The region of largest β-zone parapapillary atrophy area predicts the location of most rapid visual field progression

Christopher C. Teng, Carlos Gustavo De Moraes, Tiago S. Prata, Craig A. Liebmann, Celso Tello, Robert Ritch, Jeffrey M. Liebmann

Research output: Contribution to journalArticlepeer-review

71 Scopus citations

Abstract

Purpose: To determine if visual field (VF) progression occurs most rapidly in the region of largest β-zone parapapillary atrophy (PPA). Design: Retrospective cohort. Participants: One hundred twenty-five patients from the New York Glaucoma Progression Study with both β-zone PPA and VF progression. Methods: Treated open-angle glaucoma patients with 8 or more Swedish Interactive Threshold Algorithm Standard 24-2 VFs (Humphrey Field Analyzer II; Carl Zeiss Meditec, Inc., Dublin, CA) in either eye were identified. Eyes with optic disc photographs, β-zone PPA, less than 6 diopters myopia, and VF progression were studied. Visual field progression was defined using trend analysis as the presence of at least 2 adjacent progressing points in the same hemifield using standard pointwise linear regression (PLR) criteria. Main Outcome Measures: The correlation between β-zone PPA and location of most rapid future VF progression. Results: One hundred twenty-five eyes (125 patients; mean age, 71.9±12.3 years; 58% women; 75% European descent) with β-zone PPA and VF progression were enrolled. The mean follow-up was 6.8±1.7 years and the mean number of VFs was 12.5±3.6. Ninety-three patients (74%) had more β-zone PPA inferiorly and 32 patients (26%) had more β-zone PPA superiorly. The fastest VF progression occurred in the superior hemifield in 77 patients (62%) and in the inferior hemifield in 48 (38%) patients. Patients with superior VF progression had a superior localized mean rate of progression of -1.57±1.7 dB/year, and patients with inferior VF progression had an inferior localized mean rate of -0.94±1.4 dB/year (P = 0.012). The mean number of points reaching the predefined PLR end points was 5.6±7.5 for the superior VF hemifield and 3.0±4.9 for the inferior hemifield (P = 0.006). The hemifield with more points reaching PLR progression end points, with fastest average velocity of progression, or both was spatially consistent with the location of largest β-zone PPA in 89 (71%) patients (P = 0.0001, Fisher exact test; κ = 0.35; 95% confidence interval, 0.170.53). Conclusions: In treated glaucoma patients with β-zone PPA and VF progression, the location of largest β-zone PPA typically correlates spatially with the region of the most rapid future VF progression.

Original languageEnglish
Pages (from-to)2409-2413
Number of pages5
JournalOphthalmology
Volume118
Issue number12
DOIs
StatePublished - Dec 2011
Externally publishedYes

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