September 2016
Volume 57, Issue 12
Open Access
ARVO Annual Meeting Abstract  |   September 2016
African Descent and Evaluation Study (ADAGES): The relationship between the presence and enlargement of beta-zone parapapillary atrophy (bPPA), African (AD) or European descent (ED), and rates of visual field (VF) progression in patients with glaucoma
Author Affiliations & Notes
  • James Thomas Murphy
    Harkness Eye Institute, Columbia University Medical Center, New York, New York, United States
  • Chad Kaplan
    Harkness Eye Institute, Columbia University Medical Center, New York, New York, United States
  • C Gustavo De Moraes
    Harkness Eye Institute, Columbia University Medical Center, New York, New York, United States
  • Dana Blumberg
    Harkness Eye Institute, Columbia University Medical Center, New York, New York, United States
  • Alon Skaat
    Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  • George A Cioffi
    Harkness Eye Institute, Columbia University Medical Center, New York, New York, United States
  • Christopher A Girkin
    School of Medicine, University of Alabama, Birmingham, Alabama, United States
  • Felipe A Medeiros
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, San Diego, New York, United States
  • Robert N Weinreb
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, San Diego, New York, United States
  • Linda M Zangwill
    Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego, San Diego, New York, United States
  • Jeffrey M Liebmann
    Harkness Eye Institute, Columbia University Medical Center, New York, New York, United States
  • Footnotes
    Commercial Relationships   James Murphy, None; Chad Kaplan, None; C Gustavo De Moraes, National Eye Institute (F), Research to Prevent Blindness (F); Dana Blumberg, None; Alon Skaat, None; George Cioffi, National Eye Institute (F), Research to Prevent Blindness (F); Christopher Girkin, Carl Zeiss Meditech, Inc. (F), EyeSight Foundation of Alabama (F), Heidelberg Engineering, GmbH (F), National Eye Institute (F), Research to Prevent Blindness (F), SOLX (F); Felipe Medeiros, Alcon (C), Allergan (F), Allergan (C), Ametek (F), Ametek (C), Bausch & Lomb (F), Carl-Zeiss Meditec, Inc. (F), Carl-Zeiss Meditec, Inc. (C), Carl-Zeiss Meditec, Inc. (R), Heidelberg Engineering (F), Heidelberg Engineering (C), Sensimed (F), Topcon (F); Robert Weinreb, Alcon (C), Allergan (C), Amatek (C), Bausch & Lomb (C), Carl-Zeiss Meditec, Inc. (C), Carl-Zeiss Meditec, Inc. (R), Carl-Zeiss Meditec, Inc. (F), Forsight (C), Genentech (F), Heidelberg Engineering (F), Konan (F), National Eye Institute (F), Neurovision (F), Optovue (F), Quark (F), Reichert (F), Tomey (F), Topcon (C), Topcon (F), Valeant (C); Linda Zangwill, Carl-Zeiss Meditec, Inc. (F), Carl-Zeiss Meditec, Inc. (R), Heidelberg Engineering GmbH (F), Optovue, Inc. (F), Optovue, Inc. (R), Quark (F), Topcon Medical Systems, Inc. (F); Jeffrey Liebmann, Alcon, Inc. (C), Allergan, Inc. (C), Bausch & Lomb (C), Bausch & Lomb (F), Carl-Zeiss Meditec, Inc. (C), Carl-Zeiss Meditec, Inc. (F), Diopysis (F), Diopysis (C), Heidelberg Engineering GmbH (F), Heidelberg Engineering GmbH (C), Merz Pharmaceuticals, Inc. (C), National Eye Institute (F), New York Glaucoma Research Institute (F), Optovue, Inc. (F), Quark Pharmaceuticals, Inc. (C), Reichert, Inc. (F), Reichert, Inc. (C), Sensimed, Inc. (C), SOLX, Inc. (F), Sustained Nano Systems (E), Sustained Nano Systems (P), Topcon, Inc. (F), Valeant Pharmaceuticals, Inc. (C)
  • Footnotes
    Support  NIH grants EY11008, EY019869, P30EY022589, U10EY14267, EY021818, EY025056, EY022039, EY023704, K12EY024225, R01EY025253; Alcon Laboratories Inc., Allergan Inc., Pfizer Inc., Merck Inc., Santen Inc., Eyesight Foundation of Alabama, Research to Prevent Blindness, Edith C. Blum Research Fund of the New York Glaucoma Research Institute, Shirlee and Bernard Brown Research Laboratory
Investigative Ophthalmology & Visual Science September 2016, Vol.57, 355. doi:
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      James Thomas Murphy, Chad Kaplan, C Gustavo De Moraes, Dana Blumberg, Alon Skaat, George A Cioffi, Christopher A Girkin, Felipe A Medeiros, Robert N Weinreb, Linda M Zangwill, Jeffrey M Liebmann; African Descent and Evaluation Study (ADAGES): The relationship between the presence and enlargement of beta-zone parapapillary atrophy (bPPA), African (AD) or European descent (ED), and rates of visual field (VF) progression in patients with glaucoma. Invest. Ophthalmol. Vis. Sci. 2016;57(12):355.

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      © ARVO (1962-2015); The Authors (2016-present)

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Abstract

Purpose : We have recently shown that bPPA is more common in AD than ED patients with glaucoma.[1] Nonetheless, it remains unclear whether this feature has the same clinical significance between ancestry groups when assessing progression. We tested the hypotheses that (i) bPPA enlargement during follow-up is also more frequent in AD eyes and (ii) the presence of bPPA at baseline and its enlargement are associated with faster VF progression in both groups.

Methods : From the ADAGES, 814 eyes of AD (395) and ED (421) patients with glaucoma diagnosis and who had at least one follow-up disc photo were included. Two graders masked to clinical and race data reviewed the baseline and last disc photos and graded them for the presence of bPPA at baseline and ‘bPPA progression’ (development or enlargement). We investigated the relationships between (i) the presence of bPPA at baseline and ancestry group, (ii) presence of bPPA at baseline and rates of VF progression; and (iii) bPPA progression and VF progression. Mixed-effects linear models were tested with VF mean deviation as dependent variable and ‘Time’ (alone and with interaction terms) as independent variables. Interaction terms (‘Race*Baseline bPPA’ and ‘Race*bPPA Progression’) were included to test the hypothesis that the relationship between baseline bPPA and bPPA progression vs. rates of VF progression differ between ancestry groups.

Results : AD eyes were more likely to have bPPA at baseline than ED eyes (OR=1.34, 95% CI=1.07 to 1.69, P=0.011), even though bPPA progression was less common in AD eyes (OR=0.43, 95% CI=0.24 to 0.75, P= 0.003). bPPA at baseline was associated with faster VF progression in ED but not AD eyes (β=-0.07, 95% CI= -0.13 to -0.01, P=0.014). Similarly, bPPA progression was associated with faster VF progression in ED eyes only (β= -0.13, 95% CI=-0.25 to -0.008, P=0.036).

Conclusions : Despite greater frequency of bPPA in AD patients with glaucoma, its presence at baseline and enlargement during follow-up were associated with faster VF progression in ED but not AD eyes. These findings suggest different clinical implications of bPPA and bPPA progression in ED and AD patients.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.

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