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Editors Selection IGR 12-2

Progression: Beta zone and progression

Goji Tomita

Comment by Goji Tomita on:

26149 Beta-Zone parapapillary atrophy and the velocity of glaucoma progression, Teng CC; De Moraes CG; Prata TS et al., Ophthalmology, 2010; 117: 909-915

See also comment(s) by Douglas Anderson


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Reported factors for the onset and progression of open-angle glaucoma include older age, African descent, larger vertical cup-to-disc ratio, thinner central corneal thickness, higher intraocular pressure (IOP), exfoliation syndrome, and disc hemorrhage. However, whether the presence, absence, or size of the beta-zone parapapillary atrophy (PPA) could help provide predictive information about future glaucoma progression was not completely cleared. A large beta-zone PPA reportedly may be taken as a relative indicator for an increased risk of further progression of glaucoma. It was also reported that PPA-to-disc area ratio, cup-to-disc ration, and IOP significantly influence the progression of visual field (VF) damage in normal-tension glaucoma. Teng et al. (579) retrospectively investigated and compared the rate and risk of glaucomatous VF progression in eyes with and without beta-zone PPA at the time of baseline assessment. They found that eyes with beta-zone PPA progressed more rapidly (-0.84 dB/yrs) than eyes without it (-0.51 dB/yrs). A significant influence of presence of beta-zone PPA (hazard ratio, 2.59) as well as mean IOP and IOP fluctuation was also detected by multivariate regression. Although retrospective, their study gives specific progression values for beta-zone PPA eyes for the first time, and it was confirmed that beta-zone PPA is an important risk factor for glaucoma progression. Since eyes with beta-zone PPA reach progression endpoints more rapidly and have faster global rates of progression, in addition to optic disc and retinal nerve fiber layer, the structural assessment of the glaucomatous eye may have to include parapapillary retina and choroid to determine more accurately the risk for disease progression.



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