LAUSR

PURPOSE To determine whether decreased optic nerve head blood flow (ONH BF) precedes or follows decreased circumpapillary retinal nerve fiber layer thickness (cpRNFLT) in eyes with open-angle glaucoma (OAG). DESIGN Retrospective, longitudinal. PARTICIPANTS This study followed 350 eyes of 225 OAG patients for at least 2 years and collected data from each subject from at least 5 examinations made with laser speckle flowgraphy (LSFG) and optical coherence tomography (OCT). METHODS In the superior, temporal, and inferior ONH quadrants, tissue-area mean blur rate (MT), representing ONH-tissue BF, was measured with LSFG, while cpRNFLT was measured with OCT. A multivariable linear mixed-effects model was used to identify potential predictors of faster MT decrease, adjusting for possible confounding factors. Based on these results, each quadrant of each patient was assigned a risk point if it was superior or temporal; patient age older than median (61 years); and patient pulse rate higher than median (74 bpm). The quadrants were then compared with a mixed-effects Cox model for MT and cpRNFLT changes, defined as a difference between the baseline value and the values from the latest 2 consecutive follow-up visits greater than 1.96 * the corresponding coefficient of variation. MAIN OUTCOME MEASURES Ophthalmic and systemic variables, MT and cpRNFLT in the superior, temporal, and inferior quadrants. RESULTS The multivariable model showed that MT decrease was faster in older patients with higher pulse rate and slower in inferior quadrants (P < 0.05). Quadrants with 0 risk points showed primary cpRNFLT decrease (P = 0.048), 1-risk point quadrants showed simultaneous cpRNFLT and MT decrease (P = 0.260), and 2-risk point and 3-risk point quadrants showed primary MT decrease (P < 0.001). CONCLUSIONS Older patients with higher pulse rate are at greater risk of a primary reduction in ONH-tissue BF, i.e., preceding cpRNFLT decrease, in the superior and temporal quadrants.