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

Abstract

PurposeTo 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. DesignRetrospective cohort study. MethodsPatients 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). ResultsA 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 disc 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. ConclusionsThe 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.