The role of clinical parapapillary atrophy evaluation in the diagnosis of open angle glaucoma

Joshua R Ehrlich, Nathan M RadcliffeDepartment of Ophthalmology, Weill Cornell Medical College, New York, NY, USAPurpose: To determine if clinical evaluation of parapapillary atrophy (PPA) significantly improves the ability to distinguish open-angle glaucoma (OAG) patients from glaucoma suspects.Met...

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Autores principales:	Joshua R Ehrlich, Nathan M Radcliffe
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2010
Materias:	Ophthalmology RE1-994
Acceso en línea:	https://doaj.org/article/64fa46b75f1045f5b607b88a15bf77f9
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spelling	oai:doaj.org-article:64fa46b75f1045f5b607b88a15bf77f92021-12-02T07:34:23ZThe role of clinical parapapillary atrophy evaluation in the diagnosis of open angle glaucoma1177-54671177-5483https://doaj.org/article/64fa46b75f1045f5b607b88a15bf77f92010-08-01T00:00:00Zhttp://www.dovepress.com/the-role-of-clinical-parapapillary-atrophy-evaluation-in-the-diagnosis-a5130https://doaj.org/toc/1177-5467https://doaj.org/toc/1177-5483Joshua R Ehrlich, Nathan M RadcliffeDepartment of Ophthalmology, Weill Cornell Medical College, New York, NY, USAPurpose: To determine if clinical evaluation of parapapillary atrophy (PPA) significantly improves the ability to distinguish open-angle glaucoma (OAG) patients from glaucoma suspects.Methods: Patients in this study were under evaluation for glaucoma and had open angles, at least one reliable 24-2 SITA-standard automatic perimetry, and digital stereophotographs of the optic disc. PPA was identified clinically as a parapapillary region of absent (&beta;PPA) or hyper/hypopigmented (&alpha;PPA) retinal pigment epithelium. A single masked observer evaluated photos for: vertical cup-to-disc ratio (CDR), clock hours of total and &beta;PPA, &beta;PPA as percentage width of the optic disc, presence or absence of &beta;PPA at each disc quadrant, and ordinal rating of total PPA. Generalized linear models were used to determine odds of an abnormal or borderline glaucoma hemifield test (GHT) as a function of PPA variables and covariates; model fit was assessed using the log-likelihood ratio test.Results: Of 410 consecutive patients, 540 eyes (of 294 patients) met inclusion criteria. Mean age was greater among patients with abnormal compared with normal GHT (P &lt; 0.001), but sex and race/ethnicity did not differ between groups (P &ge; 0.22). Age, central corneal thickness (CCT) and CDR (P &le; 0.006), but not intraocular pressure (IOP) (P = 0.71), were significant univariable predictors of the odds of an abnormal GHT. All PPA parameters significantly &shy;predicted GHT (P &le; 0.03), except presence of temporal &beta;PPA (P = 0.25). Adjustment for age, CCT, IOP, and CDR reduced the association between PPA and GHT, and model fit was not greatly improved by addition of PPA variables.Conclusions: Addition of most PPA parameters to a model already containing commonly assessed variables including age, CCT, IOP, and CDR does not significantly improve the ability to distinguish OAG patients from glaucoma suspects.Keywords: glaucoma, visual fields, parapapillary atrophy, optic nerve Joshua R EhrlichNathan M RadcliffeDove Medical PressarticleOphthalmologyRE1-994ENClinical Ophthalmology, Vol 2010, Iss default, Pp 971-976 (2010)
institution	DOAJ
collection	DOAJ
language	EN
topic	Ophthalmology RE1-994
spellingShingle	Ophthalmology RE1-994 Joshua R Ehrlich Nathan M Radcliffe The role of clinical parapapillary atrophy evaluation in the diagnosis of open angle glaucoma
description	Joshua R Ehrlich, Nathan M RadcliffeDepartment of Ophthalmology, Weill Cornell Medical College, New York, NY, USAPurpose: To determine if clinical evaluation of parapapillary atrophy (PPA) significantly improves the ability to distinguish open-angle glaucoma (OAG) patients from glaucoma suspects.Methods: Patients in this study were under evaluation for glaucoma and had open angles, at least one reliable 24-2 SITA-standard automatic perimetry, and digital stereophotographs of the optic disc. PPA was identified clinically as a parapapillary region of absent (&beta;PPA) or hyper/hypopigmented (&alpha;PPA) retinal pigment epithelium. A single masked observer evaluated photos for: vertical cup-to-disc ratio (CDR), clock hours of total and &beta;PPA, &beta;PPA as percentage width of the optic disc, presence or absence of &beta;PPA at each disc quadrant, and ordinal rating of total PPA. Generalized linear models were used to determine odds of an abnormal or borderline glaucoma hemifield test (GHT) as a function of PPA variables and covariates; model fit was assessed using the log-likelihood ratio test.Results: Of 410 consecutive patients, 540 eyes (of 294 patients) met inclusion criteria. Mean age was greater among patients with abnormal compared with normal GHT (P &lt; 0.001), but sex and race/ethnicity did not differ between groups (P &ge; 0.22). Age, central corneal thickness (CCT) and CDR (P &le; 0.006), but not intraocular pressure (IOP) (P = 0.71), were significant univariable predictors of the odds of an abnormal GHT. All PPA parameters significantly &shy;predicted GHT (P &le; 0.03), except presence of temporal &beta;PPA (P = 0.25). Adjustment for age, CCT, IOP, and CDR reduced the association between PPA and GHT, and model fit was not greatly improved by addition of PPA variables.Conclusions: Addition of most PPA parameters to a model already containing commonly assessed variables including age, CCT, IOP, and CDR does not significantly improve the ability to distinguish OAG patients from glaucoma suspects.Keywords: glaucoma, visual fields, parapapillary atrophy, optic nerve
format	article
author	Joshua R Ehrlich Nathan M Radcliffe
author_facet	Joshua R Ehrlich Nathan M Radcliffe
author_sort	Joshua R Ehrlich
title	The role of clinical parapapillary atrophy evaluation in the diagnosis of open angle glaucoma
title_short	The role of clinical parapapillary atrophy evaluation in the diagnosis of open angle glaucoma
title_full	The role of clinical parapapillary atrophy evaluation in the diagnosis of open angle glaucoma
title_fullStr	The role of clinical parapapillary atrophy evaluation in the diagnosis of open angle glaucoma
title_full_unstemmed	The role of clinical parapapillary atrophy evaluation in the diagnosis of open angle glaucoma
title_sort	role of clinical parapapillary atrophy evaluation in the diagnosis of open angle glaucoma
publisher	Dove Medical Press
publishDate	2010
url	https://doaj.org/article/64fa46b75f1045f5b607b88a15bf77f9
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The role of clinical parapapillary atrophy evaluation in the diagnosis of open angle glaucoma

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