Improvements in image acquisition, motion correction, and segmentation algorithms have enhanced accuracy and repeatability, supporting broader clinical translation. Conclusions: AS-OCT and AS-OCTA have become useful adjunctive imaging tools for the cornea and ocular surface evaluation. Their non-invasive, quantitative, and reproducible metrics may enable earlier diagnosis, objective staging, and longitudinal monitoring of OSD. Integration of OCT-based imaging with artificial intelligence and multimodal data, including tear proteomics and meibography, may optimize personalized treatment for ocular surface disorders. Full article

Background/Objectives: Optical coherence tomography-angiography (OCT-A) is a non-invasive method of visualizing the capillary system. As vascular dysregulation impacts glaucoma pathogenesis, the aim of this study was to evaluate APSified-BMO-based-peripapillary vessel density (VD) in patients with ocular hypertension (OHT), pre-perimetric-open-angle glaucoma, as well as primary (POAG) and secondary (SOAG) open-angle glaucoma in comparison to healthy controls using OCT-A. Methods: The present study included 180 eyes from 115 patients of the Erlangen Glaucoma Registry, divided into 35 eyes with OHT, 16 pre-perimetric-OAG eyes, 64 OAG eyes—which were subdivided into 37 POAG and 27 SOAG eyes—and 65 healthy controls. All subjects underwent measurements of the retinal nerve fiber layer (RNFL), inner nuclear layer (INL), retinal ganglion cell (RGC) layer, and Bruch membrane opening–minimum rim width (BMO-MRW). APSified-BMO-based-peripapillary vessel density (VD) was visualized by using OCT-A and quantified using the Erlangen Angio Tool. Results: Mean APSified-BMO-based peripapillary VD showed a significant correlation with age (p < 0.0001). Considering the age effect, mean APSified-BMO-based peripapillary VD of OAG was significantly lower compared to healthy eyes (p < 0.0001) and OHT (p = 0.016). Subgroup analysis yielded a significant difference in mean APSified-BMO-based peripapillary VD between controls and POAG (p = 0.001) and SOAG (p = 0.018), respectively. In addition, a significant difference was observed between OHT and POAG patients (p = 0.036). No significant differences were observed between the OHT, pre-perimetric-OAG, and healthy eyes, respectively. Conclusions: As peripapillary VD was significantly decreased in glaucoma patients compared to controls, the data might suggest that peripapillary VD might be useful for monitoring glaucoma progress. Full article