{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:54:06Z","timestamp":1785405246735,"version":"3.56.0"},"reference-count":34,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"NIH","award":["R01EY034718"],"award-info":[{"award-number":["R01EY034718"]}]},{"name":"NYEE Foundation"},{"DOI":"10.13039\/100002924","name":"Glaucoma Foundation","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100002924","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/01qc2fa96","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/100001818","name":"Research to Prevent Blindness","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100001818","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/04drjs621","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Barry Family Center for Ophthalmic Artificial Intelligence & Human Health"},{"name":"Ministry of Health"},{"DOI":"10.13039\/501100015822","name":"Fondazione Roma","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100015822","id-type":"DOI","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/00gtjrz72","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Axial myopia is a risk factor for glaucoma, yet the mechanism(s) linking axial length (AL) to visual field (VF) damage remain unclear. This pilot study investigates to what extent peripapillary vessel density (pVD) mediates the relationship between AL and VF outcomes in patients with primary open-angle glaucoma (POAG). Methods: This cross-sectional pilot study included a primary cohort of 26 POAG eyes with directly measured AL, with an exploratory expanded cohort of 71 POAG eyes used to assess the consistency of findings. Optical coherence tomography angiography quantified pVD across eight sectors. VF outcomes included mean deviation, pattern standard deviation, and visual field index. Mediation analyses used ordinary least squares regression adjusted for age, intraocular pressure, and scan quality. Indirect effects were assessed via bias-corrected bootstrap confidence intervals. Results: In both primary and expanded cohorts, inferior-temporal pVD mediated the relationship between AL and all VF outcomes. Additional sectors emerged as mediators in the expanded cohort, suggesting broader vascular involvement. Conclusions: Peripapillary microvascular compromise significantly mediates the impact of AL on glaucomatous VF loss, supporting a possible biomechanical\u2013vascular model of POAG eyes across a range of axial lengths.<\/jats:p>","DOI":"10.3390\/jcm15093555","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T09:03:37Z","timestamp":1778144617000},"page":"3555","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Peripapillary Vessel Density Mediates the Relationship Between Axial Length and Visual Field Damage in Glaucoma"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8073-1804","authenticated-orcid":false,"given":"Samuel","family":"Potash","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8770-3726","authenticated-orcid":false,"given":"Alon","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alice","family":"Verticchio Vercellin","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keren","family":"Wood","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gal Yaakov","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"Goldschleger Eye Institute, Tel Hashomer 52621, Israel"},{"name":"Sheba Medical Center, Ramat Gan 52621, Israel"},{"name":"Tel Aviv University, Tel Aviv 69978, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Rosen","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"SUNY Downstate Health Sciences University, Brooklyn, NY 11203, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-5178-6404","authenticated-orcid":false,"given":"Minwoo","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob","family":"Rothstein","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"},{"name":"Yeshiva University, New York, NY 10003, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1904-0907","authenticated-orcid":false,"given":"Yash","family":"Lahoti","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lucia","family":"Tanga","sequence":"additional","affiliation":[{"name":"IRCCS-Fondazione Bietti, 00184 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0966-6311","authenticated-orcid":false,"given":"Carmela","family":"Carnevale","sequence":"additional","affiliation":[{"name":"IRCCS-Fondazione Bietti, 00184 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brent A.","family":"Siesky","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"16067","DOI":"10.1038\/nrdp.2016.67","article-title":"Primary open-angle glaucoma","volume":"2","author":"Weinreb","year":"2016","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/S0181-5512(08)71443-8","article-title":"Risk factors for primary open-angle glaucoma","volume":"31","author":"Bron","year":"2008","journal-title":"J. Fr. Ophtalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1016\/S1350-9462(02)00008-3","article-title":"The impact of ocular blood flow in glaucoma","volume":"21","author":"Flammer","year":"2002","journal-title":"Prog. Retin. Eye Res."},{"key":"ref_4","first-page":"257","article-title":"Glaucoma, capillaries and pericytes. 1. Blood flow regulation","volume":"210","author":"Anderson","year":"1996","journal-title":"Ophthalmologica"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1097\/IJG.0000000000000587","article-title":"Microvascular compromise develops following nerve fiber layer damage in normal-tension glaucoma without choroidal vasculature involvement","volume":"26","author":"Lee","year":"2017","journal-title":"J. Glaucoma"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1016\/j.ophtha.2011.03.012","article-title":"Myopia as a risk factor for open-angle glaucoma: A systematic review and meta-analysis","volume":"118","author":"Marcus","year":"2011","journal-title":"Ophthalmology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1177\/112067219200200108","article-title":"Prevalence of myopia in open angle glaucoma","volume":"2","author":"Mastropasqua","year":"1992","journal-title":"Eur. J. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1080\/08820538.2021.1897855","article-title":"Glaucoma mimickers: A major review of causes, diagnostic evaluation, and recommendations","volume":"36","author":"Senthil","year":"2021","journal-title":"Semin. Ophthalmol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1167\/iovs.64.11.12","article-title":"How myopia and glaucoma influence the biomechanical susceptibility of the optic nerve head","volume":"64","author":"Chuangsuwanich","year":"2023","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1985","DOI":"10.1007\/s00417-025-06809-6","article-title":"Asymmetric stress distribution on lamina cribrosa in glaucoma patients with high myopia","volume":"263","author":"Kang","year":"2025","journal-title":"Graefes Arch. Clin. Exp. Ophthalmol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1038\/s41598-017-17843-8","article-title":"Lamina cribrosa morphology predicts progressive retinal nerve fiber layer loss in eyes with suspected glaucoma","volume":"8","author":"Kim","year":"2018","journal-title":"Sci. Rep."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"390","DOI":"10.1097\/00061198-200110000-00005","article-title":"Retinal microcirculation correlates with ocular wall thickness, axial eye length, and refraction in glaucoma patients","volume":"10","author":"Michelson","year":"2001","journal-title":"J. Glaucoma"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1111\/j.1755-3768.2012.02386.x","article-title":"Choroidal hemodynamic in myopic patients with and without primary open-angle glaucoma","volume":"91","author":"Samra","year":"2013","journal-title":"Acta Ophthalmol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1001\/jamaophthalmol.2018.0776","article-title":"Association of myopia with peripapillary perfused capillary density in patients with glaucoma: An optical coherence tomography angiography study","volume":"136","author":"Suwan","year":"2018","journal-title":"JAMA Ophthalmol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Fan, X., Xu, H., Zhai, R., Sheng, Q., Sun, Y., Shao, T., and Kong, X. (2022). Peripapillary vascular reactivity in primary open-angle glaucoma with high myopia by using optical coherence tomography angiography. Front. Med., 9.","DOI":"10.3389\/fmed.2022.850483"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1001\/jamaophthalmol.2017.0261","article-title":"Peripapillary retinal nerve fiber layer vascular microcirculation in eyes with glaucoma and single-hemifield visual field loss","volume":"135","author":"Chen","year":"2017","journal-title":"JAMA Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1007\/s10792-024-02961-w","article-title":"Axial length, more than aging, decreases the thickness and superficial vessel density of retinal nerve fiber layer in non-glaucomatous eyes","volume":"44","author":"Huang","year":"2024","journal-title":"Int. Ophthalmol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1167\/iovs.62.9.37","article-title":"Longer axial length potentiates relationship of intraocular pressure and peripapillary vessel density in glaucoma patients","volume":"62","author":"Juliano","year":"2021","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1066","DOI":"10.1136\/bjophthalmol-2016-309377","article-title":"Diagnostic ability of peripapillary vessel density measurements of optical coherence tomography angiography in primary open-angle and angle-closure glaucoma","volume":"101","author":"Rao","year":"2017","journal-title":"Br. J. Ophthalmol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1097\/IJG.0000000000000670","article-title":"Relationship of optic nerve structure and function to peripapillary vessel density measurements of optical coherence tomography angiography in glaucoma","volume":"26","author":"Rao","year":"2017","journal-title":"J. Glaucoma"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Kim, S.B., Lee, E.J., Han, J.C., and Kee, C. (2017). Comparison of peripapillary vessel density between preperimetric and perimetric glaucoma evaluated by OCT-angiography. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0184297"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1167\/tvst.9.13.26","article-title":"Correlation of visual field with peripapillary vessel density through optical coherence tomography angiography in normal-tension glaucoma","volume":"9","author":"Lin","year":"2020","journal-title":"Transl. Vis. Sci. Technol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1016\/j.ajo.2016.06.009","article-title":"Microvascular density in glaucomatous eyes with hemifield visual field defects: An optical coherence tomography angiography study","volume":"168","author":"Akagi","year":"2016","journal-title":"Am. J. Ophthalmol."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Holl\u00f3, G. (2017). Relationship between optical coherence tomography sector peripapillary angioflow-density and Octopus visual field cluster mean defect values. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0171541"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"6079","DOI":"10.1167\/iovs.16-19984","article-title":"Discriminant function of optical coherence tomography angiography to determine disease severity in glaucoma","volume":"57","author":"Kumar","year":"2016","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1167\/iovs.64.4.14","article-title":"Structure function relationships of vessel density and retinal nerve fiber layer thickness in early glaucomatous eyes with high myopia","volume":"64","author":"Akiyama","year":"2023","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"585","DOI":"10.1136\/bjophthalmol-2018-312085","article-title":"Relationship between vessel density and visual field sensitivity in glaucomatous eyes with high myopia","volume":"103","author":"Shin","year":"2019","journal-title":"Br. J. Ophthalmol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"640","DOI":"10.1097\/IJG.0000000000002251","article-title":"Influence of refractive error on circumpapillary structure\u2013function versus vessel density\u2013function relationships in open angle glaucoma","volume":"32","author":"Emoto","year":"2023","journal-title":"J. Glaucoma"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Qiu, C., Qian, S., Sun, X., Zhou, C., and Meng, F. (2015). Axial myopia is associated with visual field prognosis of primary open-angle glaucoma. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0133189"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1167\/iovs.17-22949","article-title":"Changes in axial length and progression of visual field damage in glaucoma","volume":"59","author":"Yanagisawa","year":"2018","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2148","DOI":"10.1167\/iovs.13-13607","article-title":"Circadian pattern of intraocular pressure fluctuations in young myopic eyes with open-angle glaucoma","volume":"55","author":"Kook","year":"2014","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_32","first-page":"1093","article-title":"Mice with an induced mutation in collagen 8A2 develop larger eyes and are resistant to retinal ganglion cell damage in an experimental glaucoma model","volume":"18","author":"Steinhart","year":"2012","journal-title":"Mol. Vis."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"3462004","DOI":"10.1155\/2021\/3462004","article-title":"Factors associated with changes in peripapillary retinal nerve fibre layer thickness in healthy myopic eyes","volume":"2021","author":"Du","year":"2021","journal-title":"J. Ophthalmol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1038\/s41433-023-02899-w","article-title":"The long and short of it: A comprehensive assessment of axial length estimation in myopic eyes from ocular and demographic variables","volume":"38","author":"Lingham","year":"2024","journal-title":"Eye"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3555\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,8]],"date-time":"2026-05-08T04:22:28Z","timestamp":1778214148000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/9\/3555"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,6]]},"references-count":34,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15093555"],"URL":"https:\/\/doi.org\/10.3390\/jcm15093555","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,6]]}}}