Peripapillary focal retinal arteriolar narrowing in open angle glaucoma

Optic disc photographs of 750 patients attending a glaucoma practice were examined to identify focal peripapillary arteriolar narrowing.

A subgroup of 110 of these patients' photographs, who had also had finger circulation tested for vasospasm to cold, were divided into patients with peripapillary focal narrowing and a control group without such a narrowing. These groups were compared with regard to their clinical status, optic disc morphology, and visual field characteristics.

Patients with focal arteriolar narrowing were statistically significantly older (p < 0.0001) and had greater cup/disc ratio (p < 0.0001), suggesting more glaucomatous damage than those without focal narrowing. Focal narrowing was statistically significantly more common in patients with glaucoma than in patients with ocular hypertension (p < 0.0001) and were significantly more common when peripapillary atrophy was present (p < 0.0012). The location of the focal narrowing correlated with the presence of a visual field defect in the corresponding hemifield (p < 0.0001 for both upper and lower hemifields). There was no association between focal arteriolar narrowing and digital vasospasm to cold in our study. Peripapillary focal arteriolar narrowings appear to be related to the severity of glaucoma, although the effects of age were not excluded. A patient is presented in whom the narrowing disappeared within a few months suggesting focal vasoconstriction in her.

Focal narrowing may be indicative of more widespread vascular pathology in the same region; however, we do not know whether these changes precede glaucomatous damage or occur secondarily to glaucomatous damage.