To investigate the presence of flavoprotein fluorescence (FPF) at the optic nerve head (ONH) rim as a marker of mitochondrial dysfunction in primary open-angle glaucoma (POAG) and control eyes.
Retrospective cross-sectional study, with patients recruited from the New York Eye and Ear Infirmary of Mount Sinai.
A total of 86 eyes (50 eyes of 30 POAG patents and 36 eyes of 20 controls) were enrolled. The presence of POAG was defined by circumpapillary retinal nerve fiber layer thickness below the bottom fifth percentile of the normative database, glaucomatous ONH changes, and visual field defects on 24-2 tests.
POAG and control eyes were imaged using the OcuMet Beacon. A 23°x23° infrared scan was obtained, and an FPF scan was performed within a capture field spanning 13 degrees in diameter. The ONH margins on the infrared image were identified by software algorithms. FPF then was measured within an elliptical annulus around the ONH rim, with the inner and outer boundaries corresponding to 0.5 to 1.1 times the ONH rim size.
FPF at the OHN rim in POAG and control eyes.
Differences in FPF between POAG and control eyes were characterized through mixed-effects logistic regression, adjusted for age and interocular pressure. FPF was significantly higher in POAG versus control eyes, with a mean±SD of 46.4±27.9 versus 28.0±11.7 (P<0.001), respectively. Evaluation of anatomical quadrants revealed greater FPF in POAG versus control eyes at the temporal (P=0.001), superior (P<0.001), nasal (P=0.002), and inferior (P=0.001) quadrants. Among POAG eyes, FPF showed correlation to visual field mean deviation (P<0.001), visual field pattern standard deviation (P=0.003), and circumpapillary retinal nerve fiber thickness (P=0.001) on linear mixed-effects models.
Higher FPF in POAG versus control eyes suggests the presence of mitochondrial dysfunction at the ONH rim in eyes with glaucomatous damage. The degree of FPF corresponds to disease severity, as measured by visual field and nerve fiber layer thickness metrics. FPF may thus represent a metabolic indicator of disease status that reveals the extent of injury in glaucoma.

Copyright © 2021. Published by Elsevier Inc.

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