Study on the correlation between the thickness of paraoptic nerve fiber layer and optic disc morphology in myopia / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To study the thickness of peripapillary retinal nerve fibre layer and morphological changes of optic disc in myopic subjects using optical coherence tomography(OCT). <p>METHODS:Prospective study. A total of 61 myopic subjects(95 eyes)with a mean age of 27.76±7.05 years and 15 controls(30 eyes)with a mean age of 28.33±3.08 years were included. All subjects underwent standard comprehensive refraction(SE), axial length(AL), intraocular pressure(IOP), dilated fundus examination,, and OCT. Based on SE, myopic subjects were divided into three groups: 14 eyes in the moderate to low myopia group(-3D≤SE<-6D), 56 eyes in the high myopia group(-6D≤SE≤-9D), and 25 eyes in the ultra-high myopia group(SE> -9D). The mean retinal nerve fiber layer thickness of the optic disc and the nerve fiber layer thickness of the four quadrants were analyzed, as well as the peripapillary atrophy area(PPA), optic disc ovality index(OI), and horizontal optic disc tilt(HOT).<p>RESULTS:The thickness of nerve fiber layer in each quadrant was significantly different among the four groups(<i>P</i><0.01). The mean thickness of nerve fiber layer, the thickness of superior nerve fiber layer and the thickness of nasal nerve fiber layer were significantly higher in the control group than in the three myopic groups(all <i>P</i><0.05). The thickness of temporal nerve fiber layer in the control group was significantly lower than that in the high myopia group and the super high myopia group(<i>P</i><0.001, <i>P</i>=0.002), and also significantly lower in the moderate and low myopia group than that in the super high myopia group(<i>P</i>=0.043); the PPA of the four groups was statistically different(<i>P</i><0.001), in which the super high myopia group and the high myopia group was significantly greater than that in the low myopia group and the control group(<i>P</i><0.01); the HOT of the four groups was statistically different(<i>P</i>=0.020), in which the high myopia group and the super high myopia group was significantly higher than that in the control group(<i>P</i><0.001, <i>P</i><0.001). The nerve fiber layer thickness in the upper and lower quadrants was negatively correlated with OI, HOT, and PPA(all<i> P</i><0.05), while the nerve fiber layer thickness in the temporal side was positively correlated with OI, HOT, and PPA(all <i>P</i><0.05).<p>CONCLUSION: Mean and superior and inferior nerve fiber layer thickness was thinner in myopic patients, with temporal thickening and no change in the nasal side. The tilt of optic disc and the area of peripapillary atrophy were increased in high myopia, which were closely related to the thickness of nerve fiber layer.

Research progress on morphology and associations of peripapillary atrophy / 中华眼底病杂志

Through the different image technologies, peripapillary atrophy can be classified into four types: α zone, β zone, γ zone and δ zone. Each type of them has different imaging and histological features. Peripapillary atrophy is a common structure in peoples' eyes and it is correlated with many factors and diseases such as age, myopia, glaucoma, non-arteritic anterior ischemic optic neuropathy and age-related macular degeneration which bring difficulties to our diagnosis and antidiastole. Classifying and qualifying peripapillary atrophy properly, which can evaluate the changes and degrees, can benefit our studies about their mechanism and offer the clinical biological indictors and research basis.

Fundus features of high myopia in young adults: a three-year follow-up / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM:To evaluate changes in peripapillary atrophy(PPA)and retinal in young adults with high myopia(HM)for three years.<p>METHODS:A total of 22 HM patients(<i>n</i>=32 eyes, >-9 D), 35-45y, were enrolled in this self-controlled retrospective review. The following parameters were measured at baseline and 3-year follow-up visits: area of optic nerve head(ONH); area of peripapillary atrophy(PPA); area of peripapillary chorioretinal atrophy(PCA); type of PPA; average retinal thickness(ART); and total central retinal volume(TCRV). <p>RESULTS: There were no changes in the area of ONH(<i>t</i>=0.95, <i>P</i>=0.35)between baseline and 3-year follow-up visits. In contrast, the areas of PPA and PCA were significantly greater(0.69±0.71 and 0.57±0.97mm²,respectively)at the 3-year follow-up versus baseline(<i>t</i>=-3.99, <i>P</i>=0.001 and <i>t</i>=-2.33, <i>P</i>=0.03, respectively)visits. There were no changes in the type of the PPA. ART and TCRV did not differ significantly at the 3-year follow-up versus baseline visits(<i>P</i>>0.05).<p>CONCLUSION:Increased areas of PCA and PPA are the main fundus features of HM(>-9 D)in young adults. PPA and PCA should be important morphological parameters during follow-up for HM in clinic.

Application of Spectral-domain Optical Coherence Tomography for Measuring Peripapillary Atrophy in Glaucoma / 中国医科大学学报

Objective to measure peripapillary atrophy(PPA)in glaucoma with high-resolution spectral domain-optical coherence tomography (SD-OCt)and conventional color fundus photograph,and compare the consistency of the results between the two imaging methods. Methods A to-tal of 30 patients(54 eyes)with glaucoma from Department of Opthalmology,the First Hospital,China Medical University were prospectively includ-ed for the study. SD-OCt images and color fundus photographs taken through the region of PPA were qualitatively analyzed. the average width of β-PPA area in 6 reference lines centered optic nerve were measured using SD-OCt and color fundus photograph. Correlation and agreement between the two measuring methods were analyzed. Results the average width of β-PPA was 229.89±99.82 μm using color fundus photographs and 224.14±97.10 μm using SD-OCt,respectively. there was no significant difference(P = 0.280). the correlation coefficient was 0.825 between re-sults measured by SD-OCt and color fundus photographs for β-PPA area(P < 0.001),and agreement between the two methods was good(ICC=0.923,95% CI 0.870-0.954). Conclusion the correlation and consistency is good between SD-OCt and conventional color fundus photograph measuring β-PPA area. β-PPA area can be estimated with SD-OCt.

Repeatability of Peripapillary Atrophy Parameters Measured Using Optic Disc Stereophotography and Evaluation of Its Diagnostic Ability

PURPOSE: To investigate the measurement repeatability of peripapillary atrophy (PPA) parameters obtained by optic disc stereophotography (ODP) and evaluate the usefulness of PPA parameters to differentiate open-angle glaucoma (OAG) from normal eyes in patients with PPA. METHODS: Sixty-five eyes of 65 patients with PPA were examined. Disc area, cup area, rim area, vertical cup to disc (CD) ratio, CD area ratio, PPA area, zone beta (beta) area and zone alpha (alpha) area were obtained by ODP using intrinsic algorithms. The area under the receivers operating characteristic (AUROC) curves was used to compare the PPA parameters with that of the disc parameters to differentiate OAG from normal eyes. Two examiners analyzed PPA parameters to confirm reproducibility and repeatability of ODP. RESULTS: Vertical CD ratio (VCD), area CD ratio, zone beta area, zone beta area per PPA area, zone beta area per disc area and axial length were significantly larger in OAG patients (p 0.997). CONCLUSIONS: The PPA measurement obtained by ODP has good reproducibility and consistency and can be a useful tool in monitoring PPA changes in glaucoma patients.

Analysis of Peripapillary Atrophy According to the Optic Disc Shape Using Spectral Domain OCT

PURPOSE: To analyze the structural changes in the beta-zone of peripapillary atrophy (PPA-beta) using cross-sectional image of the optic disc head from spectral-domain optical coherence tomography (SD-OCT) according to the optic disc shape. METHODS: One hundred thirty-seven eyes in 137 patients with glaucoma having PPA-beta and 31 normal eyes (control group) were evaluated retrospectively. Cross-sectional images of the optic disc were taken using the Cirrus HD-OCT. We classified optic disc patterns into normal, focal, myopic, generalized enlargement and senile sclerotic appearance types and analyzed the shape of Bruch's membrane (BM), composition of retinal layer and retinal slope according to the optic disc shape. RESULTS: Among the 137 eyes with glaucoma, 54 eyes were focal disc type, 34 eyes were myopic disc type, 28 eyes were generalized enlargement disc type and 21 eyes were senile sclerotic disc type. The myopic disc group showed a noticeable difference compared to the other groups in terms of a higher percentage of BM defect type, the lowest retinal slope (70.6 +/- 12.0degrees) and the earlier termination of retinal layers. The generalized enlargement disc group showed the highest percentage of curved BM type. Retinal slope angle increased with age and decreased with axial length. CONCLUSIONS: In the beta-zone of peripapillary atrophy, there were several differences in the shape of Bruch's membrane, composition of retinal layers and the retinal slope according to the optic disc shape.

Comparison of Diagnostic Power Among OCT Parameters According to Peripapillary Atrophy in High Myopic Glaucoma

PURPOSE: To evaluate diagnostic power to detect glaucoma in high myopic eyes with peripapillary atrophy among optical coherence tomography (OCT) parameters. METHODS: Fifty eyes of 31 glaucoma patients with myopia of -6.00 diopters or less and a peripapillary atrophy (PPA) were classified into a group with a PPA located beyond the circumpapillary OCT scan circle (group A) and a group with a PPA confined within the scan circle (group B). Circumpapillary retinal nerve fiber layer (cpRNFL), total macula (TM), and ganglion cell-inner plexiform layer (GCIPL) thickness were measured in each group and the diagnostic power of each measurement was compared by area under the receiver operating characteristic curve (AUC). RESULTS: There were no significant differences in the age, gender, intraocular pressure, optic disc size, and mean deviation between the 2 groups. The spherical equivalent of group A was significantly larger than group B (mean -11.9 vs. -7.3 diopters, p = 0.002). In group A, the AUC of average GCIPL thickness was significantly higher than average cpRNFL and average TM thickness (p 0.05). CONCLUSIONS: Assessment of GCIPL parameters is a useful technique for glaucoma diagnosis in patients with high myopia and PPA extending beyond circumpapillary OCT scan circle.

The Relations Between Progression of Peripapillary Chorioretinal Atrophy and Progression of Normal Tension Glaucoma

PURPOSE: To evaluate the relations between progression of glaucoma in visual field and peripapillary area change in normal tension glaucoma (NTG). METHODS: We respectively evaluated 66 patients (66 eyes) with normal tension glaucoma; these patients were classified as progressive glaucoma group and non-progressive glaucoma group by visual field test. Interobserver and intraobserver agreement was evaluated for qualitative assessment. Zone beta change was measured by Image J (National Institute of Health, Bethesda, USA) by two methods. One method used paired t-test and the other method used CV (correlation of variation) to define significant progression of zone beta. RESULTS: 46 patients (46 eyes) were classified as progressive glaucoma and 20 patients (20 eyes) were classified as non-progressive glaucoma. There was no statistically significant different change of zone beta between two groups and there were no changes of zone beta over coefficient of variation (CV). CONCLUSIONS: The measurement of change of zone beta seems to be of no use in recognition of progression in normal tension glaucoma.

Characterization of Peripapillary Atrophy Using Spectral Domain Optical Coherence Tomography

PURPOSE: To characterize the features of peripapillary atrophy (PPA), as imaged by spectral-domain optical coherence tomography (SD-OCT). METHODS: 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 beta-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. RESULTS: Nineteen consecutive eyes of 10 subjects were imaged. The RNFL was observed in the PPA beta-zone of all eyes, and no eye showed an IS/OS complex in the beta-zone. The BRL was absent in the beta-zone of two eyes. The BRL was incomplete or showed posterior bowing in the beta-zone of five eyes. CONCLUSIONS: The common findings in the PPA beta-zone were that the RNFL was present, but the photoreceptor layer was absent. Presence of the BRL was variable in the beta-zone areas.

Evaluation of Ocular Risk Factors Related to Asymmetric Visual Field Defects in Normal Tension Glaucoma

PURPOSE: To evaluate ocular risk factors related to asymmetric visual field defects in normal tension glaucoma (NTG). METHODS: We retrospectively evaluated 92 NTG patients (184 eyes) with asymmetric visual field defects; these patients were classified as having more affected eye (ME) group or less affected eye (LE) group. The differences between ME and LE based on the intra-individual comparison were assessed with several ocular risk factors such as best corrected visual acuity, refractive error, intraocular pressure (IOP), the number of glaucoma medications, disc hemorrhage, central corneal thickness, zone beta of peripapillary atrophy (PPA), and disc size. All subjects were divided into two groups according to the severity of bilateral mean deviation (MD, Delta6dB) and evaluated. RESULTS: The MD was -11.2+/-6.5 in the ME group, and -5.9+/-5.4 in the LE group (p=0.00). The optic disc size was 2.62+/-0.8 in the ME group, 2.48+/-0.5 in the LE group (p=0.00), and there were no statistically significant differences in the other factors. Regarding the difference in the MD, the optic disc size was statistically significant in the less different group, and the angle of PPA was statistically significant in the more different group (p=0.00 and p=0.01, respectively). CONCLUSIONS: The optic disc size is a risk factor related to visual field defects in the ME group and the less affected patients, and the PPA is a risk factor, thought to be associated with ischemia, related to visual field defects in the more affected patients with asymmetric normal tension glaucoma.

The Influence of Demographic Characteristics on the Qualitative Signs of Glaucomatous Optic Disc

PURPOSE: To evaluate the influence of age, gender, and refractive error on the qualitative signs of glaucomatous optic nerve damage in normal eyes. METHODS: We evaluated color optic disc photographs for the presence or absence of 10 qualitative signs: rim shape alteration (alteration of ISN'T rule), thinnest rim width outside the temporal sector, rim notch, optic disc hemorrhage, baring of circumlinear vessel, bayonetting of vessel, nasalization of vessel, abnormally large peripapillary atrophy, abnormal form of peripapillary atrophy, and zone beta in 181 eyes of 181 normal subjects. The influence of age, gender, and refractive error on each qualitative sign was analysed by multiple logistic regression. RESULTS: Refractive error was related to zone beta (odds ratio=2.29, 95% confidence interval [CI]=1.21~4.33, p=0.009) and the frequency of zone beta was higher in myopic eyes. Age was weakly associated with abnormally large peripapillary atrophy (odds ratio=1.03, 95% CI=1.01~1.06, p=0.02). Gender, on the other hand, had no influence on qualitative signs. CONCLUSIONS: Our findings indicate that the qualitative signs of glaucomatous optic nerve damage were not affected by age, gender, and refractive error, except for zone beta and abnormally large peripapillary atrophy. Myopia was related to zone beta, and age was related to abnormally large peripapillary atrophy in normal eyes.

Peripapillary Atrophy in Primary Open-Angle Glaucoma and Normal-Tension Glaucoma

PURPOSE: To study the relation between the progression of glaucoma and the expression of zone beta in primary open-angle glaucoma (POAG) and normal-tension glaucoma (NTG). METHODS: One hundred thirty eyes with POAG and 62 with NTG were enrolled in this study. We classified them based on the expression of zone beta and compared their optic nerve head parameters. We looked for changes in optic nerve head parameters depending on the expression of zone beta in patients who received HRT at least 1 year previously, and whose maximal intraocular pressure (IOP) during the follow-up periods was controlled under 21 mmHg. RESULTS: In the POAG patients, the group with zone beta had significantly larger cup-to-disc (C/D) ratio, and significantly smaller neural rim area and volume, than the group without zone beta. In the NTG patients optic nerve head parameters did not show statistically significant difference. Compared with the previous values, C/D ratio, neural rim area and volume showed significant progression in POAG with zone beta, but did not show significant change in POAG without zone beta and in NTG. CONCLUSIONS: In POAG, the expression of zone beta was associated with more severe optic nerve damage and faster progression than in patients without zone beta. In NTG, the expression of zone beta was not associated with significant changes in the optic nerve shape or the progression of glaucoma.

Influence of Peripapillary Atrophy on the Progress of Diabetic Retinopathy

PURPOSE: To evaluate the influence of peripapillary atrophy on the progress of diabetic retinopathy. METHODS: Interval between the diagnosis of diabetes and the onset of diabetic retinopathy was compared between 77 eyes of 50 patients with peripapillary atrophy and 253 eyes of 172 patients without peripapillary atrophy who visited the Korea university ophthalmology department between January 2002 and May 2002, No one had glaucoma or high myopia. Pepipapillary atrophy was classified by severity and compared. RESULTS: Time to the onset of nonproliferative diabetic retinopathy was longer in the patients with peripapillary atrophy (13.7 years) than the patients without peripapillary atrophy (11.2 years) (p

Correlation Between Disc Hemorrhage and Peripapillary Atrophy in Glaucoma Patients with Unilateral Disc Hemorrhage

PURPOSE: To investigate the correlation of peripapillary atrophy with disc hemorrhage in glaucoma patients with a unilateral disc hemorrhage METHODS: A retrospective review was performed on the medical records of 36 glaucoma patients (7 with primary open-angle glaucoma and 29 with normal-tension glaucoma) with a unilateral disc hemorrhage during a mean follow-up period of 25 months. Topographic measurements were performed with Heidelberg Retina Tomograph (HRT) within three months of detection of a disc hemorrhage. The parameters of zone beta of peripapillary atrophy were analyzed by the atrophy zone analysis program and compared with the fellow eyes. RESULTS: The area, angular and radial extent of zone beta, and ratio of zone beta area to disc area were significantly greater in the hemorrhagic eyes than in the contralateral eyes. The difference of refractive error, intraocular pressure, MD and CPSD of visual fields was not found to be significant between both eyes. CONCLUSIONS: The area and extent of peripapillary atrophy was significantly greater in the eyes with disc hemorrhage compared to the contralateral control eyes. This study suggested quantitatively that the peripapillary atrophy is associated closely with disc hemorrhage in glaucoma patients.

Retinal Nerve Fiber Layer Thickness and Peripapillary Atrophy in Glaucoma with Small Discs

PURPOSE: To evaluate the usefulness of the retinal nerve fiber layer thickness and peripapillary atrophy in discrimination between normal and glaucoma patients with small optic discs which can be potentially misleading by cup-to-disc ratio. METHODS: Eyes with average disc diameter 1.617 mm or less which is 33 percentile by topographic scanning system (TopSST M, version 2.2, LDT, Inc., U.S.A) in our normal population study were enrolled. 82 eyes of 82normal subjects, 30 eyes of 30 patients with primary open-angle glaucoma (POAG), 16 eyes of 16 patientswith normal tension glaucoma (NTG) were studied. Program 30-2 of the Humphrey Field and scanning laser polarimetry (Nerve Fiber Analyzer II : NFAII, version 2.1., LDT, Inc., U.S.A.) were performed and color optic disc photographs had been taken. The differences in NFA parameters and peripapillary atrophy (zone alpha and zone beta) between normal subjects and glaucoma patients were examined. RESULTS: Considering all the NFA parameters, superonasal ratio of POAG and NTG group was significantly lower than normal group (p=0.002, p=0.043, respectively) and inferonasal ratio of POAG group was significantly lower than normal group (p=0.020). Zone beta atrophy was detected more frequently in POAG and NTG group than normal group (p=0.015, 0.007, respectively). No significant correlation was found between superonasal, inferonsal ratio and visual field indices and the presence of zone beta was not associated with progression of visual field. CONCLUSIONS: In small optic discs which had been presented diagnostic difficulties with optic disc status, retinal nerve fiber layer thickness (superonasal or inferonasal ratio) and/or peripapillary atrophy (zone beta) analysis can be helpful in identifying glaucoma.

Influence of Acute or Subacute Attack on Peripapillary Atrophy in Primary Angle-closure Glaucoma

PURPOSE: To determine whether acute or subacute attack influences the peripapillary atrophy in patients with primary angle-closure glaucoma (PACG). METHODS: Thirty-three eyes with PACG that had an acute or subacute attack (symptomatic PACG group) and 30 eyes with chronic PACG that had no attack (asymptomatic chronic PACG group) were studied. The rim/disc area ratio were matched in both groups. There were no statistically significant differences in the age, sex, refractive error, optic disc area, and visual field mean deviation between the two groups. RESULTS: Nineteen of 33 eyes (57.6%) with symptomatic PACG group and 20 of 30 eyes (66.7%) with asymptomatic chronic PACG group had zone beta. The mean zone beta/disc area ratio was 0.31 in symptomatic PACG group and was 0.52 in asymptomatic chronic PACG group. There were no statistically significant differences regarding the prevalence of zone beta (P=0.63) and the zone beta/disc area ratio (P=0.09) between the two groups. CONCLUSIONS: These findings suggest that the peripapillary atrophy in PACG is almost independent of acute or subacute attack.

Peripapillary Atrophy in Primary Angle-closure Glaucoma

To determine the frequency of peripapillary atrophy (zone beta)and the relationship between peripapillary atrophy and glaucomatous optic nerve damage in eyes with primary angle-closure glaucoma, we performed magnification-corrected morphometry of photographs of 88 eyes of 64 patients with primary angle-closure glaucoma. Forty-nine (56%)of 88 eyes with primary angle-closure glaucoma had zone beta. The zone beta/disc area ratio increased significantly (P=0.0001)with a decreasingrim/disc area ratio (r=-0.49).Moreover, the area, angular extent, width, and the frequency of zone betaincreased significantly with increasing stage of glaucoma (P<0.005).In contrast, there was no significant correlation between the zone beta/disc area ratio and perimetric results.We found that zone betawas present in more than half and it is closely associated with glaucomatous optic nerve damage in primary angle-closure glaucoma.

Significance of Peripapillary Atrophy in the Diagnosis of Open-angle Glaucoma

This study was performed to determine whether peripapillary atrophy can be helpful in diagnosis of glaucoma and to investigate the correlation between peripapillary atrophy and optic disc head configuration in patients with primary open-angle glaucoma and normal-tension glaucoma. For all eyes, color polaroid optic disc photographs had been taken with Topcon retinal camera and reviewed. 93 eyes of normal subjects, 47 eyes of 47 patients with primary open-angle glaucoma and 47 eyes of 47 patients with normal-tension glaucoma were analyzed. Zone beta was detected more often in patients with normal-tension glaucoma and primary open-angle glaucoma (P<0.05). There was no significant difference in frequency of peripapillary atrophy between in patients with normal-tension glaucoma and primary open-angle glaucoma (P=0.071). In primary open-angle glaucoma,total,nasal and temporal neuroretinal rim area and total, inferior, nasal and temporal neuroretinal rim area/disc area ratio were smaller in patients with zone beta than without zone beta (P<0.05). The presence of zone beta was associated with neural tissue loss and progression of visual field in primary open-angle glaucoma (P<0.05). In conclusion,peripapillary atrophy, especially zone beta, is associated with glaucoma. Therefore, evaluation of peripapillary atrophy can be help-ful in diagnosing glaucoma. The presence of zone beta is associated with functional and structural optic nerve damage and is of predictive value in the future glaucomatous damage in primary open-angle glaucoma.

Comparison of Optic Ne rve Head Blood Flow in Normal-tension Glaucoma with Asymmetric Visual Field Loss

To evaluate intraindividual, interocular differences in blood flow of the optic nerve head in normal-tension glaucoma(NTG)patients with interocular asymmetric visual field loss, thirty-eight eyes of 19 NTG patients(mean age+/-SD, 56.1+/-15.0 years)with interocular asymmetric visual field loss of >3dB in the mean deviation or corrected pattern standard deviation were measured for the blood flow parameters(Volume, Velocity, Flow)at the temporal rim of the optic nerve head using scanning laser Doppler flowmetry(Heidelberg Retina Flowmeter or HRF). Measurements for peripapillary atrophy(area of zone beta)were performed using scanning laser tomography (Heidelberg Retina Tomograph). Visual field defects were evaluated by automated static threshold perimetry. The mean+/-standard deviation of the mean defect of the visual field indices was -1.38+/-3.02dB for the less affected eyes, and -6.23+/-3.84dB for the more affected eyes. All blood flow parameters were significantly smaller in the less affected eyes(0.004

Correlation of Peripapillary Atrophy with Optic Disc Cupping and Disc Hemorrhage in Primary Open Angle Glaucoma

To investigate the correlation of peripapillary atrophy with optic disc dupping and disc hemorrhage in primary open angle glaucoma(POAG) patients, tomographic measurements were performed with Heidelberg Retina Tomograph(HRT, Heidelberg Engineering, Germany). We analyzed cup to disc area ratio(C/D ratio) and peripapillary atrophy to disc area ratio(P/D ratio) from 28 eyes of 14 POAG patients with peripapillary atrophy(Group A), only C/D ratio from 28 eyes of 14 POAG patients without peripapillary atrophy(Group B), and only P/D ratio from 28 eyes of non-glaucomatous subjects with peripapillary atrophy(Group C). Group A was subclassified into thos with disc hemorrhage (Group A-1) and those without dixd hemorrhage(Group A-2), and changes of visual field defects were also analyzed from each subgroup witn Humphrey automated perimetry (Allergan Humphrey, USA, C24-2) at the six-month follow-up. Cup to disc area ratio(0.54+/-0.160)in the Group A was signifcantly higher than that(0.406+/-0.130) in the Group B, and P/D ratio was higher in Group A(0.619+/-0.203) than in the Group C(0.484+/-0.130). P/D ratio was also higher in Group A-1(0.725+/-0.34) than in the Group A-2(0.605+/-0.273). There was no significant difference in mean deviation(M/D) and corrected pattern standard deviation(CPSD) between Group A-1 and Group A-2. The results led us to the conclusion that peripapillary atrophy had significant correlation with glaucomatous damage on optic disc and disc hemorrhage in glaucoma patients. Therefore more attention should be paid tod a glaucoma patient especially when he or she presents with peripapillary atrophy.