Longitudinal OCTA Evaluation of Optic Nerve Head Microvasculature in Non-Highly Myopic Eyes With Peripapillary Fundus Tessellation Over Six Years

Purpose: To evaluate 6-year changes in optic nerve head (ONH) perfusion using optical coherence tomography angiography (OCTA) in non-highly myopic eyes with peripapillary fundus tessellation (pFT). Methods: Adults ≥ 50 years from a rural cohort who completed 6-year follow-up and had no high myopia were included. Eyes were classified as pFT or non-pFT (npFT) by baseline fundus photographs. Baseline ocular biometry, retinal nerve fiber layer (RNFL) thickness, papillary vessel density (PVD), and peripapillary vessel density (PPVD), and their longitudinal changes were compared. Generalized estimating equation (GEE) models were used to assess factors associated with baseline pFT, adjusting for laterality and confounders. Results: Among 356 eyes of 210 participants, 182 showed pFT (51.1%): grade 1, 25.8%; grade 2, 21.3%; grade 3, 3.9%. Baseline axial length (AL) was longer in pFT than npFT eyes (23.01 mm vs. 22.69 mm; P < 0.001). In multivariable GEE logistic regression, older age (odds ratio [OR] = 1.10; 95% confidence interval [CI], 1.03-1.17; P = 0.003), higher systolic blood pressure (per 10 mm Hg; OR = 1.22; 95% CI, 1.02-1.46; P = 0.028), and longer AL (OR = 3.43; 95% CI, 1.99-5.90; P < 0.001) were independently associated with pFT. Over 6 years, reductions in PVD and PPVD were greater in pFT than npFT eyes (1.47 ± 2.74 vs. 0.94 ± 2.58 and 1.21 ± 3.12 vs. 0.52 ± 2.76). Interaction analyses showed that age-related declines in PPVD (P for interaction = 0.006) and PVD (P for interaction = 0.037) were steeper in eyes with pFT than in eyes without pFT. Conclusions: ONH microvascular density declined more markedly with age in non-highly myopic older adults with pFT than in eyes without pFT during the 6-year follow-up.