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.

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.

Intra-individual, Inter-ocular Comparison In Normal Tension Glaucoma with Unilateral Field Loss

PURPOSE: To investigate whether there are differences in ocular risk factors reportedly associated with the development of normal tension glaucoma (NTG) between glaucomatous eyes and normal visual field (VF) eyes of monocular NTG patients. METHODS: Thirty-six patients who had NTG in one eye and normal RNFL and VF in the fellow eye were included in this hospital-based cross-sectional retrospective survey. We analyzed the difference between glaucomatous eyes and normal VF eyes according to an intra-individual, inter-ocular comparison of ocular parameters, including intraocular pressures (IOP), central corneal thickness (CCT), optic disc size, myopia, optic disc hemorrhage, and zone beta of peripapillary atrophy. Measurements of optic disc size and area and the angular and radial extent of zone beta were obtained using a Heidelberg Retina Tomograph. We also evaluated the correlation of each parameter with mean deviation (MD) and pattern standard deviation (PSD). RESULTS: There were no inter-ocular differences of IOP, CCT, optic disc size, or myopia (n=36). Optic disc hemorrhage was found in only three glaucomatous eyes. The area of zone beta was greater in glaucomatous eyes than in normal VF eyes (p=0.003). No parameters were correlated with MD or PSD. CONCLUSIONS: Except for optic disc hemorrhage and zone beta area, all other parameters showed no inter-ocular differences. The asymmetry of disc hemorrhage and zone beta area in monocular NTG patients implies that optic disc ischemia might play a role in the pathogenesis of NTG.

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 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.

Peripapillary Atrophy: 2. Its Correlations with Glaucomatous Optic Nerve Damage

This study was undertaken to evaluate how closely peripapillary atrophy(PPA) is related to structual and functional optic nerve damage in primary open-angle glaucoma. Magnification-corrected morphometry of photographs using computer graphic program and automated static threshold perimetry were performed on 234 eyes of 141 patients with primary open-angle glaucoma and 139 eyes of 86 normal subjects(control). For the data analysis, only one eye of each patient was randomly selected. Both groups did not differ significantly in age, refractive error and disc area. PPA differentiated into two different zone(alpha and beta). The area of zone alpha, zone beta and the total PPA enlarged significantly)P=0.0001) with a decreasing rim/disc area ratio(r=0.36, r=0.46, r=0.50, respectively), rim area(r=-0.27, r=-0.44, r=-0.43, respectively) and mean deviation(r=-0.30, r=-0.34, r=-0.39, respectively). They enlarged significantly(P=0.0001) with an increasing vertical(r=0.35, r=0.42, r=0.46, respectively) and horizontal cup to disc ratio(r=0.31, r=0.37, r=0.41, respectively) and cup area(r=0.36, r=0.41, r=0.46, respectively). Concerning peripapillary parameters, the correlation coefficients were generally lowest for zone beta and the highest for total PPA. The peripapillary atrophy showed a spatial relation to neuroretinal rim loss. These results indicate that enlargement of PPA is related to the severity of the glaucomatous optic nerve damage and visual field defects.

Peripapillary Atrophy: 1, Comparison of Normal Eyes and Eyes with Primary Open-Angle Glaucoma

To confirm the value of the peripapillary atrophy(PPA) for the diagnosis and follow-up of patients with glaucoma, we performed magnification-corrected morphometry of photographs of 234 eyes of 141 patients with primary open-angle glaucoma and 139 eyes of 86 normal subjects. For the data analysis, only one eye of each patient was randomly selected. Both groups did not differ significantly in age. refractive error and disc area. According to the neuroretinal rim/disc area ratio, the glaucoma group was divided into four stages(1; more than 0.61, 2; 0.60~0.41, 3; 0.40~0.21, 4; less than 0.20). PPA differentiated into two different zones(alpha and beta). Zone alpha(0.76+/-0.55mm2 vs 0.47+/-0.32mm2) and zone beta(0.50+/-0.63mm2 vs 0.06+/-0.15mm2) and the total PPA(1.26+/-0.97mm2 vs 0.54+/-0.38mm2) were significantly larger(p=0.0001), and zone beta occurred more often(59.5% vs 17.4%, P=0.0001) in the glaucoma group than in the normal group. The area, angular extent and width of both zones enlarged significantly with increasing stage of glaucoma. The frequency of zone beta increased with advancing stage of glaucoma. These findings suggest that both zone alpha and beta increase continuously with advancing neural rim damage. Therefore, the PPA is useful for the diagnosis and progression of glaucomatous nerve damage.