Elsevier

Ophthalmology

Volume 118, Issue 12, December 2011, Pages 2409-2413
Ophthalmology

Original article
The Region of Largest β-Zone Parapapillary Atrophy Area Predicts the Location of Most Rapid Visual Field Progression

Presented in part at: Association for Research in Vision and Ophthalmology Annual Meeting, May 2010, Fort Lauderdale, Florida.
https://doi.org/10.1016/j.ophtha.2011.06.014Get rights and content

Purpose

To determine if visual field (VF) progression occurs most rapidly in the region of largest β-zone parapapillary atrophy (PPA).

Design

Retrospective cohort.

Participants

One hundred twenty-five patients from the New York Glaucoma Progression Study with both β-zone PPA and VF progression.

Methods

Treated open-angle glaucoma patients with 8 or more Swedish Interactive Threshold Algorithm Standard 24-2 VFs (Humphrey Field Analyzer II; Carl Zeiss Meditec, Inc., Dublin, CA) in either eye were identified. Eyes with optic disc photographs, β-zone PPA, less than 6 diopters myopia, and VF progression were studied. Visual field progression was defined using trend analysis as the presence of at least 2 adjacent progressing points in the same hemifield using standard pointwise linear regression (PLR) criteria.

Main Outcome Measures

The correlation between β-zone PPA and location of most rapid future VF progression.

Results

One hundred twenty-five eyes (125 patients; mean age, 71.9±12.3 years; 58% women; 75% European descent) with β-zone PPA and VF progression were enrolled. The mean follow-up was 6.8±1.7 years and the mean number of VFs was 12.5±3.6. Ninety-three patients (74%) had more β-zone PPA inferiorly and 32 patients (26%) had more β-zone PPA superiorly. The fastest VF progression occurred in the superior hemifield in 77 patients (62%) and in the inferior hemifield in 48 (38%) patients. Patients with superior VF progression had a superior localized mean rate of progression of −1.57±1.7 dB/year, and patients with inferior VF progression had an inferior localized mean rate of −0.94±1.4 dB/year (P = 0.012). The mean number of points reaching the predefined PLR end points was 5.6±7.5 for the superior VF hemifield and 3.0±4.9 for the inferior hemifield (P = 0.006). The hemifield with more points reaching PLR progression end points, with fastest average velocity of progression, or both was spatially consistent with the location of largest β-zone PPA in 89 (71%) patients (P = 0.0001, Fisher exact test; κ = 0.35; 95% confidence interval, 0.17–0.53).

Conclusions

In treated glaucoma patients with β-zone PPA and VF progression, the location of largest β-zone PPA typically correlates spatially with the region of the most rapid future VF progression.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Methods

The New York Glaucoma Progression Study consists of more than 40 000 consecutive subjects (>130 000 VF tests) evaluated in the glaucoma referral practice of the authors (J.M.L., R.R., C.T.) from January 1999 through September 2009. After an initial visit consisting of a complete ophthalmologic examination, perimetry (24–2 Swedish Interactive Threshold Algorithm SAP, Humphrey Field Analyzer II; Carl Zeiss Meditec, Inc., Dublin, CA) and optic disc stereophotographs, patients were re-examined,

Results

One hundred twenty-five eyes (125 patients; mean age, 71.9±12.3 years; 58% women; 75% European descent) with glaucomatous optic neuropathy, baseline VF damage, β-zone PPA, and VF progression were enrolled. All subjects had been treated with a variety of glaucoma treatments. Mean IOP was 15.5±2.7 mmHg; peak IOP was 20.7±4.3; IOP fluctuation was 2.8±1.4 mmHg; central corneal thickness was 529±37 μm; and VF mean deviation was −7.3±4.9 dB. Mean follow-up was 6.8±1.7 years, and the mean number of VF

Discussion

The association between PPA and glaucoma was described first by Elschnig14 and Bücklers.15 Others recognized the presence of PPA in glaucoma.16, 17 Anderson8 theorized that PPA location was associated with localized disc and VF damage. Reviewing 108 cases with disc photographs and VFs, he concluded that the appearance of parapapillary tissue helps determine how susceptible a disc is to pressure-induced damage and which portion of the disc and field would be most affected. In 62 consecutive

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    Manuscript no. 2010-1263.

    Financial Disclosures: Supported by an American Glaucoma Society Clinician Scientist Research Award (C.C.T.) San Francisco, California; the Pierre F. Simon Charitable Trust Research Fund of the New York Glaucoma Research Institute, New York, New York; and the Glaucoma Research and Education Fund of Lenox Hill Hospital, New York, New York (C.G.D.M.).

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