Emerging evidence suggests that structural changes in glaucoma may begin far earlier than functional loss becomes apparent. In a long-term retrospective cohort study of glaucoma suspect eyes, microvascular dropout (MvD) and β-zone parapapillary atrophy (PPA) progression were found to be independent predictors of optic disc structural progression, even in eyes that had not yet developed perimetric glaucoma. Notably, the presence of MvD increased the risk of progression significantly (OR ~15.8), underscoring the vascular component in early glaucomatous damage.
More strikingly, eyes demonstrating both MvD and β-zone PPA progression showed the highest probability of structural deterioration (~75%), highlighting a synergistic risk profile. These findings reinforce the importance of incorporating OCTA-based vascular assessment alongside structural imaging in glaucoma suspects. Early…
