The Promise of Optical Coherence Tomography Angiography in Glaucoma.

Optical coherence tomography angiography (OCTA) studies in primary open-angle glaucoma have consistently demonstrated reduced microcirculation in the superficial optic nerve, peripapillary retina, and the macula of glaucoma patients. These studies clearly demonstrate the superior resolution of OCTA compared with prior methods that were used to measure ocular blood flow (OBF) or its surrogates. How will OCTA help the glaucoma clinician now and in the future? What else must we learn before achieving more practical usefulness from OCTA for glaucoma? First, OCTA will supplement current glaucoma diagnostic tools to aid in the early detection of glaucoma. Diagnostic accuracy of OCTA vessel density measurements from small studies to date support its promise in this role, and this surely will be enhanced with ongoing improvements to OCTA hardware and software. Currently, peripapillary retinal nerve fiber layer (RNFL) and inner macula thickness measurements by OCT are routine tools to aid in the detection of glaucoma and its progression, but these are