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Nathan M. Radcliffe, Daniel M. Vu, Sarah J. Haseltine, Joshua R. Ehrlich, Fabiana Q. Silva; Relationship between Peripapillary Atrophy and Optic Nerve Parameters Measured with High-Definition Optical Coherence Tomography. Invest. Ophthalmol. Vis. Sci. 2012;53(14):718.
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© ARVO (1962-2015); The Authors (2016-present)
Peripapillary atrophy (PPA) has been associated with glaucoma prevalence and severity and is known to be larger in regions of damaged retinal nerve fiber (RNFL) and neuroretinal rim. The purpose of this study is to characterize the relationship between PPA and optic nerve head parameters measured by High-Definition Optical Coherence Tomography (HD-OCT).
Patients under evaluation for glaucoma were considered for inclusion in this retrospective study. We included eyes that had been imaged with HD-OCT (Cirrus, Carl Zeiss Meditec, Dublin, CA) with optic nerve head cube scans with good alignment and signal strength >6. Each patient had digital photos of the optic nerve (ON; Topcon Co., Tokyo, Japan), a full ophthalmic examination and a reliable visual field test (24-2 SITA standard). ON photos were evaluated by a single masked observer and βPPA was identified and characterized. Two-sample t-tests were used to examine differences in continuous variables between patients with and without βPPA, while Fisher’s exact test was used for categorical variables. Generalized estimating equations were used to construct logistic models adjusting for intereye correlation among patients.
We identified 287 eyes of 160 patients meeting our inclusion criteria. Our sample consisted of 143 (50.4%) open angle glaucoma patients and 115 (40.5%) glaucoma suspects. Compared to eyes without βPPA (n=41), patients with βPPA (n=119) had significantly thinner average RNFL (86.2 vs. 78.9µm; p=0.003), and superior (p=0.01) and inferior RNFL (p<0.001). Simple logistic regression showed that average RNFL (OR=0.6, CI 0.5, 0.8, p<0.001), vertical cup to disc ratio (VCDR; OR=1.4, CI 1.1, 1.8, p=0.02) and rim area (OR=0.9, CI=0.8, 1.0, p=0.004) were significant predictors of the presence of any βPPA. However, age was not a significant predictor (p=0.08). In a multivariable analysis including all the above variables, only average RNFL thickness retained significant association with the presence of βPPA (OR=0.7, CI 0.5, 1.0, p=0.02).
Of all the optic nerve features quantified by HD-OCT, average RNFL best correlates with βPPA.
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