Correlation between Peripapillary Atrophy and Optic Nerve Damage in Normal-tension Glaucoma

Department of Ophthalmology, College of Medicine, Seoul National University Hospital, Korea.
Ophthalmology (Impact Factor: 6.14). 11/1996; 103(11):1899-906. DOI: 10.1016/S0161-6420(96)30409-0
Source: PubMed


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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    • "PPA can be seen in both healthy and glaucomatous eyes but is known to be more frequent and severe in glaucomatous eyes [11-13]. Some studies have reported that an increase in the PPA area can be an indicator of glaucoma progression [14,15]. Thus, PPA is not rare in glaucoma patients, although PPA size can vary. "
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    ABSTRACT: To characterize the features of peripapillary atrophy (PPA), as imaged by spectral-domain optical coherence tomography (SD-OCT). SD-OCT imaging of the optic disc was performed on healthy eyes, eyes suspected of having glaucoma, and eyes diagnosed with glaucoma. From the peripheral β-zone, the retinal nerve fiber layer (RNFL), the junction of the inner and outer segments (IS/OS) of the photoreceptor layer, and the Bruch's membrane/retinal pigment epithelium complex layer (BRL) were visualized. Nineteen consecutive eyes of 10 subjects were imaged. The RNFL was observed in the PPA β-zone of all eyes, and no eye showed an IS/OS complex in the β-zone. The BRL was absent in the β-zone of two eyes. The BRL was incomplete or showed posterior bowing in the β-zone of five eyes. The common findings in the PPA β-zone were that the RNFL was present, but the photoreceptor layer was absent. Presence of the BRL was variable in the β-zone areas.
    Full-text · Article · Dec 2010 · Korean Journal of Ophthalmology
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    • "21 mmHg with optic disc and/or visual field changes indicative of glaucoma. Optic nerveheads were considered glaucomatous on biomicroscopical examination with the Volk lens in the presence of focal or generalized narrowing or disappearance of the neuroretinal rim with an enlarged amount of cupping or pallor (Park et al. 1996). Ocular hypertension (OHT) was defined as IOP > 21mmHg without optic nervehead changes or visual field defects. "
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