Elsevier

Ophthalmology

Volume 117, Issue 5, May 2010, Pages 909-915
Ophthalmology

Original article
β-Zone Parapapillary Atrophy and the Velocity of Glaucoma Progression

Presented in part at: American Glaucoma Society Annual Meeting, March 2009, San Diego, California.
https://doi.org/10.1016/j.ophtha.2009.10.016Get rights and content

Purpose

β-Zone parapapillary atrophy (PPA) occurs more commonly in eyes with glaucoma. Rates of glaucomatous visual field (VF) progression in eyes with and without β-zone PPA at the time of baseline assessment were compared.

Design

Retrospective, comparative study.

Participants

Two hundred forty-five patients from the New York Glaucoma Progression Study.

Methods

Subjects with glaucomatous optic neuropathy and repeatable VF loss were assessed for eligibility. Eyes with a Heidelberg Retina Tomograph II (HRT) examination, at least 5 visual field tests after the HRT in either eye, optic disc photographs, and <6 diopters of myopia were enrolled. β-Zone PPA was defined as a region of chorioretinal atrophy with visible sclera and choroidal vessels adjacent to the optic disc. Global rates of VF progression were determined by automated pointwise linear regression analysis. Univariate analysis included age, gender, ethnicity, central corneal thickness (CCT), refractive error, baseline mean deviation, baseline intraocular pressure (IOP), mean IOP, IOP fluctuation, disc area, rim area, rim area-to-disc area ratio, β-zone PPA area, β-zone PPA area-to-disc area ratio, and presence or absence of β-zone PPA.

Main Outcome Measures

The relationship between β-zone PPA and the rate and risk of glaucoma progression.

Results

Two hundred forty-five eyes of 245 patients (mean age, 69.6±12.3 years) were enrolled. The mean follow-up was 4.9±1.4 years and the mean number of VFs after HRT was 9.3±2.7. β-Zone PPA was present in 146 eyes (65%). Eyes with β-zone PPA progressed more rapidly (−0.84±0.8 dB/year) than eyes without it (−0.51±0.6 dB/year; P<0.01). Multivariate regression showed significant influence of mean IOP (hazard ratio [HR], 1.11; P<0.01), IOP fluctuation (HR, 1.17; P = 0.02), and presence of β-zone PPA (HR, 2.59; P<0.01) on VF progression. Moderate (0.5–1.5 dB/year; P = 0.01) and fast (>1.5 dB/year; P = 0.08) global rates of progression occurred more commonly in eyes with β-zone PPA than in eyes without it. Thinner CCT (<525 μm) had a weak but significant correlation with presence of β-zone PPA (κ = 0.13).

Conclusions

Eyes with β-zone PPA are at increased risk for glaucoma progression and warrant close clinical surveillance.

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 (GAPS) consisted of 43 660 consecutive subjects (132 512 VF tests) evaluated in the glaucoma referral practice of the authors (JML, RR, CT) from January 1999 through December 2008. After an initial visit consisting of a complete ophthalmologic examination, perimetry (24-2 Swedish interactive threshold algorithm [SITA] standard automated perimetry, Humphrey Field Analyzer II; Carl Zeiss Meditec, Inc., Dublin, CA) and optic disc stereophotographs, patients

Results

Two hundred forty-five eyes (245 patients) met the entry criteria. The mean age ± standard deviation was 69.6±12.3 years; 62% were women and 84% were of European descent. All subjects were treated with a variety of glaucoma treatments. Mean follow-up was 4.9±1.4 years, and the mean number of VFs was 9.3±2.7. Baseline characteristics of the 2 groups are shown in Table 1.

β-Zone PPA was present in 146 eyes (65%; group A). The average β-zone PPA size was 0.93±0.74 mm2. In the univariate analysis,

Discussion

The presence of β-zone PPA as a risk factor for global rates of VF progression was evaluated using automated pointwise linear regression. Patients with β-zone PPA based on stereophotography, measured by HRT-II, and an adequate number of VFs after the HRT image were evaluated for progression. Glaucomatous eyes with β-zone PPA progressed faster than eyes without β-zone PPA, and the presence of any amount of β-zone PPA increased the risk of progression.

The association between PPA and glaucoma was

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    Manuscript no. 2009-595.

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

    Supported by the Catherine and Ephraim Gildor Research Fund of the New York Glaucoma Research Institute, New York, New York.

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