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Ten-year-and-beyond longitudinal change of ß-zone parapapillary atrophy in glaucoma: association with retinal nerve fibre layer defect
  1. Eunoo Bak,
  2. Yong Woo Kim,
  3. Young Kook Kim,
  4. Jin Wook Jeoung,
  5. Ki Ho Park
  1. Department of Ophthalmology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
  1. Correspondence to Professor Ki Ho Park, Ophthalmology, Seoul National University Hospital, Jongno-gu 110-744, Republic of Korea; kihopark{at}


Background To investigate the longitudinal change of localised retinal nerve fibre layer (RNFL) defects associated with change of ß-zone parapapillary atrophy (PPA) in primary open-angle glaucoma (POAG) eyes.

Methods POAG patients with a localised RNFL defect and ß-zone PPA who had undergone disc/RNFL photography at 1-year intervals for 10 years or longer were enrolled. The topographic parameters of ß-zone PPA (area, maximal radial extent and angular extent around disc) were measured. Progression of RNFL defect was defined as widening of defect and/or appearance of new defect. The factors associated with progression of RNFL defect were assessed by OR using multivariable logistic regression.

Results A total of 209 patients (209 eyes) with POAG were included (mean: 54 years old). Over the course of 11.5±2.3-year follow-up period, progression of RNFL defect was detected in 114 eyes (54.5%). Enlargement of PPA parameters (area and angular extent) was significantly more common in patients with RNFL defect progression than in eyes without progression (all p<0.001, respectively). Widening of radial extent did not show a significant difference in both groups (p=0.61). Increment of angular extent was in the direction of RNFL defect progression in 82.1% of eyes. Progression of RNFL defect was significantly associated with disc haemorrhage (OR: 6.653, p<0.001), enlargement of PPA area (OR: 4.114, p=0.004) and angular extent (OR: 6.572, p<0.001).

Conclusions Progression of RNFL defect is associated with increment of angular extent of PPA in POAG eyes.

  • glaucoma
  • imaging

Data availability statement

Data may be obtained from a third party and are not publicly available. Not applicable.

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Data availability statement

Data may be obtained from a third party and are not publicly available. Not applicable.

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

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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