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Rohith Voora, Mohamad Moghadam, Jason Han Lee, Christopher Bowd, James Proudfoot, Sasan Moghimi, Patricia Isabel C Manalastas, Mark Christopher, Jeffrey M Liebmann, Christopher A Girkin, Robert N Weinreb, Akram Belghith, Linda M Zangwill; Beta and Gamma Parapapillary Atrophy (PPA) Zone Areas in Myopic Eyes With and Without Glaucoma. Invest. Ophthalmol. Vis. Sci. 2019;60(9):5550. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Anatomical characteristics including tilting and torsion of the optic nerve head (ONH) often confound accurate detection of glaucoma in myopes by clinical examination or stereophotograph assessment. We sought to determine if b-PPA with intact Bruch’s membrane and g-PPA without intact Bruch’s membrane measured using optical coherence tomography can differentiate between myopic eyes with and without glaucoma.
Cross sectional data from 189 eyes of 123 glaucoma patients and 45 eyes of 25 controls without glaucoma from the Diagnostic Innovations in Glaucoma Study (DIGS) and African Descent and Glaucoma Evaluation Study (ADAGES) were included. b- and g-PPA areas were manually delineated on individual Spectralis optic nerve head radial B-scans using custom software and Bruch’s membrane opening (BMO) points were software generated and corrected if automated placement was inaccurate. Univariable and multivariable analyses were used to assess whether b- and g-PPA areas can differentiate between glaucoma and healthy eyes in general, and in a myopic subset of 29 normal and 170 glaucoma eyes (axial length > 24 mm).
The mean (95% CI) visual field (VF) mean deviation (MD) of the glaucoma patients was -7.10 dB (-8.16, -6.05 dB). Larger b-PPA area was significantly associated with more severe VF damage (p=0.04) but was not significantly larger in glaucoma eyes compared to control eyes (mean (95% CI) = 1.06 mm2 (0.94, 1.17 mm2) and 0.81 mm2 (0.64, 0.98 mm2) respectively; p= 0.107). g-PPA area was not associated with VF MD and did not differ in glaucoma eyes compared to control eyes (mean (95% CI) 0.15 mm2 (0.06, 0.24 mm2) and 0.17 mm2 (0.13, 0.22 mm2) respectively; p=0.630). In the myopic subset of 170 eyes of 100 glaucoma patients and 29 eyes of 18 controls without glaucoma neither b- nor g-PPA area was significantly associated with a diagnosis of glaucoma or severity of the disease measured by VF MD (all p-values >0.05).
In this study population with a range of refractive error, b-PPA area but not g-PPA area was significantly associated with severity of visual field damage. However, in the myopic subset of eyes, b-PPA area alone did not discriminate between myopic eyes with and without glaucoma and was not significantly associated with VF MD and therefore is of limited value for glaucoma detection.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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