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AJ Lee, PR Healey, E Rochtchina, JJ Wang, P Mitchell; Relationship of Peri-Papillary Atrophy to Glaucoma: The Blue Mountains Eye Study . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2950.
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Purpose: To describe the prevalence of alpha- and beta-peripapillary atrophy (α- and ß-PPA) and to quantify the relationship between presence of ß-PPA and either glaucoma or ocular hypertension (OH) in a defined older population, taking into account influences from other glaucoma risk factors, particularly myopia. Methods: The Blue Mountains Eye Study examined 3654 people aged 49-97 years, 82% of a defined population, west of Sydney Australia. α- and ß-PPA were graded from stereoscopic optic disc photographs using the classification described by Jonas. Glaucoma was diagnosed from presence of characteristic visual field loss combined with matching signs of optic disc cupping and rim thinning, independently of intraocular pressure (IOP). Myopia was assessed from spherical equivalent refraction, after a subjective refraction using the ETDRS method. Results: Glaucoma was present in 3.0% and OH was present in 5.2% of participants in this population. α-PPA was found in 87% of subjects, while ß-PPA was present in 24%. The widest area of ß-PPA involvement was temporal to the optic disc. The prevalence of both PPA types increased with age and ß-PPA was more frequent in men (26%) than in women (22%), after adjusting for age. ß-PPA was strongly related to the presnce of myopia, with rates of 20% for non-myopic subjects increasing to 66% for subjects with myopia of at least 5 diopters. ß-PPA prevalence was much higher in subjects with (61%) than in those without glaucoma (23%), but not among subjects with OH (22%). The glaucoma prevalence was three times higher in subjects with (7.4%), than without ß-PPA (1.4%), odds ratio (OR) 3.2, 95% confidence interval (CI) 2.1-4.9, after adjusting for glaucoma risk factors, including age, sex, hypertension, glaucoma family history, pseudoexfoliation, optic disc hemorrhage and myopia. Significant odds for the relationship between ß-PPA and glaucoma, however, were found both for non-myopic subjects (OR 3.7, CI 2.2-6.3) and myopic subjects (OR 2.3, CI 1.1-4.8), considered separately. There were no differences in this association between those with high- or low-pressure glaucoma. Conclusions: These data provide detailed prevalence of α-, ß-PPA and the influence of myopia, in an older population. ß-PPA was independently associated with a three-fold increased prevalence of glaucoma, after adjustment for other glaucoma risk factors. Although ß-PPA was strongly related to myopia, the association between ß-PPA and glaucoma remained statistically significant in both myopic and non-myopic subjects.
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