Research progress on morphology and associations of peripapillary atrophy_Chinese Journal of Ocular Fundus Diseases

Authors：

Sun Jiao ,  Wang Jialin , Wang Yanling

Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China;

Corresponding author：

Wang Jialin, Email: wangjialin@bjmu.edu.cn

Keywords：

Myopia; Glaucoma; Review; Peripapillary atrophy

DOI：

10.3760/cma.j.issn.1005-1015.2019.05.020

Video：

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Abstract Full text Figures/Tables Video References Cited by

Through the different image technologies, peripapillary atrophy can be classified into four types: α zone, β zone, γ zone and δ zone. Each type of them has different imaging and histological features. Peripapillary atrophy is a common structure in peoples’ eyes and it is correlated with many factors and diseases such as age, myopia, glaucoma, non-arteritic anterior ischemic optic neuropathy and age-related macular degeneration which bring difficulties to our diagnosis and antidiastole. Classifying and qualifying peripapillary atrophy properly, which can evaluate the changes and degrees, can benefit our studies about their mechanism and offer the clinical biological indictors and research basis.

Citation： Sun Jiao, Wang Jialin, Wang Yanling. Research progress on morphology and associations of peripapillary atrophy. Chinese Journal of Ocular Fundus Diseases, 2019, 35(5): 510-513. doi: 10.3760/cma.j.issn.1005-1015.2019.05.020 Copy

1.	Dai Y, Jonas JB, Huang H, et al. Microstructure of parapapillary atrophy: beta zone and gamma zone[J]. Invest Ophthalmol Vis Sci, 2013, 54(3): 2013-2018. DOI: 10.1167/iovs.12-11255.
2.	王涵, 徐亮, 杨桦, 等. 不同类型青光眼和正常人视盘旁萎缩弧β区的比较研究[J]. 眼科, 2008, 17(1): 20-24. DOI: 10.3321/j.issn:0412-4081.2008.01.007.Wang H, Xu L, Yang H, et al. Peripapillary atrophy β zone in different types of glaucoma and normal persons[J]. Ophthalmol CHN, 2008, 17(1): 20-24. DOI: 10.3321/j.issn:0412-4081.2008.01.007.
3.	Tokoro T. Criteria for diagnosis of pathologic myopia[M]//Tokoro T. Atlas of posterior fundus changes in pathologic myopia. Springer Japan, 1998: 1-2.
4.	Jonas JB, Jonas SB, Jonas RA, et al. Parapapillary atrophy: histological gamma zone and delta zone[J/OL]. PLoS One, 2012, 7(10): 47237[2012-10-18]. http://dx.plos.org/10.1371/journal.pone.0047237. DOI: 10.1371/journal.pone.0047237.
5.	Jonas JB, Hayreh SS, Tao Y. Clinicopathological correlation of parapapillary atrophy in monkeys with experimental glaucoma and temporary central retinal artery occlusion[J]. Indian J Ophthalmol, 2014, 62(2): 219-223. DOI: 10.4103/0301-4738.111216.
6.	Miki A, Ikuno Y, Weinreb RN, et al. Measurements of the parapapillary atrophy zones in en face optical coherence tomography images[J/OL]. PLoS One, 2017, 12(4): 0175347[2017-4-17]. https://dx.plos.org/10.1371/journal.pone.0175347. DOI: 10.1371/journal.pone.0175347.
7.	Yu S, Hangai M, Ishikawa M, et al. Association of myopic deformation of optic disc with visual field progression in paired eyes with open-angle glaucoma[J/OL]. PLoS One, 2017, 12(1): e0170733[2017-1-23]. https://dx.plos.org/10.1371/journal.pone.0170733. DOI: 10.1371/journal.pone.0170733.
8.	Yoo YJ, Lee EJ, Kim TW. Intereye difference in the microstructure of parapapillary atrophy in unilateral primary open-angle glaucoma[J]. Invest Ophthalmol Vis Sci, 2016, 57(10): 4187-4193. DOI: 10.1167/iovs.16-19059.
9.	Kolár R, Laemmer R, Jan J, et al. The segmentation of zones with increased autofluorescence in the junctional zone of parapapillary atrophy[J]. Physiol Meas, 2009, 30(5): 505-516. DOI: 10.1088/0967-3334/30/5/007.
10.	刘维锋, 林瀚, 朱璇. 不同年龄超高度近视眼弧形斑变化的研究[J]. 眼科新进展, 2016, 36(7): 652-654.Liu WF, Lin H, Zhu X. Changes of peripapillary atrophy witll age in super-high myopia[J]. Rec Adv Ophthalmol, 2016, 36(7): 652-654.
11.	Lu CK, Tang TB, Laude A, et al. Parapapillary atrophy and optic disc region assessment (PANDORA): retinal imaging tool for assessment of the optic disc and parapapillary atrophy[J]. J Biomed Opt, 2012, 17(10): 106010. DOI: 10.1117/1.JBO.17.10.106010.
12.	Sugiyama K, Yoshimura N. Myopia and Glaucoma[M]//Yasushi I. High myopia and myopic glaucoma: findings in the peripapillary retina and choroid in highly myopic eyes. Springer Japan, 2015: 53-62.
13.	Wang Y, Xu L, Zhang L, et al. Peripapillary atrophy in elderly Chinese in rural and urban Beijing[J]. Eye, 2008, 22(2): 261-266. DOI: 10.1038/sj.eye.6702601.
14.	Marsh-Tootle WL, Harb E, Hou W, et al. Optic nerve tilt, crescent, ovality, and torsion in a multi-ethnic cohort of young adults with and without myopia[J]. Invest Ophthalmol Vis Sci, 2017, 58(7): 3158-3171. DOI: 10.1167/iovs.16-20860.
15.	Kwon JW, Choi JA, Kim JS, et al. Ganglion cell-inner plexiform layer, peripapillary retinal nerve fiber layer, and macular thickness in eyes with myopic β-zone parapapillary atrophy[J/OL]. J Ophthalmol, 2016, 2016: 3746791[2016-10-27]. https://www.hindawi.com/journals/joph/2016/3746791/. DOI: 10.1155/2016/3746791.
16.	Jonas JB, Fang Y, Weber P, et al. Parapapillary gamma and delta zones in high myopia[J]. Retina, 2018, 38(5): 931-938. DOI: 10.1097/IAE.0000000000001650.
17.	刘维锋, 石安娜, 曾瑛, 等. 高度近视眼弧形斑形态与眼底病变关系的研究[J]. 眼科新进展, 2011, 31(9): 842-845.Liu WF, Shi AN, Zeng Y, et al. Correlation of peripapilliary crescent shape with fundus disease in high myopia[J]. Rec Adv Ophthalmol, 2011, 31(9): 842-845.
18.	Vianna JR, Malik R, Danthurebandara VM, et al. Beta and gamma peripapillary atrophy in myopic eyes with and without glaucoma[J]. Invest Ophthalmol Vis Sci, 2016, 57(7): 3103-3111. DOI: 10.1167/iovs.16-19646.
19.	Hwang YH, Jung JJ, Park YM, et al. Effect of myopia and age on optic disc margin anatomy within the parapapillary atrophy area[J]. Jpn J Ophthalmol, 2013, 57(5): 463-470. DOI: 10.1007/s10384-013-0263-7.
20.	Jonas JB, Nguyen XN, Gusek GC, et al. Parapapillary chorioretinal atrophy in normal and glaucoma eyes. Ⅰ. Morphometric data[J]. Invest Ophthalmol Vis Sci, 1989, 30(5): 908-918.
21.	Kim TW, Kim M, Weinreb RN, et al. Optic disc change with incipient myopia of childhood[J]. Ophthalmology, 2012, 119(1): 21-26. DOI: 10.1016/j.ophtha.2011.07.051.
22.	Park HY, Lee K, Park CK. Optic disc torsion direction predicts the location of glaucomatous damage in normal-tension glaucoma patients with myopia[J]. Ophthalmology, 2012, 119: 1844-1851. DOI: 10.1016/j.ophtha.2012.03.006.
23.	Rensch F, Jonas JB. Direct microperimetry of alpha zone and beta zone parapapillary atrophy[J]. Br J Ophthalmol, 2008, 92(12): 1617-1619. DOI: 10.1136/bjo.2008.139030.
24.	De Moraes CG, Liebmann JM, Ritch R. Predictive factors within the optic nerve complex for glaucoma progression: disc hemorrhage and parapapillary atrophy[J]. Asia Pac J Ophthalmol (Phila), 2012, 1(2): 105-112. DOI: 10.1097/APO.0b013e31824a65f8.
25.	Skaat A, De Moraes CG, Bowd C, et al. African Descent and Glaucoma Evaluation Study (ADAGES): racial differences in optic disc hemorrhage and beta-zone parapapillary atrophy[J]. Ophthalmology, 2016, 123(7): 1476-1483. DOI: 10.1016/j.ophtha.2016.03.025.
26.	De Moraes CG, Murphy JT, Kaplan CM, et al. β-zone parapapillary atrophy and rates of glaucomatous visual field progression: African Descent and Glaucoma Evaluation Study[J]. JAMA Ophthalmol, 2017, 135(6): 617-623. DOI: 10.1001/jamaophthalmol.2017.1082.
27.	Hayes DD, Teng CC, de Moraes CG, et al. Corneal hysteresis and beta-zone parapapillary atrophy[J]. Am J Ophthalmol, 2012, 153(2): 358-362. DOI: 10.1016/j.ajo.2011.06.025.
28.	Jonas JB, Papastathopoulos KI. Optic disk appearance in pseudoexfoliation syndrome[J]. Am J Ophthalmol, 1997, 123(2): 174-180. DOI: 10.1016/S0002-9394(14)71033-5.
29.	Lee SH, Lee EJ, Kim TW. Topographic correlation between juxtapapillary choroidal thickness and parapapillary deep-layer microvasculature dropout in primary[J]. Br J Ophthalmol, 2018, 102(8): 1134-1140. DOI: 10.1136/bjophthalmol-2017-311136.
30.	Lee EJ, Kim TW, Lee SH, et al. Underlying microstructure of parapapillary deep-layer capillary dropout identified by optical coherence tomography angiography[J]. Invest Ophthalmol Vis Sci, 2017, 58(3): 1621-1627. DOI: 10.1167/iovs.17-21440.
31.	Jonas JB, Hayreh SS, Tao Y, et al. Optic nerve head change in non-arteritic anterior ischemic optic neuropathy and its influence on visual outcome[J/OL]. PLoS One, 2012, 7(5): 37499[2012-05-21]. https://dx.plos.org/10.1371/journal.pone.0037499. DOI: 10.1371/journal.pone.0037499.
32.	Hayreh S, Jonas J. Optic disc morphology after arteritic anterior ischemic optic neuropathy[J]. Ophthalmology, 2001, 108(9): 1586-1594. DOI: 10.1016/S0161-6420(01)00649-2.
33.	Garg A, Blumberg DM, Alaswad LA. Associations between β-peripapillary atrophy and reticular pseudodrusen in early age-related macular degeneration[J]. Invest Ophthalmol Vis Sci, 2017, 58(5): 2810-2815. DOI: 10.1167/iovs.16-20343.
34.	You QS, Xu L, Yang H, et al. Five-year incidence of age-related macular degeneration: The Beijing Eye Study[J]. Ophthalmology, 2012, 119(12): 2519-2525. DOI: 10.1016/j.ophtha.2012.06.043.
35.	Wang YX, Xu L, Lu W, et al. Parapapillary atrophy in patients with intracranial tumours[J]. Acta Ophthalmol, 2013, 91(6): 521-525. DOI: 10.1111/j.1755-3768.2012.02454.x.
36.	Königsreuther KA, Jonas JB. Optic disc morphology in diabetes mellitus[J]. Graefe's Arch Clin Exp Ophthalmol, 1995, 233(4): 200-204. DOI: 10.1007/BF00183592.

1. Dai Y, Jonas JB, Huang H, et al. Microstructure of parapapillary atrophy: beta zone and gamma zone[J]. Invest Ophthalmol Vis Sci, 2013, 54(3): 2013-2018. DOI: 10.1167/iovs.12-11255.
2. 王涵, 徐亮, 杨桦, 等. 不同类型青光眼和正常人视盘旁萎缩弧β区的比较研究[J]. 眼科, 2008, 17(1): 20-24. DOI: 10.3321/j.issn:0412-4081.2008.01.007.Wang H, Xu L, Yang H, et al. Peripapillary atrophy β zone in different types of glaucoma and normal persons[J]. Ophthalmol CHN, 2008, 17(1): 20-24. DOI: 10.3321/j.issn:0412-4081.2008.01.007.
3. Tokoro T. Criteria for diagnosis of pathologic myopia[M]//Tokoro T. Atlas of posterior fundus changes in pathologic myopia. Springer Japan, 1998: 1-2.
4. Jonas JB, Jonas SB, Jonas RA, et al. Parapapillary atrophy: histological gamma zone and delta zone[J/OL]. PLoS One, 2012, 7(10): 47237[2012-10-18]. http://dx.plos.org/10.1371/journal.pone.0047237. DOI: 10.1371/journal.pone.0047237.
5. Jonas JB, Hayreh SS, Tao Y. Clinicopathological correlation of parapapillary atrophy in monkeys with experimental glaucoma and temporary central retinal artery occlusion[J]. Indian J Ophthalmol, 2014, 62(2): 219-223. DOI: 10.4103/0301-4738.111216.
6. Miki A, Ikuno Y, Weinreb RN, et al. Measurements of the parapapillary atrophy zones in en face optical coherence tomography images[J/OL]. PLoS One, 2017, 12(4): 0175347[2017-4-17]. https://dx.plos.org/10.1371/journal.pone.0175347. DOI: 10.1371/journal.pone.0175347.
7. Yu S, Hangai M, Ishikawa M, et al. Association of myopic deformation of optic disc with visual field progression in paired eyes with open-angle glaucoma[J/OL]. PLoS One, 2017, 12(1): e0170733[2017-1-23]. https://dx.plos.org/10.1371/journal.pone.0170733. DOI: 10.1371/journal.pone.0170733.
8. Yoo YJ, Lee EJ, Kim TW. Intereye difference in the microstructure of parapapillary atrophy in unilateral primary open-angle glaucoma[J]. Invest Ophthalmol Vis Sci, 2016, 57(10): 4187-4193. DOI: 10.1167/iovs.16-19059.
9. Kolár R, Laemmer R, Jan J, et al. The segmentation of zones with increased autofluorescence in the junctional zone of parapapillary atrophy[J]. Physiol Meas, 2009, 30(5): 505-516. DOI: 10.1088/0967-3334/30/5/007.
10. 刘维锋, 林瀚, 朱璇. 不同年龄超高度近视眼弧形斑变化的研究[J]. 眼科新进展, 2016, 36(7): 652-654.Liu WF, Lin H, Zhu X. Changes of peripapillary atrophy witll age in super-high myopia[J]. Rec Adv Ophthalmol, 2016, 36(7): 652-654.
11. Lu CK, Tang TB, Laude A, et al. Parapapillary atrophy and optic disc region assessment (PANDORA): retinal imaging tool for assessment of the optic disc and parapapillary atrophy[J]. J Biomed Opt, 2012, 17(10): 106010. DOI: 10.1117/1.JBO.17.10.106010.
12. Sugiyama K, Yoshimura N. Myopia and Glaucoma[M]//Yasushi I. High myopia and myopic glaucoma: findings in the peripapillary retina and choroid in highly myopic eyes. Springer Japan, 2015: 53-62.
13. Wang Y, Xu L, Zhang L, et al. Peripapillary atrophy in elderly Chinese in rural and urban Beijing[J]. Eye, 2008, 22(2): 261-266. DOI: 10.1038/sj.eye.6702601.
14. Marsh-Tootle WL, Harb E, Hou W, et al. Optic nerve tilt, crescent, ovality, and torsion in a multi-ethnic cohort of young adults with and without myopia[J]. Invest Ophthalmol Vis Sci, 2017, 58(7): 3158-3171. DOI: 10.1167/iovs.16-20860.
15. Kwon JW, Choi JA, Kim JS, et al. Ganglion cell-inner plexiform layer, peripapillary retinal nerve fiber layer, and macular thickness in eyes with myopic β-zone parapapillary atrophy[J/OL]. J Ophthalmol, 2016, 2016: 3746791[2016-10-27]. https://www.hindawi.com/journals/joph/2016/3746791/. DOI: 10.1155/2016/3746791.
16. Jonas JB, Fang Y, Weber P, et al. Parapapillary gamma and delta zones in high myopia[J]. Retina, 2018, 38(5): 931-938. DOI: 10.1097/IAE.0000000000001650.
17. 刘维锋, 石安娜, 曾瑛, 等. 高度近视眼弧形斑形态与眼底病变关系的研究[J]. 眼科新进展, 2011, 31(9): 842-845.Liu WF, Shi AN, Zeng Y, et al. Correlation of peripapilliary crescent shape with fundus disease in high myopia[J]. Rec Adv Ophthalmol, 2011, 31(9): 842-845.
18. Vianna JR, Malik R, Danthurebandara VM, et al. Beta and gamma peripapillary atrophy in myopic eyes with and without glaucoma[J]. Invest Ophthalmol Vis Sci, 2016, 57(7): 3103-3111. DOI: 10.1167/iovs.16-19646.
19. Hwang YH, Jung JJ, Park YM, et al. Effect of myopia and age on optic disc margin anatomy within the parapapillary atrophy area[J]. Jpn J Ophthalmol, 2013, 57(5): 463-470. DOI: 10.1007/s10384-013-0263-7.
20. Jonas JB, Nguyen XN, Gusek GC, et al. Parapapillary chorioretinal atrophy in normal and glaucoma eyes. Ⅰ. Morphometric data[J]. Invest Ophthalmol Vis Sci, 1989, 30(5): 908-918.
21. Kim TW, Kim M, Weinreb RN, et al. Optic disc change with incipient myopia of childhood[J]. Ophthalmology, 2012, 119(1): 21-26. DOI: 10.1016/j.ophtha.2011.07.051.
22. Park HY, Lee K, Park CK. Optic disc torsion direction predicts the location of glaucomatous damage in normal-tension glaucoma patients with myopia[J]. Ophthalmology, 2012, 119: 1844-1851. DOI: 10.1016/j.ophtha.2012.03.006.
23. Rensch F, Jonas JB. Direct microperimetry of alpha zone and beta zone parapapillary atrophy[J]. Br J Ophthalmol, 2008, 92(12): 1617-1619. DOI: 10.1136/bjo.2008.139030.
24. De Moraes CG, Liebmann JM, Ritch R. Predictive factors within the optic nerve complex for glaucoma progression: disc hemorrhage and parapapillary atrophy[J]. Asia Pac J Ophthalmol (Phila), 2012, 1(2): 105-112. DOI: 10.1097/APO.0b013e31824a65f8.
25. Skaat A, De Moraes CG, Bowd C, et al. African Descent and Glaucoma Evaluation Study (ADAGES): racial differences in optic disc hemorrhage and beta-zone parapapillary atrophy[J]. Ophthalmology, 2016, 123(7): 1476-1483. DOI: 10.1016/j.ophtha.2016.03.025.
26. De Moraes CG, Murphy JT, Kaplan CM, et al. β-zone parapapillary atrophy and rates of glaucomatous visual field progression: African Descent and Glaucoma Evaluation Study[J]. JAMA Ophthalmol, 2017, 135(6): 617-623. DOI: 10.1001/jamaophthalmol.2017.1082.
27. Hayes DD, Teng CC, de Moraes CG, et al. Corneal hysteresis and beta-zone parapapillary atrophy[J]. Am J Ophthalmol, 2012, 153(2): 358-362. DOI: 10.1016/j.ajo.2011.06.025.
28. Jonas JB, Papastathopoulos KI. Optic disk appearance in pseudoexfoliation syndrome[J]. Am J Ophthalmol, 1997, 123(2): 174-180. DOI: 10.1016/S0002-9394(14)71033-5.
29. Lee SH, Lee EJ, Kim TW. Topographic correlation between juxtapapillary choroidal thickness and parapapillary deep-layer microvasculature dropout in primary[J]. Br J Ophthalmol, 2018, 102(8): 1134-1140. DOI: 10.1136/bjophthalmol-2017-311136.
30. Lee EJ, Kim TW, Lee SH, et al. Underlying microstructure of parapapillary deep-layer capillary dropout identified by optical coherence tomography angiography[J]. Invest Ophthalmol Vis Sci, 2017, 58(3): 1621-1627. DOI: 10.1167/iovs.17-21440.
31. Jonas JB, Hayreh SS, Tao Y, et al. Optic nerve head change in non-arteritic anterior ischemic optic neuropathy and its influence on visual outcome[J/OL]. PLoS One, 2012, 7(5): 37499[2012-05-21]. https://dx.plos.org/10.1371/journal.pone.0037499. DOI: 10.1371/journal.pone.0037499.
32. Hayreh S, Jonas J. Optic disc morphology after arteritic anterior ischemic optic neuropathy[J]. Ophthalmology, 2001, 108(9): 1586-1594. DOI: 10.1016/S0161-6420(01)00649-2.
33. Garg A, Blumberg DM, Alaswad LA. Associations between β-peripapillary atrophy and reticular pseudodrusen in early age-related macular degeneration[J]. Invest Ophthalmol Vis Sci, 2017, 58(5): 2810-2815. DOI: 10.1167/iovs.16-20343.
34. You QS, Xu L, Yang H, et al. Five-year incidence of age-related macular degeneration: The Beijing Eye Study[J]. Ophthalmology, 2012, 119(12): 2519-2525. DOI: 10.1016/j.ophtha.2012.06.043.
35. Wang YX, Xu L, Lu W, et al. Parapapillary atrophy in patients with intracranial tumours[J]. Acta Ophthalmol, 2013, 91(6): 521-525. DOI: 10.1111/j.1755-3768.2012.02454.x.
36. Königsreuther KA, Jonas JB. Optic disc morphology in diabetes mellitus[J]. Graefe's Arch Clin Exp Ophthalmol, 1995, 233(4): 200-204. DOI: 10.1007/BF00183592.

Chinese Journal of Ocular Fundus Diseases

Research progress on morphology and associations of peripapillary atrophy

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