Enlargement of parapapillary atrophy in follow-up of chronic open-angle glaucoma.

PURPOSE To assess the frequency of an enlargement of parapapillary atrophy in follow-up of eyes with open-angle glaucoma. METHODS Prospective observational longitudinal study. SETTING Institutional. PATIENTS The study included 978 eyes (511 Caucasian subjects) with open-angle glaucoma (n = 548; including 194 eyes with normal-pressure glaucoma), ocular hypertension (n = 289), or without optic nerve disease (n = 141). Highly myopic eyes with a myopic refractive error exceeding -8 diopters were excluded. Mean follow-up was 4.5 +/- 2.4 years (median, 3.8 years; range: 1.5 to 9.8 years). OBSERVATION PROCEDURES Optic disk photographs taken annually. MAIN OUTCOME MEASURES Two examiners compared optic disk slides for enlargement of parapapillary atrophy (zone beta) and for signs of progressive disk damage. RESULTS An enlargement of parapapillary beta zone was detected in 16 eyes (1.6%) after 3.9 +/- 2.6 (0.6 to 9.1) years of follow-up. It was observed in 15 eyes (2.7%) with open-angle glaucoma, 1 eye (0.3%) with ocular hypertension, and in none of the normal eyes. After excluding eyes with a myopic refractive error exceeding -3 diopters, enlargement of beta zone was significantly more common in eyes with progressive glaucoma (5/81 or 6.2%) than in eyes with nonprogressive glaucoma (3/354 or 0.8%; P <.001). CONCLUSIONS Parapapillary atrophy (zone beta) enlarges during follow-up of relatively few eyes with chronic open-angle glaucoma. In the refractive range above -3 diopters, enlargement of beta zone occurs significantly more frequently (P <.001) in progressive glaucoma than in nonprogressive glaucoma. In view of its low frequency, enlargement of beta zone may not be a very useful marker for glaucoma progression.

[1]  Jost B Jonas,et al.  Small neuroretinal rim and large parapapillary atrophy as predictive factors for progression of glaucomatous optic neuropathy. , 2002, Ophthalmology.

[2]  M. Mochizuki,et al.  Peripapillary crescent enlargement in highly myopic eyes evaluated by fluorescein and indocyanine green angiography , 2003, The British journal of ophthalmology.

[3]  J. Caprioli,et al.  Ability of Peripapillary Atrophy Parameters to Differentiate Normal-tension Glaucoma From Glaucomalike Disk , 2001, Journal of glaucoma.

[4]  M. Kass,et al.  Clinical factors associated with progression of glaucomatous optic disc damage in treated patients. , 2001, Archives of ophthalmology.

[5]  J. Jonas,et al.  Parapapillary chorioretinal atrophy in normal and glaucoma eyes. I. Morphometric data. , 1989, Investigative ophthalmology & visual science.

[6]  J. Jonas,et al.  Optic disc histomorphometry in normal eyes and eyes with secondary angle-closure glaucoma , 2004, Graefe's Archive for Clinical and Experimental Ophthalmology.

[7]  W. Feuer,et al.  Possibly reduced prevalence of peripapillary crescents in ocular hypertension. , 1989, Canadian Journal of Ophthalmology-journal Canadien D Ophtalmologie.

[8]  Douglas R. Anderson,et al.  Acquired peripapillary changes and progression in glaucoma , 1988, Graefe's Archive for Clinical and Experimental Ophthalmology.

[9]  J. Jonas,et al.  Parapapillary chorioretinal atrophy in chronic high-pressure experimental glaucoma in rhesus monkeys. , 1998, Investigative ophthalmology & visual science.

[10]  M. Kass,et al.  Parapapillary chorioretinal atrophy in patients with ocular hypertension. II. An evaluation of progressive changes. , 1997, Archives of ophthalmology.

[11]  P. Puska,et al.  Peripapillary atrophy in unilateral capsular glaucoma , 1993, Graefe's Archive for Clinical and Experimental Ophthalmology.

[12]  M. Araie,et al.  Factors contributing to the progression of visual field damage in eyes with normal-tension glaucoma. , 1994, Ophthalmology.

[13]  J. Jonas,et al.  Direct clinico-histological correlation of parapapillary chorioretinal atrophy. , 1993, The British journal of ophthalmology.

[14]  P. D. G. K. Krieglstein.  Glaucoma Update VI , 1999, Springer Berlin Heidelberg.

[15]  M. Kass,et al.  Comparative optic disc analysis in normal pressure glaucoma, primary open-angle glaucoma, and ocular hypertension. , 1996, Ophthalmology.

[16]  D. R. Anderson,et al.  The configuration of peripapillary tissue in unilateral glaucoma. , 1988, Archives of ophthalmology.

[17]  J. Jonas,et al.  Ranking of optic disc variables for detection of glaucomatous optic nerve damage. , 2000, Investigative ophthalmology & visual science.

[18]  J. Jonas,et al.  Optic disc morphology in myopic primary open-angle glaucoma , 1997, Graefe's Archive for Clinical and Experimental Ophthalmology.

[19]  H. Littmann.  [Determination of the real size of an object on the fundus of the living eye]. , 1982, Klinische Monatsblatter fur Augenheilkunde.

[20]  J. Jonas,et al.  Relationship between parapapillary atrophy and visual field abnormality in primary open-angle glaucoma. , 1999, American journal of ophthalmology.

[21]  H Uchida,et al.  Increasing peripapillary atrophy is associated with progressive glaucoma. , 1998, Ophthalmology.

[22]  J. Jonas,et al.  Agreement of measurement of parapapillary atrophy with confocal scanning laser ophthalmoscopy and planimetry of photographs. , 1999, Journal of glaucoma.

[23]  A. Tuulonen,et al.  Change of Peripapillary Atrophy in Glaucoma , 1987 .

[24]  M. Kass,et al.  Concordance of parapapillary chorioretinal atrophy in ocular hypertension with visual field defects that accompany glaucoma development. , 2000, Ophthalmology.

[25]  J. Jonas,et al.  The full-field flicker test in early diagnosis of chronic open-angle glaucoma. , 1997, American journal of ophthalmology.

[26]  J. Jonas,et al.  Glaucomatous parapapillary atrophy. Occurrence and correlations. , 1992, Archives of ophthalmology.

[27]  G. Tomita,et al.  Correlation between peripapillary atrophy and optic nerve damage in normal-tension glaucoma. , 1996, Ophthalmology.

[28]  M. Kass,et al.  Parapapillary chorioretinal atrophy in patients with ocular hypertension. I. An evaluation as a predictive factor for the development of glaucomatous damage. , 1997, Archives of ophthalmology.

[29]  J. Jonas,et al.  Interobserver variation in the measurements of peripapillary atrophy in glaucoma. , 1996, Ophthalmology.

[30]  Douglas R. Anderson,et al.  Correlation of the Peripapillary Anatomy with the Disc Damage and Field Abnormalities in Glaucoma , 1983 .

[31]  J. Jonas,et al.  Ophthalmoscopic evaluation of the optic nerve head. , 1999, Survey of ophthalmology.

[32]  J. Jonas,et al.  Histomorphometry of the optic disc in highly myopic eyes with absolute secondary angle closure glaucoma , 1998, The British journal of ophthalmology.

[33]  D. R. Anderson,et al.  Clinical histologic correlation of human peripapillary anatomy. , 1989, Ophthalmology.