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R. M. St Clair, C. Fraser, J. R. Ehrlich, N. M. Radcliffe; Peripapillary Atrophy is Associated With Glaucoma in Whites, Blacks, and Hispanics, Independent of Race. Invest. Ophthalmol. Vis. Sci. 2010;51(13):3989.
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Peripapillary atrophy (PPA) is associated with glaucoma 1. Black and Hispanic races have higher prevalences of glaucoma 2. We sought to evaulate the relationship between peripapillary atrophy (PPA) and glaucoma in a group of white, black, and Hispanic patients.
410 patients under evaluation for glaucoma were considered for inclusion in this retrospective study. Of those, 261 patients (475 eyes) had at least one reliable field and were included. Each patient had optic nerve stereophotographs, a full ophthalmic examination, and 24-2 SITA standard automatic perimetry with the Humphrey Field Analyzer II. Optic nerve stereophotographs were evaluated by a single masked observer for total and ß PPA clock hours, ß -PPA percent width of the optic disc, presence/absence of ß-PPA in each disc quadrant, and a 0-3 ordinal rating of total PPA. Logistic models were fit to determine odds ratios (ORs) of abnormal glaucoma hemifield test (GHT) as a function of PPA and race.
PPA varied significantly by race. Compared to whites (n=83), blacks (n=82) and Hispanics (n=96) were significantly less likely have a higher ordinal rating of total PPA (OR blacks: 0.50, Hispanics: 0.62; p≤0.05) and had less clock hours of ß-PPA (p<0.01). PPA is associated with glaucoma, defined by an abnormal GHT: patients with at least 5 total clock hours of PPA, or superior, inferior or nasal ß-PPA were more likely to have an abnormal GHT (p≤0.05). Blacks were somewhat more likely than whites to have an abnormal GHT (OR=1.65, p=0.07), as well as worse MD (p≤0.05); these relationships were not significant for Hispanics compared to whites (p≥0.1).The relationship between PPA and abnormal GHT was not modified by race (p>0.05 for interaction terms): the OR (and 95% CI) of abnormal GHT for patients with a higher ordinal rating of total PPA was 2.63 (1.35, 5.10) for whites, 2.02 (0.99, 4.15) for blacks, and 2.05 (0.72, 5.90) for Hispanics.Race did not confound the relationship between PPA and abnormal GHT:the odds ratio of having an abnormal GHT for patients with 10-12 clock hours of ß -PPA was 3.51 (1.78, 6.92) and was reduced by only 7% when adjusting for race.
Whites are significantly more likely than Hispanics and blacks to have PPA. However, the association between PPA & glaucoma is similar across races. PPA relates to glaucoma independent of the patient's race.1. Jonas JB. Clinical implications of peripapillary atrophy inglaucoma. Curr Opin Ophthalmol. 2005 Apr;16:84-8.2. Varma R, et al. Prevalence of open-angle glaucoma and ocularhypertension in Latinos: the Los Angeles Latino Eye Study.Ophthalmology. 2004 Aug;11:1439-48
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