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Original Investigation
June 2017

β-Zone Parapapillary Atrophy and Rates of Glaucomatous Visual Field Progression: African Descent and Glaucoma Evaluation Study

Author Affiliations
  • 1Bernard and Shirlee Brown Glaucoma Research Laboratory, Edward S. Harkness Eye Institute, Department of Ophthalmology, Columbia University Medical Center, New York, New York
  • 2Goldschleger Eye Institute, Sheba Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
  • 3Department of Ophthalmology, School of Medicine, University of Alabama, Birmingham
  • 4Hamilton Glaucoma Center, Department of Ophthalmology, University of California, San Diego
JAMA Ophthalmol. 2017;135(6):617-623. doi:10.1001/jamaophthalmol.2017.1082
Key Points

Question  Does race affect the association between β-zone parapapillary atrophy and the velocity of visual field progression?

Findings  In a longitudinal cohort study of 634 patients (1090 eyes) with ocular hypertension or glaucoma followed up for a mean of 9 years, patients of European descent with glaucoma and β-zone parapapillary atrophy experienced faster visual field progression compared with those of African descent with β-zone parapapillary atrophy.

Meaning  The results of this study suggest that the effect of β-zone parapapillary atrophy on the velocity of visual field progression depends on race and glaucoma status.


Importance  β-zone parapapillary atrophy (βPPA) has been reported as a risk factor for glaucoma onset and progression. Previous studies have shown that the prevalence of βPPA differs between individuals of African descent (AD) and European descent (ED).

Objective  To test whether the association between the presence and progression of βPPA vs visual field progression of glaucoma differs between these 2 ancestry groups.

Design, Setting, and Participants  In a prospective, multicenter, longitudinal cohort study, 634 individuals (1090 eyes) enrolled in the African Descent and Evaluation Study (ADAGES) with a diagnosis of glaucomatous optic neuropathy (GON) or ocular hypertension (OHT) and at least 2 disc stereophotographs were included. Two graders masked to clinical and ancestry data reviewed and graded the baseline and last disc stereophotographs for the presence of βPPA at baseline and βPPA progression (development or enlargement). Mixed-effects linear models were tested with visual field mean deviation as a dependent variable and time (alone and with interaction terms) as independent variables. ADAGES enrollment began in January 2003 and ended in July 2006; follow-up ended in 2016.

Exposures  Disc stereophotographs.

Main Outcomes and Measures  Progression of βPPA in AD and ED individuals.

Results  In 634 patients, a total of 814 eyes of AD (395 eyes) and ED (419) patients with GON and 276 eyes of AD (106) and ED (170) patients with OHT who were enrolled in ADAGES were analyzed. There were 336 (53.0%) women in the study; mean (SD) age was 61.9 (12.7) years. In the OHT group, the association between βPPA at baseline and visual field progression was not significantly different between AD and ED eyes (β = 0.071; 95% CI, −0.016 to 0.158; P = .11), nor was the association between βPPA progression and visual field progression (β = 0.020; 95% CI, −0.465 to 0.506; P = .93). In the GON group, ED eyes with baseline βPPA progressed faster than did AD eyes with baseline βPPA (β = −0.124; 95% CI, −0.241 to −0.007; P = .04), although the association between βPPA progression and visual field progression did not differ significantly between race groups (β = −0.101; 95% CI, −0.323 to 0.119; P = .37).

Conclusions and Relevance  Race had a significant effect on the association between baseline βPPA and rates of visual field progression in eyes with GON. Progression of βPPA was not associated with faster visual field progression in either racial group.