Original articleThe Region of Largest β-Zone Parapapillary Atrophy Area Predicts the Location of Most Rapid Visual Field Progression
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.).