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Editors Selection IGR 15-4

Clinical Examination Methods: Peripapillary atrophy

Comment by Jost Jonas on:

51898 Topographic Correlation between β-Zone Parapapillary Atrophy and Retinal Nerve Fiber Layer Defect, Cho BJ; Park KH, Ophthalmology, 2013; 120: 528-534

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Cho et al. from Korea investigated whether a spatial correlation exists between beta zone of parapapillary atrophy and retinal nerve fiber layer (RNFL) defects. In a retrospective, cross-sectional study, optic disc photographs of 128 consecutive patients (128 eyes) with primary open-angle glaucoma and a single localized RNFL defect were examined. The authors found that 82 (64%) eyes with a single localized RNFL defect had beta zone; that the maximum radial extent of beta zone and the RNFL defect were located in the same hemifield in 88% of eyes; and that correspondingly the angular location of the RNFL defect showed a linear correlation with the location of the maximal extent of beta zone. The authors concluded that in primary open-angle glaucoma, a localized RNFL defect is spatially correlated with beta zone. Confirming previous hospital studies on Caucasians, this study emphasizes the importance of the association between beta zone and glaucoma. As all previous investigations, the present study could however not give clues for the pathogenesis on the spatial (and temporal) correlation beta zone and glaucoma. Recent histomorphometric investigations and clinical studies applying optical coherence tomography of the optic nerve head showed a differentiation of the conventional beta zone (which was also examined in the present study) into a 'new' beta defined as the presence of Bruch's membrane and absence of retinal pigment epithelium, and a new gamma zone defined as the absence of Bruch's membrane. Interestingly, new' beta zone was mainly correlated with glaucoma, while gamma zone was associated mostly with axial myopia. It may raise the question whether the differentiation between 'new' beta zone and gamma zone, up to now summarized into 'old' beta zone, may further increase the statistical strength of the association between glaucoma and 'new' beta zone in clinical practice and may perhaps help to elucidate the pathogenesis.

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