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C. C. Teng, C. G. V. De Moraes, T. S. Prata, C. A. Liebmann, C. Tello, R. Ritch, J. M. Liebmann; The Region of Largest Beta-Zone Parapapillary Atrophy Area Predicts the Location of Most Rapid Visual Field Progression. Invest. Ophthalmol. Vis. Sci. 2010;51(13):2979.
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In cross-sectional assessments, the region of largest beta-zone parapapillary atrophy (b-PPA) often corresponds spatially to a region of visual field (VF) damage. We investigated whether the most rapid VF progression occurs in this region.
Treated glaucoma patients with >= 9 SITA-Standard 24-2 VFs in either eye from 1999-2008 were identified. Eyes with optic disc photographs, HRT imaging, at least 5 VFs following the HRT, <6 D myopia, b-PPA, and VF progression were studied. b-PPA was defined as a region of chorioretinal atrophy with visible sclera and choroidal vessels adjacent to the optic disc. Using stereophotographs, the disc region (superior vs inferior) with largest amount of b-PPA was identified. Baseline ocular parameters and patient demographics were recorded. VF progression was defined using pointwise linear regression as the presence of a test point with a slope of sensitivity over time >1.0 dB loss/year (P< 0.01). For edge points, a stricter slope criterion of >2.0 dB loss/year (P< 0.01) was used. If both hemifields progressed, we chose the hemifield with fastest rate of progression.
We enrolled 94 eyes (94 patients; mean age, 71.7±12.9 yrs) with b-PPA and VF progression. Mean values were: baseline IOP, 18.3±4.8 mmHg; CCT, 537±41 um; VF mean deviation, -4.8±3.8 db; disc area, 1.95±0.46 mm2; b-PPA area, 0.86±0.65 mm2; b-PPA area/disc area ratio, 0.45±0.36; rim area, 1.06±0.43 mm2 and rim area/disc area ratio, 0.56±0.23. The mean rate of VF progression was 0.93±0.69 dB/yr. 60 patients (64%) had more b-PPA in the inferior disc region and 34 (36%) in the superior disc region. 63 patients (67%) had fastest VF progression in the superior hemifield and 31 (33%) in the inferior hemifield. The location of most rapid VF progression was consistent with the location of largest b-PPA in 63 (67%) patients (p = 0.012; Fisher’s Exact test, Cohen’s Kappa = 0.27; 95% CI [0.07 - 0.47]; p =0.008).
In treated glaucoma eyes with b-PPA, the location of most rapid VF progression is likely to occur in the location of largest amount of b-PPA.
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