Optic disc morphology in "age-related atrophic glaucoma"

Area of Science:

• Ophthalmology
• Glaucoma Research
• Optic Nerve Imaging

Background:

• Primary open-angle glaucoma (POAG) is a leading cause of irreversible blindness.
• Fundus tessellation, a pattern of choroidal visibility, is common in myopic eyes.
• The relationship between fundus tessellation and optic disc morphology in POAG remains unclear.

Purpose of the Study:

• To investigate if varying degrees of fundus tessellation correlate with optic disc morphology and intraocular pressure (IOP) in POAG patients.
• To identify potential subtypes of POAG based on fundus tessellation patterns.

Main Methods:

• Morphometric analysis of optic disc photographs from 562 POAG patients with myopia < -8 diopters.
• Classification into tessellated (n=256) and nontessellated (n=306) subgroups, matched for neuroretinal rim area and refractive error.
• Comparison of IOP, optic disc parameters, and visual field defects between subgroups.

Main Results:

• The tessellated subgroup exhibited significantly lower mean maximal IOP, larger parapapillary atrophy, shallower optic cups, and higher patient age compared to the nontessellated subgroup.
• Fundus tessellation degree positively correlated with parapapillary atrophy and negatively with mean maximal IOP and optic cup depth.
• Higher degrees of tessellation were associated with the greatest parapapillary atrophy and lowest mean maximal IOP.

Conclusions:

• Marked fundus tessellation in low-pressure POAG is associated with significant parapapillary atrophy, shallow optic cupping, and older patient age.
• Findings suggest a distinct POAG subtype in older individuals with relatively low IOP, characterized by diffuse optic nerve atrophy.
• Fundus tessellation may serve as a clinical indicator for specific POAG phenotypes.