β-Zone Parapapillary Atrophy and Rates of Glaucomatous Visual Field Progression

Abstract

IMPORTANCE β-zone parapapillary atrophy (βPPA) has been reported as a risk factor for glaucoma onset and progression. Previous studies have shown that the prevalence of βPPA differs between individuals of African descent (AD) and European descent (ED). OBJECTIVE To test whether the association between the presence and progression of βPPA vs visual field progression of glaucoma differs between these 2 ancestry groups. DESIGN, SETTING, AND PARTICIPANTS In a prospective, multicenter, longitudinal cohort study, 634 individuals (1090 eyes) enrolled in the African Descent and Evaluation Study (ADAGES) with a diagnosis of glaucomatous optic neuropathy (GON) or ocular hypertension (OHT) and at least 2 disc stereophotographs were included. Two graders masked to clinical and ancestry data reviewed and graded the baseline and last disc stereophotographs for the presence of βPPA at baseline and βPPA progression (development or enlargement). Mixed-effects linear models were tested with visual field mean deviation as a dependent variable and time (alone and with interaction terms) as independent variables. ADAGES enrollment began in January 2003 and ended in July 2006; follow-up ended in 2016. EXPOSURES Disc stereophotographs. MAIN OUTCOMES AND MEASURES Progression of βPPA in AD and ED individuals. RESULTS In 634 patients, a total of 814 eyes of AD (395 eyes) and ED (419) patients with GON and 276 eyes of AD (106) and ED (170) patients with OHT who were enrolled in ADAGES were analyzed. There were 336 (53.0%) women in the study; mean (SD) age was 61.9 (12.7) years. In the OHT group, the association between βPPA at baseline and visual field progression was not significantly different between AD and ED eyes (β = 0.071; 95% CI, −0.016 to 0.158; P = .11), nor was the association between βPPA progression and visual field progression (β = 0.020; 95% CI, −0.465 to 0.506; P = .93). In the GON group, ED eyes with baseline βPPA progressed faster than did AD eyes with baseline βPPA (β = −0.124; 95% CI, −0.241 to −0.007; P = .04), although the association between βPPA progression and visual field progression did not differ significantly between race groups (β = −0.101; 95% CI, −0.323 to 0.119; P = .37). CONCLUSIONS AND RELEVANCE Race had a significant effect on the association between baseline βPPA and rates of visual field progression in eyes with GON. Progression of βPPA was not associated with faster visual field progression in either racial group.

Posterior staphyloma is associated with the microvasculature and microstructure of myopic eyes

“…In other words, disease progression in myopic glaucoma patients with PS is more stable than those without PS. However, the area of the PPA β-zone is closely related to glaucoma progression [24,25], Therefore, it is of vital importance to pay additional attention to the eyes of young myopic patients with PS at an early stage although we did not find significant differences in the degree of optic disc rotation and mean RNFL thickness in the present study. Jonas et al [26] has already confirmed that axial elongation is correlated with a smaller angle of temporal arterial arcade, caused by an elongation of the distance between the disc and foveola.…”

Understanding racial disparities of glaucoma

“…Optic disc hemorrhages occur more frequently in subjects of European descent compared to African descent, with higher prevalence of beta-zone parapapillary atrophy in those of African descent [67]. These findings may be a result of anatomical structural differences, but do not correlate with VF progression rates [68]. The neuroretinal rim minimum distance band, a surrogate measurement of neuroretinal rim tissue, is thinner in African Americans compared to White normal subjects [69], potentially explained by larger optic disc size in these individuals [70].…”

Controversies in the association of parapapillary atrophy with glaucoma

“…[ 2 24 ] It is also regarded as an independent risk factor and an important morphologic indicator for the progression of glaucoma when an end point was defined as loss of neuroretinal rim (NRR). [ 9 27 ]…”

“…According to some authors, it remains debatable whether PPA is an epiphenomenon or causally related to glaucomatous optic neuropathy (GON). [ 9 ] It is also not clear whether PPA is present before the onset of glaucoma and predisposes the eye to glaucomatous optic nerve damage, or whether it develops later, in association with glaucoma and progresses along with GON. [ 10 ] Due to the conflicting reports regarding PPA, it remains to be seen how these findings can be appropriately used in clinical practice.…”