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

Figures & data

Figure 1 Clinical parapapillary atrophy (PPA) evaluation of 2 patients. A) Total PPA clock hours, 12; βPPA clock hours, 5; βPPA as percentage of disc, 60%; βPPA present, temporal; ordinal rating of total PPA, 3. B) Total PPA clock hours, 8; βPPA clock hours, 4; βPPA as percentage of disc, 20%; βPPA present, temporal; ordinal rating of total PPA, 2.

Table 1 Patient and parapapillary atrophy characteristics

	Glaucoma suspects	OAG	P-value
Number eyes (patients)	229 (157)	311 (209)	–
Age (years)	55.3 (±5.2)	61.9 (±14.2)	<0.001
Female (%)	64.1	66.0	0.76
Race/ethnicity (%)
Caucasian	34.6	26.3	0.22
African-American	20.5	30.6
Hispanic	29.5	32.1
Other race/ethnicity	15.4	11.0
Clock hours total PPA	5.1 (±3.5)	6.7 (±3.7)	<0.001
Clock hours βPPA	3.7 (±3.5)	5.2 (±4.3)	<0.001
Percent width βPPA	15.1 (±22.0)	21.0 (±28.2)	0.02
Percent eyes with βPPA at disc quadrant:
Temporal (%)	44.5	49.5	0.25
Inferior (%)	24.9	34.4	0.02
Nasal (%)	18.3	34.7	<0.001
Superior (%)	13.5	24.1	0.002
Percent eyes with PPA ordinal rating:
0 (%)	7.4	5.5	<0.001
1 (%)	54.2	38.1
2 (%)	31.9	39.4
3 (%)	6.6	17.1

Abbreviations: OAG, open-angle glaucoma; PPA, parapapillary atrophy.

Table 2 Simple logistic models: odds of open-angle glaucoma as a function of common clinical variables

	OR (95% CI)	P-value
Age (per 10 years)	1.4 (1.2, 1.6)	<0.001
CCT (per 10 μm)	0.9 (0.9, 1.0)	0.006
IOPa (per 1 mm Hg)	1.0 (1.0, 1.0)	0.71
CDR (per 0.1 units)	1.3 (1.2, 1.4)	<0.001

a IOP values were with treatment in 59% of patients classified as OAG.

Abbreviations: CCT, central corneal thickness; IOP, intraocular pressure; CDR, vertical cup-to-disc ratio.

Table 3 Simple and multiple logistic models: odds of open-angle glaucoma as a function of parapapillary atrophy (PPA) variables

A. Simple logistic models			B. Adjusted models and model fit
	Crude OR (95% CI)	P-value	Adjusted ORa (95% CI)	P-value	Likelihood-ratio testP-value (X^2)
Clock hours total PPA (per 3 hours)	1.4 (1.2, 1.7)	<0.001	1.2 (1.0, 1.4)	0.10	0.06 (3.6)
Clock hours βPPA (per 3 hours)	1.4 (1.2, 1.6)	<0.001	1.1 (0.9, 1.3)	0.20	0.16 (2.0)
Nasal βPPA	1.4 (1.5, 3.7)	<0.001	1.6 (1.0, 2.7)	0.06	0.03 (4.5)
Inferior βPPA	1.6 (1.0, 2.4)	0.03	1.1 (0.7, 1.7)	0.70	0.65 (0.2)
Temporal βPPA	1.2 (0.8, 1.8)	0.30	0.9 (0.6, 1.3)	0.60	0.49 (0.5)
Superior βPPA	2.0 (1.2, 3.4)	0.006	1.2 (0.7, 2.1)	0.50	0.51 (0.5)
Ordinal rating total PPA (reference: rating = 0)
1	1.0 (0.4, 2.1)	0.90	0.8 (0.4, 1.7)	0.50	0.08 (6.8)
2	1.7 (0.7, 3.8)	0.20	1.1 (0.5, 2.6)	0.70
3	3.5 (1.4, 9.1)	0.009	1.6 (0.6, 4.6)	0.30

a Adjusted for: age, CCT, IOP, and CDR.