Correlation between peripapillary atrophy and optic nerve damage in normal-tension glaucoma.
ABSTRACT To investigate the correlation between peripapillary atrophy and visual field defects as well as optic nerve head configurations in patients with normal-tension glaucoma (NTG).
Topographic measurements for peripapillary atrophy and optic nerve head using confocal scanning laser tomography and automated static threshold perimetry were performed on 102 eyes of 51 patients with NTG. Peripapillary atrophy was divided into (1) a central zone (zone Beta) with visible, large choroidal vessels and sclera, and (2) a peripheral zone (zone Alpha) with irregular hyper- and hypopigmentation. The area, angular extent around the disc, and radial extent of each zone were measured.
The area and extent of zone Beta increased significantly with increasing visual field defects expressed in terms of mean deviation, corrected pattern standard deviation, central visual field defects within 5 degrees of fixation, and superior hemifield defects (r = 0.3770-0.5291, P < 0.01). The angular extent of zone Beta represented localized field defects better (r = 0.5217, P < 0.001) than diffuse field defects (r = -0.3770, P < 0.01). Zone Beta significantly correlated with optic nerve head topography. Intraindividual right-left-side differences of corrected pattern standard deviation showed the highest correlation with the side differences of zone Beta area (r = 0.6305, P < 0.001). The location of visual field defects correlated significantly with the location of peripapillary atrophy (chi-square = 9.0484, P = 0.011). Zone Alpha was not significantly correlated with visual field defects or optic nerve head configurations (P > 0.05).
Peripapillary atrophy is significantly associated with functional and structural optic nerve damage in NTG.
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ABSTRACT: Purpose: To evaluate the reproducibility of measurements of area of β-zone parapapillary atrophy (β-PPA) using blue laser fundus autofluorescence (FAF) and confocal scanning laser ophthalmoscopy reflectance (CSLO) measurements and to assess agreement between the two imaging modalities. Methods: Sixty-five eyes of 45 patients (mean age, 68.2 ± 11.3 years) with established or suspected glaucoma from the Diagnostic Innovations in Glaucoma Study (DIGS) were prospectively included. FAF scans were obtained with the Spectralis HRA+OCT and CSLO reflectance images with the HRTII (both from Heidelberg Engineering, Heidelberg, Germany). Two masked graders independently measured β-PPA area on 3 consecutive scans using the semi-automated BluePeak RegionFinder software (BPRF) and on CSLO reflectance images using the optic disc contour line. Reproducibility of β-PPA area measurements was assessed using intraclass correlation coefficients (ICC). Results: Intragrader reproducibility was 0.997 (95% CI, 0.996-0.998) and 0.995 (95% CI, 0.992-0.996) for grader 1 and 2, respectively, using FAF-BPRF, and by CSLO, it was 0.991 (95% CI, 0.986-0.994) and 0.988 (95% CI, 0.982-0.992). Intergrader agreement (ICC) was 0.53 (95% CI, 0.331-0.685) for FAF-BPRF and 0.404 (95% CI, 0.149-0.601) for CSLO (comparison between ICC, p = 0.368). Agreement (ICC) between the two devices was worse for grader 1 (0.356; 95% CI, 0.129-0.549) than grader 2 (0.856; 95% CI, 0.774-0.910) (p < 0.001). Conclusions: Despite excellent intragrader reproducibility for β-PPA measurements with FAF-BPRF and CSLO, intergrader reproducibility is low to moderate. Measurements of β-PPA area obtained with the two instruments are of moderate agreement and, therefore, are not interchangeable.Acta ophthalmologica 03/2013; · 2.44 Impact Factor
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ABSTRACT: Beta-Zone parapapillary atrophy (PPA) occurs more commonly in eyes with glaucoma. Rates of glaucomatous visual field (VF) progression in eyes with and without beta-zone PPA at the time of baseline assessment were compared. Retrospective, comparative study. Two hundred forty-five patients from the New York Glaucoma Progression Study. 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. beta-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, beta-zone PPA area, beta-zone PPA area-to-disc area ratio, and presence or absence of beta-zone PPA. The relationship between beta-zone PPA and the rate and risk of glaucoma progression. 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. beta-Zone PPA was present in 146 eyes (65%). Eyes with beta-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 beta-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 beta-zone PPA than in eyes without it. Thinner CCT (<525 microm) had a weak but significant correlation with presence of beta-zone PPA (kappa = 0.13). Eyes with beta-zone PPA are at increased risk for glaucoma progression and warrant close clinical surveillance.Ophthalmology 05/2010; 117(5):909-15. · 5.56 Impact Factor
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ABSTRACT: The purpose of the study is to elucidate a topographic correlation between optic disc hemorrhages and retinal nerve fiber layer defects as well as peripapillary atrophy in normal-tension glaucoma (NTG). The authors prospectively studied the relation between the precise locations of disc hemorrhages and retinal nerve fiber layer defects in the first part of the study. The authors also compared morphometrically the peripapillary atrophy and the optic disc in eyes with disc hemorrhage with eyes without a history of disc hemorrhage in age-matched patients in the second part of the study. In part 1, 42 patients with NTG (male/female = 11/31; age, 56.8 +/- 14.2 years) in whom new disc hemorrhages developed were enrolled. In part 2, 51 randomly selected age-matched patients with NTG without a history of disc hemorrhage (male/female = 16/35; age, 55.7 +/- 12.5) were examined. In part 1, retinal nerve fiber layer defects were observed by scanning laser ophthalmoscopy using an argon-blue laser. In part 2, the area, angular extent, and radial extent of zone beta of peripapillary atrophy and the structural parameters of optic disc were measured by scanning laser tomography using a diode laser. In part 1, the authors detected 64 disc hemorrhages in 48 eyes of 42 patients; retinal nerve fiber layer defects were shown in 47 (97.9%) of 48 eyes by scanning laser ophthalmoscopy. Of 64 disc hemorrhages, 51 (79.7%) coincided with retinal nerve fiber layer defects in location. These 51 hemorrhages were present on the border (41.2%) or adjacent to the border (58.8%) between the retinal nerve fiber layer defect and the apparently healthy-looking retinal nerve fiber layer. In part 2, the prevalence, area, angular extent of zone beta, and ratio of zone beta area to disc area were significantly greater in the disc hemorrhage group than in the nonhemorrhage group, even though there were no significant differences in disc parameters between the two groups. Disc hemorrhage is associated closely with retinal nerve fiber layer defect in location and the size of peripapillary atrophy in NTG.Ophthalmology 12/1997; 104(11):1926-33. · 5.56 Impact Factor