Morphologic predictive factors for development of optic disc hemorrhages in glaucoma

PURPOSE: To evaluate which optic disc parameters are predictive factors for the development of disc hemorrhages in chronic open-angle glaucoma. METHODS: The prospective comparative clinical observational study included 432 eyes of 281 white patients with chronic open-angle glaucoma. Mean follow-up time was 38.8 months (median, 31.5). Eyes in the whole study group were divided into those with an optic disc hemorrhage during the follow-up period (hemorrhagic group; n = 38; 8.8%), those without disc hemorrhages and with neuroretinal rim loss as sign of progression of glaucoma (rim loss group; n = 42; 9.7%), and those with neither disc hemorrhages nor neuroretinal rim loss (stable group; n = 352; 81.5%). Color stereo optic disc photographs were obtained repeatedly in all patients and subjected to qualitative and morphometric evaluation. RESULTS: At baseline, neuroretinal rim area was significantly (P < 0.03) smaller and the beta zone of parapapillary atrophy (temporal lower sector) was significantly (P < 0.03) larger in the hemorrhagic group than in the stable group. Both study groups did not vary significantly (P > 0.05) in optic disc size and shape, optic cup depth, alpha zone of parapapillary atrophy, and retinal vessel diameter. In multivariate analysis, the neuroretinal rim area was the only significant predictor of hemorrhages. The hemorrhagic group and the rim loss group did not differ significantly (P > 0.05) in any optic disc parameter measured. CONCLUSIONS: In chronic open-angle glaucoma, morphologic predictive factors for the development of disc hemorrhages are small size of neuroretinal rim and, possibly, a large parapapillary beta zone. Development of disc hemorrhages is independent of optic disc size and shape, size of alpha zone of parapapillary atrophy, retinal vessel diameter, and optic cup depth. Optic nerve heads in eyes with eventual development of disc hemorrhages and in eyes with eventual progressive rim loss without observed disc hemorrhages do not differ markedly in appearance.     

Optic disc morphology in pigmentary glaucoma

AIM—To evaluate the morphology of the optic nerve head in eyes with pigmentary glaucoma.
METHODS—Colour stereo optic disc photographs of 62 patients with pigmentary glaucoma and 566 patients with primary open angle glaucoma were morphometrically evaluated. By prestudy selection, mean visual field defect and neuroretinal rim area were not significantly different between the two groups (p=0.89 and p=0.45).
RESULTS—The pigmentary glaucoma group did not vary significantly (p >0.10) from the primary open angle glaucoma group in size and shape of the optic disc, configuration of neuroretinal rim, depth of optic cup, area of alpha zone of parapapillary atrophy, diameter of retinal vessels at the disc border, and frequency of disc haemorrhages and localised retinal nerve fibre layer defects. The beta zone of parapapillary atrophy was slightly, but not statistically significantly (p=0.06), smaller in the pigmentary glaucoma group. The mean maximal intraocular pressure and mean intraocular pressure amplitude were significantly (p<0.001) higher in the pigmentary glaucoma group.
CONCLUSIONS—In contrast with the characteristic morphology of the anterior segment and despite significantly higher intraocular pressure peaks and a larger pressure amplitude, eyes with pigmentary glaucoma compared with eyes with primary open angle glaucoma do not show a pathognomonic morphology of the optic disc and retinal nerve fibre layer. The slightly smaller beta zone of parapapillary atrophy may correspond to higher intraocular pressure in pigmentary glaucoma.

Keywords: optic disc morphology; pigmentary glaucoma; secondary open angle glaucoma     

Optic nerve head appearance in juvenile-onset chronic high-pressure glaucoma and normal-pressure glaucoma

OBJECTIVE: To evaluate the appearance of the optic nerve head in chronic high-pressure glaucoma and normal-pressure glaucoma. DESIGN: Clinic-based cross-sectional study. PARTICIPANTS: The study included 52 eyes with normal-pressure glaucoma and 28 eyes with juvenile-onset primary open-angle glaucoma that served as models for chronic high-pressure glaucoma. METHODS: Color stereo optic disc photographs and wide-angle retinal nerve fiber layer photographs were morphometrically examined. MAIN OUTCOME MEASURES: Localized retinal nerve fiber layer defects; parapapillary chorioretinal atrophy; disc hemorrhages; optic cup shape; retinal arteriole narrowing. RESULTS: Both study groups did not vary significantly in count of localized retinal nerve fiber layer defects, size of parapapillary atrophy, optic cup depth, steepness of disc cupping, rim/disc area ratio, diameter of retinal arterioles, and frequency and degree of focal retinal arteriole narrowing. In normal-pressure glaucoma versus juvenile open-angle glaucoma, localized retinal nerve fiber layer defects were significantly broader, disc hemorrhages were found significantly more often and were larger, and neuroretinal rim notches were present more frequently and were deeper. CONCLUSIONS: Chronic high-pressure glaucoma and normal-pressure glaucoma show morphologic similarities in the appearance of the optic nerve head. The lower frequencies of detected disc hemorrhages and rim notches in high-pressure glaucoma may be due to a smaller size of hemorrhages and localized retinal nerve fiber layer defects in high-pressure glaucoma. Both glaucoma types have morphologic features in common, suggesting that they may possibly belong to a spectrum of the same pathologic process.     

Central retinal vessel trunk exit and location of glaucomatous parapapillary atrophy in glaucoma

OBJECTIVE: To evaluate whether the position of the central retinal vessel trunk exit on the lamina cribrosa spatially correlates with the location of parapapillary atrophy in glaucoma. DESIGN: Clinic-based, observational, cross-sectional study. PATIENTS: Color stereo optic disc photographs of 95 patients with primary or secondary open-angle glaucoma and 65 healthy persons were morphometrically evaluated. The intrapapillary and parapapillary region was divided into four quadrants. We determined the position of the central retinal vessel trunk exit on the lamina cribrosa surface and measured the area of parapapillary atrophy and neuroretinal rim in the four quadrants. MAIN OUTCOME MEASURES: The area of neuroretinal rim and parapapillary atrophy and the position of the central retinal vessel trunk exit. RESULTS: Comparing measurements between opposite disc quadrants showed that beta zone of parapapillary atrophy was significantly (P < 0.05) larger and that the neuroretinal rim was significantly smaller when beta zone and neuroretinal rim were measured in the disc quadrant most distant to the central retinal vessel trunk exit, than if the beta zone and neuroretinal rim were measured in the quadrant containing the vessel trunk exit. Comparing measurements in the disc quadrants between eyes with different positions of the central retinal vessel trunk exit revealed that, in the respective disc quadrant, the beta zone was significantly larger and the neuroretinal rim was smaller in eyes with the vessel trunk exiting in the opposite disc quadrant than in eyes with the vessel trunk exit located in the respective disc quadrant where the measurements were obtained. CONCLUSIONS: Position of the central retinal vessel trunk exit on the lamina cribrosa influences the location of parapapillary atrophy in glaucoma. The longer the distance to the central retinal vessel trunk exit, the more enlarged is parapapillary atrophy and the smaller is the neuroretinal rim. This relationship agrees with the spatial relationship between glaucomatous neuroretinal rim loss and enlarged parapapillary atrophy in glaucoma. Diagnostically, it may indicate that, in eyes with an abnormal configuration of parapapillary atrophy or with an abnormal position of the central retinal vessel trunk exit, early glaucomatous rim changes should be looked for in the disc sector that is most distant to the central retinal vessel trunk exit and where parapapillary atrophy may be relatively large.     

Predictive factors of the optic nerve head for development or progression of glaucomatous visual field loss

PURPOSE: To evaluate which morphologic features of the optic disc are predictive factors for the development or progression of visual field loss in chronic open-angle glaucoma. METHODS: The prospective observational clinical study included 763 eyes of 416 white subjects with ocular hypertension and chronic open-angle glaucoma. During the follow-up time (mean, 67.4 months; median, 65.1; range, 6.2-104.5), all patients underwent repeated qualitative and morphometric evaluation of color stereo optic disc photographs and white-on-white visual field examination. Progression of glaucomatous visual field damage was defined by point-wise regression analysis for each of the 59 locations in the visual field. Outcome measures were qualitative and quantitative morphologic optic nerve head parameters. RESULTS: Development or progression of glaucomatous visual field defects was detected in 106 (13.9%) eyes. At baseline of the study, neuroretinal rim area was significantly (P < 0.002) smaller, the beta zone of parapapillary atrophy (P < 0.003, nasal sector) was significantly larger, and age was significantly higher (P < 0.003) in the progressive study group than in the nonprogressive study group. Both study groups did not vary significantly in size of the optic disc and the alpha zone of parapapillary atrophy. Cox proportional hazard regression analysis revealed that the progression of glaucomatous visual field loss depended significantly on the area of the neuroretinal rim (P < 0.001) and age (P < 0.001), but was independent of diameter of the retinal arterioles and veins. CONCLUSIONS: Morphologic predictive factors for development or progression of glaucomatous visual field defects in whites are small neuroretinal rim area and large beta zone of parapapillary atrophy. Age is an additional nonmorphologic parameter. Progression of glaucomatous optic nerve head changes is independent of the size of the optic disc and alpha-zone of parapapillary atrophy and retinal vessel diameter.     

Inter-eye differences in chronic open-angle glaucoma patients with unilateral disc hemorrhages

OBJECTIVE: Flame-shaped optic disc hemorrhages are a hallmark of glaucomatous optic neuropathy. The purpose of this study was to evaluate which parameters differ between companion eyes with and without an optic disc hemorrhage in patients with chronic open-angle glaucoma. DESIGN: Comparative (companion eye) observational case series. PATIENTS: The study included 99 white patients with bilateral chronic open-angle glaucoma and unilateral flame-shaped optic disc hemorrhages. METHODS: All patients underwent qualitative and morphometric evaluation of color stereo optic disc photographs. MAIN OUTCOME MEASURES: Size and shape of the optic disc, neuroretinal rim and parapapillary atrophy, diameter of the retinal vessels, intraocular pressure measurements, and both mean value and loss variance value of the visual field examination. RESULTS: In an intraindividual inter-eye comparison, the eyes with disc hemorrhages and the contralateral eyes without disc bleeding did not vary significantly (P > 0.20) in size and shape of the optic disc and neuroretinal rim, optic cup depth, size of alpha and beta zone of parapapillary atrophy, retinal vessel diameter, intraocular pressure measurements, refractive error, and perimetric indices. CONCLUSIONS: In bilateral chronic open-angle glaucoma, the development of unilateral optic disc hemorrhages does not depend on inter-eye differences in size and shape of the optic disc, neuroretinal rim and parapapillary atrophy, diameter of the retinal vessels, intraocular pressure measurements, or visual field loss.     

Morphology of the optic papilla in glaucoma. I. Primary open-angle glaucoma

BACKGROUND: Previous studies have shown that the chronic open-angle glaucomas form a heterogeneous spectrum of diseases which have in common an open anterior chamber angle and glaucomatous optic nerve damage. Purpose of this study was to evaluate whether the appearance of the optic disc differs among the various types of primary open-angle glaucoma. METHODS: Color stereo optic disc photographs of 683 patients with primary open-angle glaucoma (POAG), and 481 normal eyes were morphometrically evaluated. RESULTS: Morphologic characteristics of the glaucoma types were as follows: Highly myopic POAG: secondary macrodiscs with abnormal shape; shallow, flat, concentric disc cupping; low frequency of disc hemorrhages; large parapapillary atrophy or myopic crescent; medium to low intraocular pressure. Juvenile-onset POAG: Optic disc of normal size and shape; deep and steep disc cupping; low frequency of broad rim notches or large disc hemorrhages; small parapapillary atrophy; high minimal and maximal intraocular pressure measurements. Age-related atrophic POAG: Optic disc of normal size and shape; shallow, flat and concentric disc cupping; medium to low frequency of disc hemorrhages; large parapapillary atrophy; medium to low intraocular pressure. Eyes with normal-pressure glaucoma: Optic disc of normal size and shape; deep and steep cupping; relatively small parapapillary atrophy; high frequency of disc hemorrhages and rim notches. CONCLUSIONS: These characteristics in the appearance of the optic disc may be helpful for clinical diagnosis and therapy and may give pathogenetic hints.     

Parapapillary retinal vessel diameter in normal and glaucoma eyes. II. Correlations

The juxtapapillary diameters of the superior temporal and inferior temporal retinal artery and vein have been shown to be significantly smaller in glaucomatous eyes than in normal eyes. They had been measured in 473 eyes of 281 patients with chronic primary open-angle glaucoma and in 275 eyes of 173 normal subjects. In the current study the vessel diameters were correlated with intra- and parapapillary morphometric data and visual field indices. Only one eye per patient and subject was taken for statistical analysis. The retinal vessel calibers were significantly (P less than 0.001) correlated with: (1) the area of the neuroretinal rim as a whole and in four different optic disc sectors; (2) the rim width determined every 30 degrees; (3) the optic cup area and diameters; (4) the horizontal and vertical cup/disc ratios and (5) the quotient of them; (6) the retinal nerve fiber layer score; (7) the area of the parapapillary chorioretinal atrophy; and (8) the visual field indices. In the same eye the vessel caliber was smaller in that sector where the neuroretinal rim loss was highest and the retinal fiber layer score lowest. In intraindividual comparison the vessels were smaller in that eye with less neuroretinal rim tissue and lower nerve fiber layer score. No significant correlations were found with the form of the optic disc, the area of the peripapillary scleral ring, side, sex and refraction. The correlation coefficients were not significantly different when the control group was matched for age. The parapapillary retinal vessel diameter decreases with advancing glaucomatous optic nerve damage. It is correlated with morphometric intra- and parapapillary glaucomatous changes and perimetric defects.     

Small neuroretinal rim and large parapapillary atrophy as predictive factors for progression of glaucomatous optic neuropathy

PURPOSE: To evaluate which morphologic features of the optic disc are predictive factors for progressive neuroretinal rim loss in chronic open-angle glaucoma. DESIGN: Prospective, observational case series. PARTICIPANTS: The study included 394 eyes of 257 white patients with chronic open-angle glaucoma. Mean follow-up time was 31.8 months (median, 39.7 months). Progression of glaucoma was defined as loss of neuroretinal rim as detected by disc photographs. Presence of optic disc hemorrhages was not taken into account. METHODS: All patients underwent repeated qualitative and morphometric evaluation of color stereo optic disc photographs. Statistical analysis included Kaplan-Meier curves, and bivariate and multivariate Cox regression analysis adjusted for patients' ages. Dependency of left and right eyes from the same subject was taken into account. MAIN OUTCOME MEASURES: Qualitative and quantitative morphologic optic nerve head parameters. RESULTS: Progression of glaucomatous optic nerve changes was detected in 42 eyes (11%). At baseline of the study, neuroretinal rim area (total area, P = 0.03) was significantly smaller, and beta zone of parapapillary atrophy (total area, P = 0.04) was significantly larger in the progressive study group compared with the nonprogressive study group. Neither study group varied significantly in size and shape of the optic disc, optic cup depth, alpha zone of parapapillary atrophy, and diameter of the retinal arteries and veins (P > 0.05). Multiple Cox regression analysis revealed that the progression of glaucoma depended significantly on the area of the neuroretinal rim (temporal sector, P = 0.003) and beta zone of parapapillary atrophy (temporal inferior sector, P = 0.02). CONCLUSIONS: Important morphologic predictive factors for progression of the glaucomatous appearance of the optic nerve head in white persons are small size of neuroretinal rim and large area of beta zone of parapapillary atrophy. Progression of glaucomatous optic nerve head changes is independent of size and shape of the optic disc, size of alpha zone of parapapillary atrophy, retinal vessel diameter, and optic cup depth.     

Optic disc morphology in juvenile primary open-angle glaucoma

Background: The aim of the study was to evaluate whether, in primary open-angle glaucoma (POAG), patients younger than 40 years differ in optic disc morphology from patients older than 40 years. Methods: Out of a total group of 419 patients with POAG, we formed and compared two subgroups, one consisting of 37 patients with an age of less than 40 years, the other composed of 382 patients with an age equal to or more than 40 years. Both subgroups were matched for neuroretinal rim area. We examined the optic disc morphometrically using stereo disc photographs. Results: The younger subgroup, as compared to the older subgroup, showed deeper and steeper optic disc cupping, concentric emaciation of the neuroretinal rim, a significantly smaller area of parapapillary atrophy, and significantly higher maximal and minimal intraocular pressure measurements (P<0.001). The size and shape of the optic disc and the diameter of the retinal vessels at the optic disc border did not vary significantly. Conclusions: In POAG, patients younger than 40 years differ in optic disc morphology from patients older than 40 years. The younger patients with POAG have high minimal and maximal intraocular pressure readings and an optic disc morphology with deep and steep cupping, concentric loss of neuroretinal rim, and an almost unremarkable parapapillary atrophy. POAG in patients under 40 represents chronic high-pressure open-angle glaucoma with mainly diffuse optic nerve damage.Proprietary interest: none     

Parapapillary chorioretinal atrophy in normal and glaucoma eyes. II. Correlations

The parapapillary chorio-pigment-epithelio-retinal atrophy in glaucomatous eyes is significantly larger than in normal eyes. In a previous study its area and frequency have been measured in 582 eyes of 321 patients with chronic primary open-angle glaucoma and in 390 eyes of 231 normal subjects. In the current study the parapapillary changes were correlated with intrapapillary morphometric data and with perimetric indices. The parapapillary chorioretinal atrophy was significantly correlated with the neuroretinal rim area, the horizontal and vertical cup/disc ratios, the quotient of horizontal to vertical cup/disc ratio, the retinal nerve fiber layer score, and the mean visual field loss. It was larger in the same sector where the neuroretinal rim loss was more marked. The correlation coefficients were generally higher for zone "Beta," characterized by complete chorioretinal atrophy with visible large choroidal vessels and sclera, than for zone "Alpha," which showed irregular hypo- and hyperpigmentation. The parapapillary chorioretinal atrophy was correlated in location and time with the intrapapillary glaucomatous changes. It deserves attention in glaucoma diagnosis and follow-up. Its evaluation is especially valuable in eyes with small optic nerveheads (disc size less than 1.6 mm2) in which the intrapapillary glaucomatous changes occur later than the parapapillary ones.     

Parapapillary atrophy in the chronic open-angle glaucomas

· Background. A study was carried out to evaluate whether parapapillary atrophy varies among different chronic open-angle glaucomas. · Methods. The study included 625 Caucasian patients with primary open-angle glaucoma (POAG), 123 patients with secondary open-angle glaucoma (pseudoexfoliative glaucoma n=86; pigmentary glaucoma n=37), and 481 normal subjects. POAG was differentiated into highly myopic POAG (n=32), juvenile POAG (n=33), focal normal-pressure glaucoma (n=46), ”sclerotic POAG” with marked fundus tesselation (n=89), and ”ordinary POAG” comprising the remaining POAG eyes (n=425). Color stereo optic disc photographs were morphometrically evaluated. · Results. The beta zone of parapapillary atrophy was significantly larger in sclerotic POAG (1.00±1.37 mm²) than in pseudoexfoliative glaucoma (0.65±0.93 mm²), pigmentary glaucoma (0.42±0.58 mm²), ordinary POAG (0.66±1.06 mm²), and focal normal-pressure glaucoma (0.34±0.36 mm²). In ordinary POAG, the beta zone was significantly larger than in juvenile POAG (0.33±0.72 mm²). Compared with all glaucoma groups, the beta zone was significantly the smallest in the normal eyes (0.18±0.57 mm²). The alpha zone of parapapillary atrophy was significantly larger in the glaucoma groups than in the normal control group, with no significant difference between the glaucoma groups. The myopic crescent (4.11±3.42 mm²) present in the highly myopic eyes was significantly larger than the beta zone in any other group. · Conclusion. The beta zone of parapapillary atrophy varies by a factor of more than 3 between the various types of chronic primary and secondary open-angle glaucomas. This may be important diagnostically and pathogenetically. Received: 7 January 1999 Revised version received: 17 February 1999 Accepted: 18 February 1999     

Optic nerve damage in highly myopic eyes with chronic open-angle glaucoma

PURPOSE: To compare the amount of optic nerve damage in relation to intraocular pressure in highly myopic eyes with chronic open-angle glaucoma versus non-highly myopic eyes with chronic open-angle glaucoma. METHODS: The comparative clinical observational study included 1841 eyes of 1100 patients with chronic open-angle glaucoma. The highly myopic study group consisted of 25 eyes with a myopic refractive error equal to or higher than -8 diopters. It was subdivided into eyes with an optic disc size larger than 2.7 mm2 and eyes with an optic disc smaller than 2.7 mm2. The control group included the remaining, non-highly myopic eyes (n=1816). For all patients, a morphometric analysis of color stereo optic disc photographs was performed. Main outcome measures were morphometric optic disc measurements and intraocular pressure. RESULTS: In the highly myopic, large-optic-disc study group compared with the control group, maximal and minimal intraocular pressure readings were significantly (p<0.05) lower and neuroretinal rim area corrected for optic disc size was slightly (p=0.16) smaller. Comparing the total highly myopic study group with a control group adjusted for optic disc area, neuroretinal rim area was significantly (p=0.039) smaller in the study group with no significant difference in intraocular pressure measurements between the groups. CONCLUSIONS: At a given intraocular pressure in chronic open-angle glaucoma, optic nerve damage may be more pronounced in highly myopic eyes with large optic discs than in non-highly myopic eyes. This may suggest a higher susceptibility for glaucomatous optic nerve fiber loss in highly myopic eyes than in non-highly myopic eyes.     

Optic disc morphology in myopic primary open-angle glaucoma

Objective: To evaluate the morphology of the optic disc in highly myopic eyes with primary open-angle glaucoma. Methods: Color stereo optic disc photographs of 44 patients with primary open-angle glaucoma and a myopic refractive error exceeding –8 diopters were morphometrically examined and compared with disc photographs of 571 patients with primary open-angle glaucoma and a myopic refractive error of less than –8 diopters. Results: In the highly myopic group, compared to the control group, the optic disc was significantly (P<0.0001) larger, the disc shape was significantly (P<0.0005) more elongated, and the optic cup depth was significantly (P<0.0001) more shallow. The loss of neuroretinal rim was more concentric, and localized retinal nerve fiber layer defects were found significantly less frequently in the highly myopic group than in the control group. In the highly myopic group, zone beta of parapapillary atrophy was significantly (P<0.0001) larger. Conclusion: The optic disc morphology in primary open-angle glaucoma differs significantly between highly myopic eyes and eyes with hyperopia or low to moderate myopia. The highly myopic eyes are characterized by secondary macrodiscs with elongated shape, shallow and concentric disc cupping, large parapapillary atrophy, and low frequency of localized retinal nerve fiber layer defects. Glaucomatous optic nerve damage in highly myopic eyes, compared to eyes with a normal refractive error, is more diffuse than localized.     

Predictive factors for progressive optic nerve damage in various types of chronic open-angle glaucoma

PURPOSE: To evaluate whether various types of chronic open-angle glaucoma differ in predictive factors for progression of glaucomatous optic nerve damage. DESIGN: Observational cohort study. METHODS: SETTING: Prospective observational clinical study. PATIENTS: 517 eyes of 300 Caucasian patients with chronic open-angle glaucoma with elevated intraocular pressure (primary open-angle glaucoma, n = 289; secondary open-angle glaucoma, n = 50) and with normal intraocular pressure (n = 178). OBSERVATION PROCEDURE: During follow-up (median: 49 months, 6 months-130 months), all patients underwent repeated evaluation of color stereo optic disk photographs and white-on-white visual field examination. MAIN OUTCOME MEASURES: Progression of glaucoma was defined as neuroretinal rim loss during the study period. RESULTS: For patients with elevated intraocular pressure, significantly predictive factors for eventual progression were older age, advanced perimetric damage, smaller neuroretinal rim, and larger area of beta zone of parapapillary atrophy. In contrast, in the normal intraocular pressure group, a significant predictive factor was presence of disk hemorrhages at baseline. Within the patients with elevated intraocular pressure, the primary open-angle glaucoma group and the secondary open-angle glaucoma group did not differ in predictive factors for progression of glaucoma. CONCLUSIONS: Open-angle glaucoma patients with normal intraocular pressure and open-angle glaucoma patients with elevated intraocular pressure differ in predictive factors for eventual progression of glaucomatous optic nerve damage. It may have clinical importance and may be helpful in the discussion of the pathogenesis of the glaucomas.     

The retinal nerve fiber layer in normal and glaucomatous eyes. II. Correlations

The retinal nerve fiber layer is different in normal and glaucomatous eyes. We correlated semi-quantitative data of the retinal nerve fiber layer of 398 eyes with chronic primary open-angle glaucoma and of 234 normal eyes with the intra- and parapapillary morphometric signs and with the perimetric indices. The three parameters "sequence of the fundus sectors concerning the best visibility of the retinal nerve fiber bundles", "visibility of the nerve fiber bundles", and "localized defects" were significantly (p less than 0.001) correlated to 1) area of the neuroretinal rim as a whole and in four different optic disc sectors, 2) neuroretinal rim width determined every 30 degrees, 3) optic cup area, diameters and form, 4) horizontal and vertical cup/disc ratios and the quotient of the horizontal to vertical cup/disc ratio, 5) area and width of zone "Alpha", zone "Beta", and the total parapapillary chorio-retinal atrophy, 6) diameter of the retinal vessels, 7) grade of a "tesselated fundus", and 8) the visual field loss. If only the inferior temporal and the superior temporal sectors were considered, the retinal nerve fiber bundles were less visible in that sector with the largest notch in the neuroretinal rim, the smaller neuroretinal rim area and width, the thinner retinal vessels, and the larger zone "Alpha", zone "Beta", and total parapapillary chorio-retinal atrophy. The glaucomatous changes in the retinal nerve fiber layer are correlated in time and location with the intra- and parapapillary and the perimetric alterations. Evaluation of the retinal nerve fiber layer is a useful method to detect a glaucomatous optic nerve damage.(ABSTRACT TRUNCATED AT 250 WORDS)     

Parapapillary retinal vessel diameter in normal and glaucoma eyes. I. Morphometric data

The retinal blood vessels serve for nutrition of the retinal ganglion cells and their axons. This study was undertaken to evaluate the vessel diameter in normal and glaucoma eyes. The calibers of the superior temporal and inferior temporal retinal artery and vein were measured at the optic disc border and at a distance of 2 mm from the optic disc center; 473 eyes of 281 patients suffering from chronic primary open-angle glaucoma and 275 eyes of 173 normal subjects were examined. Fifteen-degree, color stereo optic disc photographs were used. In the normal eyes the inferior temporal vessels were significantly larger than the superior temporal vessels. This corresponds with: (1) the configuration of the normal neuroretinal rim, which is significantly broader in the inferior disc region than in the superior disc area; (2) the visibility of the retinal nerve fibers, which are better detectable in the inferior temporal area than in the superior temporal one; and (3) the foveola location 0.53 +/- 0.34 mm inferior to the optic disc center. The retinal vessel diameter was independent of the patients' age and optic disc and parapapillary chorioretinal atrophy size. In the glaucoma group the vessel caliber was significantly smaller than in the normal eyes. The differences were more marked for the arteries and the inferior temporal vessels, respectively. The vessel diameters decreased significantly with increasing glaucoma stage independently of the patients' age. The parapapillary retinal vessel diameter may reflect the need of vascular supply in the corresponding superficial retinal area. It may be correlated with the local ganglion cell density and retinal nerve fiber layer thickness.     

Optic disc morphometry correlated with confocal laser scanning Doppler flowmetry measurements in normal-pressure glaucoma

PURPOSE: To examine the relationship between morphologic optic disc parameters and hemodynamic parameters as measured by confocal laser scanning Doppler flowmetry in patients with normal-pressure glaucoma. METHODS: The study included 91 eyes of 54 patients with normal-pressure glaucoma (mean age: 57.7 +/- 9.8 years), and 136 eyes of 77 age-adjusted normal controls. Color stereo optic disc photographs were morphometrically examined, and confocal laser scanning flowmetry (Heidelberg Retinal Flowmeter) in the neuroretinal rim inside of the optic disc, and in the retina close to the temporal and nasal border of the optic nerve head was performed. RESULTS: Mean confocal laser scanning flowmetric measurements in the neuroretinal rim, temporal parapapillary retina, and nasal parapapillary retina were significantly (P<0.03) lower in the normal-pressure glaucoma group than in the age-adjusted control group. Correspondingly, mean confocal laser scanning flowmetric measurements within the neuroretinal rim decreased significantly, with relatively low correlation coefficients, decreasing neuroretinal rim area (P = 0.016; correlation coefficient r2 = 0.026), and increasing mean visual field defect (P = 0.011; r2 = 0.029). Measurements were statistically independent of alpha zone (P = 0.38; r2 = 0.004) and beta zone (P = 0.57; r2 = 0.002) of parapapillary atrophy. CONCLUSIONS: Confocal laser scanning flowmetric measurements within the neuroretinal rim were lower in eyes with normal-pressure glaucoma than in age-matched normal eyes. Confocal laser scanning flowmetric measurements decrease with increasing glaucomatous optic nerve damage. There is, however, a marked variability preventing a clear relationship between stage of glaucoma and decrease in confocal laser scanning flowmetric measurements. The correlation between parapapillary atrophy and confocal laser scanning flowmetric measurements is not statistically significant in normal-pressure glaucoma.     

Optic disc morphology after arteritic anterior ischemic optic neuropathy

OBJECTIVE: To evaluate the appearance of the nerve head in patients after giant cell arteritis-induced arteritic anterior ischemic optic neuropathy (A-AION). DESIGN: Noncomparative clinical case series. PATIENTS: The study comprised 29 patients who presented with unilateral A-AION and temporal artery biopsy-proven giant cell arteritis. Stereoscopic optic disc photographs, taken of both the affected and unaffected eyes at the onset of the disease and after a follow-up period of 20.10 +/- 25.36 months (median, 11 months; range, 2-102 months), were morphometrically evaluated. MAIN OUTCOME MEASURES: Size and shape of the optic disc, neuroretinal rim, optic cup, and alpha and beta zones of parapapillary atrophy. RESULTS: In the eyes after A-AION, at the end of the study, the neuroretinal rim was significantly (P = 0.002) smaller, and the optic disc cup area was significantly (P = 0.001) larger than those of the contralateral unaffected eyes. Alpha zone and beta zone of parapapillary atrophy did not vary significantly (P > 0.50). CONCLUSIONS: A-AION, like glaucomatous optic neuropathy, results in neuroretinal rim loss and optic disc cupping. However, in contrast to glaucoma, A-AION is not associated with an enlargement of parapapillary atrophy. The reasons and mechanisms responsible for these similarities and dissimilarities are discussed. Marked clinical, morphologic, and histopathologic similarities in optic disc cupping and loss of neuroretinal rim between A-AION and glaucomatous optic neuropathy are highly suggestive of a common mechanism for the development of the two diseases (i.e., ischemia of the optic nerve head). The subject is discussed at length.     

Influence of cilioretinal arteries on neuroretinal rim and parapapillary atrophy in glaucoma

PURPOSE: The pattern of neuroretinal rim loss and increase in the area of parapapillary atrophy in glaucoma depend on the localization of the central retinal vessel trunk in the lamina cribrosa. The purpose of the present study was to determine whether, in a similar way, the pattern of rim loss and progression of parapapillary atrophy are influenced by the presence and position of cilioretinal arteries. METHODS: Color stereo optic disc photographs (15 degrees) for morphometric evaluation of the optic nerve head were used to compare the appearance of the optic disc in 41 patients exhibiting unilateral or bilateral cilioretinal arteries in the temporal horizontal disc region with the optic disc morphology of 127 patients without cilioretinal arteries. The areas of the neuroretinal rim and alpha and beta zones of parapapillary atrophy were measured in the total disc and in four disc sectors. RESULTS: Eyes with and eyes without cilioretinal arteries did not differ significantly in the areas of neuroretinal rim and alpha and beta zones of parapapillary atrophy, when measured in the whole optic disc and in the four disc sectors separately; in ratios of the temporal horizontal area to total area of rim and parapapillary atrophy; and in the ratio of temporal horizontal rim area-to-nasal rim area, neither in an interindividual comparison nor in an intraindividual intereye comparison. CONCLUSIONS: In contrast to the position of the central retinal vessel trunk, presence and position of cilioretinal arteries do not markedly influence the pattern of neuroretinal rim loss and progression of parapapillary atrophy in glaucoma.