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 beta-zone parapapillary atrophy (PPA). Design: Retrospective cohort. Participants: One hundred twenty-five patients from the New York Glaucoma Progression Study with both beta-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, beta-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 beta-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 beta-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 beta-zone PPA inferiorly and 32 patients (26%) had more beta-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 beta-zone PPA in 89 (71%) patients (P = 0.0001, Fisher exact test; kappa = 0.35; 95% confidence interval, 0.17-0.53). Conclusions: In treated glaucoma patients with beta-zone PPA and VF progression, the location of largest beta-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. Ophthalmology 2011; 118: 2409-2413 (C) 2011 by the American Academy of Ophthalmology.