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J. R. Ehrlich, S. J. Haseltine, M. C. Shammas, N. M. Radcliffe; The Role of Clinical Parapapillary Atrophy Evaluation in the Detection of Glaucomatous Visual Field Defects. Invest. Ophthalmol. Vis. Sci. 2010;51(13):4886.
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Parapapillary atrophy (PPA) is a form of chorioretinal atrophy that abuts the optic disc and may be detected by stereoscopic examination of the optic nerve. PPA has been reported to be helpful in differentiating between normal and glaucomatous eyes . We sought to determine whether inclusion of PPA parameters as part of a standard glaucoma evaluation improves the prediction of glaucomatous visual field loss.
Of 410 consecutive patients under evaluation for glaucoma, 294 patients with 540 eyes had a reliable visual field (VF) and were included in this study. Each patient had a full ophthalmologic exam, including digital stereophotography of the fundus through dilated pupils and 24-2 SITA-standard automatic perimetry with the Humphrey Field Analyzer II. A single masked observer evaluated optic disc stereophotos for PPA parameters, including: total PPA clock hours, ß-PPA clock hours, ß-PPA width, 0-3 ordinal rating of total PPA, and presence/absence of ß-PPA in each disc quadrant. Logistic models were fit to determine odds ratios (ORs) of abnormal glaucoma hemifield test (GHT) as a function of PPA.
Increasing total clock hours, ß-clock hours, and total PPA rating, as well as presence of ß-PPA in the superior, inferior and nasal quadrants were associated with significantly increased odds of abnormal GHT (p<0.05). However, when cup-to-disc ratio (CDR), intraocular pressure (IOP), central corneal thickness (CCT), age and race were adjusted for, PPA variables were no longer significantly associated with increased odds of abnormal GHT. Increasing CDR and age remained significantly associated with abnormal GHT in all multivariable models (p<0.05).
PPA is associated with abnormal GHT in a population of patients under evaluation for glaucoma. However, PPA does not improve prediction of glaucomatous VF loss when commonly recorded variables such as CDR, CCT, IOP, age and race are already known. Increasing CDR and age are most consistently associated with abnormal GHT in multivariable models.
 Jonas JB, Naumann GO. Parapapillary chorioretinal atrophy in normal and glaucoma eyes. II. Correlations. Invest Ophthalmol Vis Sci 1989;30:919-26.
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