The region of largest β-zone parapapillary atrophy area predicts the location of most rapid visual field progression

Purpose: To determine if visual field (VF) progression occurs most rapidly in the region of largest β-zone parapapillary atrophy (PPA).

Design: Retrospective cohort.

Participants: One hundred twenty-five patients from the New York Glaucoma Progression Study with both β-zone PPA and VF progression.

Methods: Treated open-angle glaucoma patients with 8 or more Swedish Interactive Threshold Algorithm Standard 24-2 VFs (Humphrey Field Analyzer II; Carl Zeiss Meditec, Inc., Dublin, CA) in either eye were identified. Eyes with optic disc photographs, β-zone PPA, less than 6 diopters myopia, and VF progression were studied. Visual field progression was defined using trend analysis as the presence of at least 2 adjacent progressing points in the same hemifield using standard pointwise linear regression (PLR) criteria.

Main outcome measures: The correlation between β-zone PPA and location of most rapid future VF progression.

Results: One hundred twenty-five eyes (125 patients; mean age, 71.9 ± 12.3 years; 58% women; 75% European descent) with β-zone PPA and VF progression were enrolled. The mean follow-up was 6.8 ± 1.7 years and the mean number of VFs was 12.5 ± 3.6. Ninety-three patients (74%) had more β-zone PPA inferiorly and 32 patients (26%) had more β-zone PPA superiorly. The fastest VF progression occurred in the superior hemifield in 77 patients (62%) and in the inferior hemifield in 48 (38%) patients. Patients with superior VF progression had a superior localized mean rate of progression of -1.57 ± 1.7 dB/year, and patients with inferior VF progression had an inferior localized mean rate of -0.94 ± 1.4 dB/year (P = 0.012). The mean number of points reaching the predefined PLR end points was 5.6±7.5 for the superior VF hemifield and 3.0±4.9 for the inferior hemifield (P = 0.006). The hemifield with more points reaching PLR progression end points, with fastest average velocity of progression, or both was spatially consistent with the location of largest β-zone PPA in 89 (71%) patients (P = 0.0001, Fisher exact test; κ = 0.35; 95% confidence interval, 0.17-0.53).

Conclusions: In treated glaucoma patients with β-zone PPA and VF progression, the location of largest β-zone PPA typically correlates spatially with the region of the most rapid future VF progression.

Financial disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.