Can Baseline Parapapillary Atrophy Morphology Predict Future Glaucoma Progression?—An OCT Glaucoma Imaging Study

• Published in: American journal of ophthalmology 2024-11, Vol.267, p.19-29
• Main Authors: HUH, MIN GU, JEONG, YOON, SHIN, YOUNG IN, PARK, KI HO, JEOUNG, JIN WOOK
• Format: Article
• Language: English
• Subjects: Adult; Aged; Disease Progression; Female; Follow-Up Studies; Glaucoma, Open-Angle - diagnosis; Glaucoma, Open-Angle - physiopathology; Humans; Intraocular Pressure - physiology; Male; Middle Aged; Nerve Fibers - pathology; Optic Atrophy - diagnosis; Optic Disk - diagnostic imaging; Optic Disk - pathology; Retinal Ganglion Cells - pathology; Retrospective Studies; Tomography, Optical Coherence - methods; Visual Field Tests; Visual Fields - physiology
• ISSN: 0002-9394; 1879-1891; 1879-1891
• DOI: 10.1016/j.ajo.2024.05.032

To investigate glaucoma progression based on Optical Coherence Tomography (OCT) Guided Progression Analysis (GPA) according to baseline β-zone parapapillary atrophy (PPA) morphology in glaucoma patients. Retrospective cohort study. Patients over 20 years of age who had been diagnosed with primary open-angle glaucoma (POAG) at Seoul National University Hospital, Seoul, Korea between 2010 and 2020. This study included POAG patients with a minimum of 5 years of follow-up. We quantitatively measured the baseline β-zone PPA parameters, classified β-zone PPA morphology according to new classification standard we created and analyzed the corresponding GPA progression of the retinal nerve fiber layer (RNFL). A total of 210 patients with POAG (mean age: 53.8 years) were enrolled in the study. The mean follow-up period was 9.8 years. The average value of the baseline mean deviation in visual field perimetry was -2.48 dB. Longer radial extent and larger angular extent of β-zone PPA were significantly associated with progression on GPA, as was the presence of disk hemorrhage. Among the 4 classified β-zone PPA morphologies (Crescent type 1 & 2, Solar-eclipse type 1 & 2), the Solar-eclipse type 2 group showed the highest progression. A Kaplan-Meier survival analysis demonstrated significant differences among the 4 types. The larger the radial and angular extents of β-zone PPA, the more progression that was shown on OCT GPA. Furthermore, significant differences in progression were noted based on the morphological type of β-zone PPA. Our findings indicate that baseline β-zone PPA parameters and morphology are valuable predictors of future glaucoma progression.