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Morphological characteristics of parapapillary atrophy and subsequent visual field progression in primary open-angle glaucoma
  1. Ahnul Ha1,2,
  2. Yong Woo Kim1,3,
  3. Jinho Lee1,4,
  4. Eunoo Bak1,3,
  5. Young Soo Han1,3,
  6. Young Kook Kim1,3,
  7. Ki Ho Park1,3,
  8. Jin Wook Jeoung1,3
  1. 1 Department of Ophthalmology, Seoul National University College of Medicine, Seoul, South Korea
  2. 2 Department of Ophthalmology, Jeju National University Hospital, Jeju-si, South Korea
  3. 3 Department of Ophthalmology, Seoul National University Hospital, Seoul, South Korea
  4. 4 Department of Ophthalmology, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, South Korea
  1. Correspondence to Professor Jin Wook Jeoung, Department of Ophthalmology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of); neuroprotect{at}


Background/Aims To investigate the associations between the morphological characteristics of beta-zone parapapillary atrophy (β-zone PPA) and subsequent visual field (VF) progression in eyes with primary open-angle glaucoma (POAG).

Methods One hundred and twenty-one POAG eyes with β-zone PPA along with 48 normal eyes with β-zone PPA were included. β-zone PPA area was calculated based on the PPA pixel area/optic-disc pixel area ratio and the optical coherence tomography (OCT)-measured disc area. β-zone PPA margin irregularity was quantified as a function of both area (A) and perimeter (P, calculated as 1/(4πA/P²)). VF progression was defined using standard automated perimetry’s guided progression analysis software.

Results Of the 121 POAG eyes, 49 (40.5%) showed VF progression during the 10.1±1.9 years of follow-up. The baseline β-zone PPA area was similar among the three groups (Progressors, Non-progressors and Controls, p=0.995). However, the β-zone PPA irregularity index was significantly higher in the Progressors (p<0.001). The cumulative probability of VF progression was greater in the higher PPA irregularity index group (p<0.001, log-rank test). A Cox proportional hazards model showed the significant influences of optic disc haemorrhage (HR: 2.661, p=0.034) and higher baseline PPA irregularity index (HR: 1.455, p=0.007) on subsequent progression.

Conclusions In POAG eyes, baseline β-zone PPA margin regularity was significantly associated with subsequent VF progression. Irregular margin of β-zone PPA might be the mark of vulnerability in the parapapillary area to further glaucomatous damage.

  • glaucoma
  • imaging
  • optic nerve

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  • Presented at This paper was presented at the E-poster Discussion session, American Academy of Ophthalmology Annual Meeting, San Francisco, 2019.

  • Contributors AH, YKK, KHP and JWJ performed the study design. AH and JWJ helped in writing the article. Data collection was done by AH, JL, EB and YSH. Analysis and interpretation of the data were done by AH and YWK. AH, JL, EB and YSH helped in literature search. AH, YKK and KHP helped in critical revision of the article. JWJ gave the final approval of the article.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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