Microvascular Dropout, Beta-zone PPA Enlargement Predict Optic Disc Structural Progression in Glaucoma Suspects

Researchers recently observed that increasing microvascular dropout and β-zone parapapillary atrophy progression precede perimetric glaucoma. Identifying these early predictive markers in glaucoma suspects may lead to more timely intervention before vision loss occurs. Photo: Zhou LX, et al. BMC Ophthalmol. 2022; 22:431. Click image to enlarge. Recent research suggests a link between microvascular dropout (MvD) and β-zone parapapillary atrophy (PPA) in healthy and glaucomatous eyes. Subtle vascular changes have also been observed in glaucoma suspects, though it’s unclear how these vascular alterations relate to structural changes in this population. A new retrospective cohort study aiming to clarify this relationship determined that MvD and PPA progression independently predict optic disc structural progression in preperimetric glaucoma eyes. Their findings, published in American Journal of Ophthalmology, are described below.Participants were obtained from the Diagnostic Innovations in Glaucoma Study, which explored glaucoma-related structural changes in suspect eyes. The analysis included 180 eyes from 134 patients identified as glaucoma suspects, with a mean follow-up duration of 19 years. Inclusion criteria were stringent, requiring patients to present with open angles on gonioscopy, a BCVA of 20/40 or better and no prior history of significant ocular disease that could confound results. Researchers used OCT angiography to detect MvD, alongside stereophotography to evaluate structural progression of the optic disc. Structural changes were characterized by the emergence of new or enlarging defects in the retinal nerve fiber layer, as well as thinning of the neuroretinal rim.The study revealed that 58 of the 180 eyes exhibited MvD, which corresponded with more severe structural alterations over time. Additionally, a remarkable 80% of eyes that developed structural progression demonstrated β-zone PPA changes, in stark contrast to only 29.2% of non-progressing eyes that displayed similar PPA alterations.The statistical analysis showed the presence of MvD was associated with an odds ratio of 15.83 for structural progression, while β-zone PPA progression was linked to an odds ratio of 3.77. Furthermore, eyes presenting with both MvD and β-zone PPA demonstrated the highest probability of structural progression.“These structural changes were observed in glaucoma suspect eyes that remained clinically stable and did not convert to perimetric glaucoma during the period of observation in this study,” the researchers wrote in their paper. “Recognition of these changes may enhance more timely management to prevent glaucomatous vision loss,” they concluded.Click here for the journal source. Soltani T, Nishida T, Moghimi S, et al. Optic disc structural progression in glaucoma suspect eyes with microvascular dropout. Am J Ophthalmol. March 11, 2026. [Epub ahead of print].   This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.