Enhanced glaucoma detection through peripapillary vessel analysis.

Is Your Glaucoma Diagnosis Missing Something? Macular vs. Peripapillary Scans

Avery Sinclair in Health & Wellness December 2025 • 4 min read.

"Discover why peripapillary vessel analysis could be the key to earlier and more accurate glaucoma detection."

Glaucoma, a leading cause of irreversible blindness, is characterized by the progressive loss of retinal ganglion cells (RGCs) and their axons, impacting the retinal nerve fiber layer (RNFL). Early and accurate diagnosis is crucial to slowing its progression, typically involving optic disc evaluation, visual field tests, and Optical Coherence Tomography (OCT) scans.

Recent studies suggest that early glaucoma damage is detectable through OCT as reduced RNFL thickness in the peripapillary region or thinning of the ganglion cell complex within the macula. However, the diagnostic performance of macular versus peripapillary vessel parameters remains variable, leading to questions about the most effective approach for early detection.

This article explores how assessing vessel parameters in both the macular and peripapillary regions, using Spectral-Domain Optical Coherence Tomography Angiography (SD-OCTA), can improve the differentiation between primary open-angle glaucoma (POAG) and healthy eyes, offering new insights into early diagnosis.

Peripapillary vs. Macular: Why Location Matters in Glaucoma Detection

Enhanced glaucoma detection through peripapillary vessel analysis.

A recent study compared the diagnostic capabilities of vessel parameters in the macular and peripapillary regions, using SD-OCTA to differentiate POAG from healthy eyes. The study involved 126 eyes from 79 participants, including both POAG patients and healthy subjects, undergoing 6 x 6-mm scans centered on the macula and optic nerve head. Researchers analyzed vessel area density (VAD), vessel skeleton density (VSD), vessel complexity index (VCI), and flux in both regions.

The results indicated that diagnostic accuracies of perfusion parameters (VAD, VSD, VCI, and flux) were significantly greater in the peripapillary region compared to the macular region. This suggests that changes in the peripapillary microvasculature may be more indicative of early glaucoma than changes in the macula.

VAD (Vessel Area Density): The cpAUC (peripapillary area under the curve) was 0.84, while the mAUC (macular area under the curve) was 0.73 (P = 0.026).
VSD (Vessel Skeleton Density): The cpAUC was 0.84, and the mAUC was 0.72 (ΔΡ = 0.015).
VCI (Vessel Complexity Index): The cpAUC was 0.80, and the mAUC was 0.70 (ΔΡ = 0.045).
Flux: The cpAUC was 0.87, and the mAUC was 0.76 (ΔΡ = 0.0091).

These findings support the idea that glaucomatous superficial retinal vascular changes are more pronounced in the peripapillary region, highlighting the importance of peripapillary perfusion parameters in glaucoma diagnosis.

Improving Glaucoma Detection: What's Next?

The study confirms that peripapillary perfusion parameters outperform macular perfusion parameters in glaucoma diagnosis, reinforcing the understanding that glaucomatous vascular changes are more evident in the peripapillary region.

This translational relevance emphasizes the need for clinicians to prioritize peripapillary region analysis when using OCTA for glaucoma assessment. Future research should focus on optimizing imaging algorithms and exploring other factors influencing retinal perfusion to enhance diagnostic accuracy.

By refining our diagnostic approaches and deepening our understanding of retinal perfusion, we can move towards earlier and more effective glaucoma detection, ultimately preserving vision for more individuals at risk.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1167/tvst.7.6.21, Alternate LINK

Title: Diagnostic Performance Of Macular Versus Peripapillary Vessel Parameters By Optical Coherence Tomography Angiography For Glaucoma

Subject: Ophthalmology

Journal: Translational Vision Science & Technology

Publisher: Association for Research in Vision and Ophthalmology (ARVO)

Authors: Grace M. Richter, Ryuna Chang, Betty Situ, Zhongdi Chu, Bruce Burkemper, Alena Reznik, Sahar Bedrood, Amir H. Kashani, Rohit Varma, Ruikang K. Wang

Published: 2018-12-06

Everything You Need To Know

What is glaucoma, and why is early detection so important?

Glaucoma is a condition that damages the optic nerve, often caused by abnormally high pressure in your eye. It's a leading cause of irreversible blindness. Early and accurate diagnosis is crucial because it allows for intervention to slow the progression of the disease, typically involving optic disc evaluation, visual field tests, and Optical Coherence Tomography (OCT) scans.

What's the difference between the macular and peripapillary regions in the context of glaucoma detection?

The macular region is the central part of the retina responsible for sharp, central vision. The peripapillary region refers to the area around the optic nerve head, where the retinal nerve fibers exit the eye. The peripapillary region is considered more significant in this context because it showed superior diagnostic capabilities for glaucoma. Changes in the peripapillary microvasculature appear to be more indicative of early glaucoma than changes in the macula.

What are VAD, VSD, VCI, and flux, and how are they used in glaucoma diagnosis?

Vessel Area Density (VAD), Vessel Skeleton Density (VSD), Vessel Complexity Index (VCI), and flux are all measures of the blood vessels within the retina. The study used Spectral-Domain Optical Coherence Tomography Angiography (SD-OCTA) to measure these parameters in both the macular and peripapillary regions. The peripapillary region, demonstrated higher diagnostic accuracies for these parameters.

What did the study reveal about the diagnostic capabilities of macular versus peripapillary vessel parameters?

The study's results showed that peripapillary perfusion parameters (VAD, VSD, VCI, and flux) had significantly higher diagnostic accuracy in differentiating between primary open-angle glaucoma (POAG) and healthy eyes compared to macular parameters. The peripapillary area under the curve (cpAUC) values were consistently higher than the macular area under the curve (mAUC) values for all parameters, indicating that changes in the peripapillary region are a more reliable indicator of early glaucoma.

What are the implications of this study for glaucoma detection and patient care?

The implications of these findings are significant for early glaucoma detection. By focusing on peripapillary vessel analysis using SD-OCTA, clinicians may be able to diagnose glaucoma earlier and more accurately. This could lead to earlier intervention and better management of the disease, potentially slowing its progression and preserving vision. This could also lead to more precise monitoring of the disease's progression.