Peripapillary vasoconstriction in the glaucomas and the anterior ischemic optic neuropathies

Proximal constriction (retinal arteries narrower near the disk than further down the stream in the retina) was present in 96 of 226 eyes (42%) with classic glaucoma or normal-tension glaucoma, but it was present in only 11 of 206 eyes (5%) that were normal, had ocular hypertension, or had retinal disease not affecting the optic nerve. In cases of glaucoma with proximal constriction over only part of the disk circumference, its location corresponded to the sector with the greatest cupping in 60 of 66 cases (91%) and likewise corresponded to the sector in which the peripapillary zone of absent retinal pigment epithelium was widest in 48 of 55 cases (87%). Proximal constriction was also present in 16 of 45 eyes (36%) with nonischemic types of non-glaucomatous optic atrophy. The nonarteritic form of anterior ischemic optic neuropathy had proximal constriction in 19 of 28 eyes (68%), which was more frequent than in those with glaucoma (P = .017). Only one of nine eyes with the arteritic form of anterior ischemic optic neuropathy had proximal constriction, which was lower prevalence than in those with glaucoma (P = .066). General arterial narrowing (throughout the retinal course) was present in 111 of 204 (54%) of those with moderate optic nerve damage and 100 of 128 (78%) of those with severe optic nerve damage in all categories, compared with 29 of 208 (14%) of the controls with no optic nerve damage. Unlike proximal constriction, the generalized narrowing was related to severity of optic nerve damage and not to the disease category.