title: The region of largest β-zone parapapillary atrophy area predicts the location of most rapid visual field progression.
abstract: OBJECTIVE
  To determine if visual field (VF) progression occurs most rapidly in the region of largest β-zone parapapillary atrophy (PPA).
  
  
  METHODS
  Retrospective cohort.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  BACKGROUND
  The author(s) have no proprietary or commercial interest in any materials discussed in this article.
authors: Einhorn Clinical Research Center, New York Eye and Ear Infirmary, New York, New York, USA.
authors: Christopher C
authors: CC
authors: Teng
authors: Carlos Gustavo
authors: CG
authors: De Moraes
authors: Tiago S
authors: TS
authors: Prata
authors: Craig A
authors: CA
authors: Liebmann
authors: Celso
authors: C
authors: Tello
authors: Robert
authors: R
authors: Ritch
authors: Jeffrey M
authors: JM
authors: Liebmann
mesh_terms: D000368:Aged; D000465:Algorithms; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D005902:Glaucoma, Open-Angle / Q000175:diagnosis*; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D009896:Optic Atrophy / Q000175:diagnosis*; D009898:Optic Disk / Q000473:pathology*; D012189:Retrospective Studies; D014786:Vision Disorders / Q000175:diagnosis*; D058609:Visual Field Tests; D014794:Visual Fields