Wolfram (DIDMOAD) syndrome: a multidisciplinary clinical study in nine Turkish patients and review of the literature

AIM

To study Wolfram syndrome (WFS) with multidisciplinary consultations and compare the results with the literature.

METHODS

Nine patients fulfilled the ascertainment criteria of WFS (insulin-dependent diabetes mellitus and optic atrophy). All patients were evaluated by the departments of paediatrics, ophthalmology, audiology, urology and medical biology.

RESULTS

The earliest manifestation of WFS was insulin-dependent diabetes mellitus (at a median age of 6.9 y), followed by optic atrophy (8.9 y), diabetes insipidus (10.2 y) and deafness (10.5 y). Short stature was found in five cases, delayed puberty in two cases and hypergonadotropic hypogonadism in one case. Audiography disclosed hearing loss at high frequency in all patients (100%), but only five patients had clinical subjective hearing problems. Intravenous pyelography revealed hydroureteronephrosis in eight patients. Urodynamics revealed a normal bladder in only one patient. Three patients had a low-capacity, low-compliance bladder, detrusor external sphincteric dyssynergia and emptying problem, while five had an atonic bladder. Ocular findings were optic atrophy, low visual acuity and colour vision defects. Visual field tests revealed concentric and/or peripheral diminution in five patients. Visual evoked potentials were abnormal (reduced amplitude to both flash and pattern stimulation) in seven patients. Cranial magnetic resonance imaging showed mild or moderate atrophy of the optic nerves, chiasm, cerebellum, basal ganglia and brainstem in six patients; there was a partially empty sella in one case. There was no evidence of mitochondrial tRNA(Leu) (UUR) A to G (nucleotide 3243) mutation.

CONCLUSION

Wolfram syndrome should be evaluated in a multidisciplinary manner. Some specific and dynamic tests are necessary to make a more precise estimate of the prevalence and median age of the components of WFS. Short stature is a common feature in WFS. Hypogonadism may be hypogonadotropic or hypergonadotropic. Bladder dysfunction does not always present as a large atonic bladder in WFS. A low-capacity, high-pressure bladder with sphincteric dyssynergia is also common.

Ocular findings in lissencephaly

PURPOSE

To report our retrospective study of 20 cases with lissencephaly and describe ocular and visual abnormalities associated with this disorder.

METHODS

Patients with lissencephaly were identified and classified into classic (type I) or cobblestone (type 2) lissencephaly on the basis of a review of clinical records and neuroimaging studies. Only patients examined by an ophthalmologist were included in the study.

RESULTS

Only 1 patient had a normal ocular examination. Ocular abnormalities included optic nerve hypoplasia and atrophy, retinal dysplasia, retinal nonattachment, macular hypoplasia, anterior segment malformation, and strabismus.

CONCLUSIONS

Ocular abnormalities in classic (type 1) lissencephaly are less severe. Central, steady, and maintained fixation may be present despite the presence of optic nerve hypoplasia, optic atrophy, macular hypoplasia, strabismus, or refractive errors. Retinal and anterior segment abnormalities were observed only in cobblestone (type 2) lissencephaly. These patients often have severe visual impairment because of retinal or cortical disease.

Incidence of blindness in southern Germany due to glaucoma and degenerative conditions

PURPOSE

To estimate population-based incidence rates of registered blindness separately, to determine its main causes.

METHODS

The files of all newly registered blindness-allowance recipients in Württemberg-Hohenzollern, Germany (population: approximately 5 million), between 1994 and 1998 were reviewed. From ophthalmological reports on file the fulfillment of the German criteria for blindness (visual acuity of 1/50 or less or equivalent reduction of visual function) was ascertained, and the causes of blindness were obtained. Incidence rates of blindness due to macular degeneration, glaucoma, cataract, optic atrophy, and diabetic retinopathy were estimated.

RESULTS

There were 3531 newly registered blindness-allowance recipients (67.1% female; mean age, 72.8 +/- 21.0 years). Standardized incidence rates in the general population (per 100,000 person-years; 95% confidence interval): All causes 12.27 (11.87-12.68), macular degeneration 5.29 (5.02-5.55), cataract 3.32 (3.11-3.52), optic atrophy 2.86 (2.66-3.05), glaucoma 2.43 (2.25-2.61), diabetic retinopathy 2.13 (1.96-2.30), other or unknown causes 5.17 (4.91-5.43). In many cases, blindness was attributable to more than one cause. Assuming that incidence rates are the same in other parts of the country, 9,939 (9,608-10,270) new cases of blindness were estimated to occur in Germany per year.

CONCLUSIONS

The most common single cause of blindness was macular degeneration. Incidence rates of blindness due to such treatable conditions as glaucoma were also high. This finding suggests that the taking of measures for secondary prevention (e.g., early detection and optimal treatment of patients with glaucoma and diabetic retinopathy) should be intensified.

Engelmann's disease with optic atrophy

Engelman-Camurati disease is a rare Diaphyseal dysplasia, characterized by endosteal and periostal thickness of cortex of shaft of tubular bone sparing metaphysis and epiphysis. The bone of the hand, feet, ribs, scapulae and pubis are not affected.

Self-inflicted repetitive optic nerve injury: a case report

PURPOSE

To describe an obsessive-compulsive patient who developed blindness after self-inflicted repetitive optic nerve injury.

METHODS

Case report.

RESULTS

A myopic 46-year-old male became blind as a result of intermittent rubbing of his eyes, causing stretching of the optic nerves. Extensive ocular, neurologic and systemic work-ups were negative. Cerebral and orbital MR studies showed severe bilateral optic nerve atrophy. Psychiatric evaluation confirmed obsessive-compulsive personality.

CONCLUSIONS

Self-inflicted optic nerve injury should be included in the differential diagnosis of progressive optic neuropathy in a young adult.

Posterior segment involvement in ocular Behçet's disease

PURPOSE

Posterior segment involvement, which can lead to blindness with recurrent inflammatory attacks, has a very important prognostic value in ocular Behçet's disease (BD). This study evaluated the frequency and characteristics of posterior segment involvement and the causes of visual impairment in patients with ocular BD.

METHODS

We retrospectively evaluated 257 eyes of the 131 patients who were followed from 1993 to 2001 in the Uveitis and BD division of SSK Ankara Eye Hospital, Turkey.

RESULTS

The mean follow-up was 49.2 +/- 27.4 months. Thirty-one of the palents were female (23.6%) and 100 male (76.4%). The mean age was 25.1 +/- 7.9. Fundus changes were observed in 213 (82.9%) eyes and were bilateral in 87%, and vitritis was present in 239 (93%) eyes. The most frequent fundus changes were vascular sheathing in 61 eyes (23.7%), optic atrophy in 46 (17.9%), macular edema in 29 (11.3%), retinal hemorrhage in 23 (9%), macular scar in 21 (8.2%), optic disc paleness in 19 (7.4%), retinal edema in 17 (6.6%), branch retinal vein occlusion in 15 (5.8%). The most common fluorescein angiography findings were diffuse vascular leakage in 98 (38%), hyperfluorescence of the optic disc in 38 (14.8%) and hyperfluorescence of the macula in 29 eyes (11.3%). Visual acuity was <1/10 in 85 (33%) of the eyes. Optic atrophy was the main cause (54.1%) of permanent visual impairment.

CONCLUSIONS

Posterior segment involvement is the most serious ocular complication of BD, leading to blindness with recurrent attacks. Following patients closely, performing fluorescein angiography in all patients diagnosed as BD even they have no clinical ocular involvement, and early treatment are very important in the prognosis of the disease.

[Possibilities of improving vision of poorly sighted patients by means of a diaphragm]

The possibility of using diaphragming means for improving the vision of poorly sighted patients is discussed. A total of 279 patients (514 eyes) aged 6-82 years were examined, 118 (42.3%) of these with ocular diseases. Comparative analysis of the time course of visual acuity was carried out in patients using diaphragming means, optimal eyeglasses, and both. Eyeglasses are preferable for the majority of patients with poor vision, as they allow a higher visual acuity than diaphragming eyeglasses. Diaphragming means are more effective in patients with opaque optic media of the eyes with slight refraction disorders. A diaphragming racket is suggested for utilization of the useful characteristics of the diaphragm; it can be combined with eyeglass correction of ametropia. A group of patients was distinguished, for whom the combination of these two types of correction is the most effective: patients with corneal dystrophy, involution cataract, retinopathy neonatorum, aphakia, high complicated myopia, and diabetic retinopathy. In addition, the diaphragming racket is recommended for use during consultations for more accurate evaluation of the correction of ametropia and the intactness of the retinal macular zone in patients with opaque optic media of the eye.

[The causes of childhood blindness and visual impairment in Poland]

AIM

To investigate the prevalence and the causes of childhood blindness and visual impairment in Poland.

MATERIAL AND METHODS

The records of 3000 visually impaired children from the archives of Polish Association of Blinds and from the centers and schools for visually handicapped children from the years 1979-1999 have been reviewed.

RESULTS

The number of the visually disabled children in Poland has increased by 70% in the recent 10 years. The main causes of blindness and serious visual loss in the years 1979-1999 are optic nerve atrophy (21.66%), retinopathy of prematurity (19.01%), cataracts (14.13%), high myopia (11.84%), congenital abnormalities (8.65%), retinal dystrophies (8.08%) and glaucoma (6.42%). Optic nerve atrophy occurred mainly in premature infants. There have been great changes in the epidemiology of blindness in the recent 20 years; the percentage of visually disabled children caused by ROP has increased from 8.1% to 54.5% and caused by optic nerve atrophy from 15.5% to 27.27%. The prevalence of other causes has decreased in the same time.

CONCLUSION

The main activities required to control blindness in Poland are promotion of pregnancy and prematurity care and improvements in the early diagnosis and treatment of retinopathy of prematurity.

Dutch patients with progressive encephalopathy with edema, hypsarrhythmia, and optic atrophy (PEHO) syndrome

PEHO syndrome (progressive encephalopathy, peripheral edema, hypsarrhythmia, and optic atrophy) is a neurodegenerative disorder first characterized in Finnish patients. Subsequent reports have occasionally identified cases of PEHO occurring in some other countries. We describe two Dutch children who represent the first reported cases with PEHO syndrome from western Europe. Both of these children showed typical characteristics of the syndrome, including generalized hypotonia and edema of their faces and extremities, profound psychomotor retardation, progressive cerebellar atrophy, and severe epilepsy which initially started as infantile spasms. Our experience has shown that distinguishing cases with true PEHO from those with other, clinically similar disorders requires a firm demonstration of both the presence and the progress of typical neuroradiological findings. Our present cases suggest that 1) PEHO syndrome is not limited to Finnish heritage, and that 2) many more patients with PEHO could be identified with increased knowledge of the syndrome.

Ophthalmological findings in patients with spinocerebellar ataxia type 1 are not correlated with neurological anticipation

BACKGROUND

Optic atrophy, attenuation of the oscillatory potentials (OPs) of the electroretinogram (ERG), and enlargement of corneal endothelial cells, have been reported in patients with spinocerebellar ataxia type 1 (SCA1). These patients have a trinucleotide repeat expansion in the SCA1 gene and show neurological anticipation. The purpose of this study was to determine whether the ophthalmological findings are correlated with the neurological disorders, and whether ophthalmological anticipation is present in patients with SCA1.

METHODS

The visual acuity, ERGs, and corneal endothelial cell density were examined in 14 patients whose DNA analysis revealed an expanded trinucleotide repeat in an allele of the SCA1 gene. The results of the tests were compared with the trinucleotide repeat number and the duration of the neuronal disease.

RESULTS

The neurological disorders in the patients showed anticipation. The negative correlation between the trinucleotide repeat number and the neurological disorder was statistically significant (P<0.0001). However, the correlations between trinucleotide repeat number and visual acuity, amplitude of OPs, and corneal endothelial cell density were not significant. Statistically significant correlations were found between the duration of the neuronal disease and the visual acuity, OPs, and corneal endothelial cell density (P<0.0001, P=0.0004, and P<0.0001, respectively). The ophthalmological disorders were prominent in patients who had neuronal disease for more than 10 years.

CONCLUSION

Unlike the neurological findings, the ophthalmological disorders in patients with SCA1 were not correlated with the trinucleotide repeat number of the SCA1 gene. The ophthalmological findings were most highly correlated with the duration of the neuronal disease.

Kidney transplantation unraveling Wolfram syndrome: a case report

BACKGROUND

In Wolfram syndrome insulin-dependent diabetes is associated with a multisystem neurodegenerative disorder. There are no prior reports of kidney transplantation in patients with Wolfram syndrome.

METHODS

Kidney transplantation was undertaken in a child with dysplastic kidneys, sensorineural hearing impairment and bilateral optic atrophy-a combination of features insufficient to define Wolfram syndrome.

RESULTS

After the procedure diabetes mellitus, diabetes insipidus and urinary bladder dysfunction emerged, thereby revealing Wolfram syndrome.

CONCLUSIONS

We discuss the etiology of our patient's postoperative events, and conclude that kidney transplantation may expose dormant manifestations-or aggravate existing manifestations-of Wolfram syndrome.

Musculoskeletal deformities in Behr syndrome

SUMMARY

Seventeen children with Behr syndrome were investigated, focusing on the musculoskeletal deformities and long-term outcome. Behr syndrome is characterized by optic atrophy beginning in early childhood associated with ataxia, spasticity, mental retardation, and posterior column sensory loss. The ataxia, spasticity, and muscle contractures, mainly of the hip adductors, hamstrings, and soleus, are progressive and become more prominent in the second decade. In 70% of the patients, contractures developed in the lower limbs, requiring surgery mainly for the Achilles tendon, hamstrings, and adductor longus. At last follow-up at an average age of 21.7 years (range, 8-31 years), 13 of the patients are housebound walkers, 2 are nonfunctional walkers, and 2 are nonwalkers.

Bull's-eye macular dystrophy associated with peripheral involvement

Although central vision in Stargardt's disease is impaired relatively early, peripheral function is usually little affected and patients do not lose all vision. We report 4 patients with bull's-eye macular dystrophy that is indistinguishable from Stargardt's disease/fundus flavimaculatus, but with very depressed peripheral retinal function. One patient had bull's-eye maculopathy with a dark choroid on the fluorescein angiogram with a normal peripheral fundus and good retinal function initially. Sixteen years later, however, peripheral bone corpuscle pigmentation and optic disc atrophy developed and the electroretinogram became nonrecordable. Three patients from another family also had peripheral pigment degeneration besides macular degeneration. These cases may represent a rare combination of Stargardt's disease and retinitis pigmentosa. However, there was no clinical sign or even suggestion of retinitis pigmentosa at the initial examination in 1 patient. The mode of inheritance in 3 of our patients is probably autosomal recessive.

Optic nerve hypoplasia and small eyes in presumed amblyopia

PURPOSE

To assess the anatomy of eyes presumed to be amblyopic and their fellow eyes.

PARTICIPANTS

Two hundred seventy-five patients diagnosed with amblyopia and 88 healthy or glaucomatous subjects.

METHODS

All subjects underwent complete examinations, including cycloplegic refraction, slit lamp examination, ophthalmoscopy, and retinal imaging. Axial lengths were determined on 263 amblyopic and 88 healthy and glaucomatous subjects by ultrasonic biometry.

MAIN OUTCOME MEASURES

Optic disc areas were determined by magnification correction of disc images performed with formulas. Dysversion of the optic disc was determined by simultaneous viewing of disc photographs, digitized images of both eyes, or both.

RESULTS

The mean disc area of eyes presumed to be amblyopic was 1.72 mm(2) +/- 0. 73 SD and 1.95 mm(2) +/- 0.69 SD for nonamblyopic eyes (P =.0017). The mean disc area for 176 optic discs of glaucomatous and healthy eyes was 2.61 mm(2) +/- 0.95 SD. The mean axial length for eyes in the general population is 23.65 mm +/- 1.35 SD. The healthy and glaucomatous group in this study had a mean axial length of 23.89 mm +/- 1.29 SD. The eyes with poorer vision that were assumed to be amblyopic averaged 22.42 mm +/- 2.01 SD in length, whereas their nonamblyopic fellow eyes averaged 22.83 mm +/- 1.89 SD (P =.022). The differences between eyes in the healthy population and eyes that are presumably amblyopic, as well as the healthy and fellow eyes, are highly significant (P <.0001)(7.0 x 10(-16)).

CONCLUSION

Vision impairment in presumed amblyopia is associated with optic nerve hypoplasia with relative microphthalmos, which is more notable in those eyes with poorer vision.

Perineurial cell hyperplasia in early-onset polyneuropathy with multiple cranial neuropathies

We describe a patient who as a teenager developed a sensory-motor polyneuropathy with optic atrophy. Over the next three decades, multiple cranial neuropathies appeared. Striking areas of subperineurial cellular proliferation were observed on sural nerve biopsy. The ultrastructural and immunohistochemical characteristics of these aggregates were those of perineurial cell hyperplasia. To our knowledge, this is the second full report associating perineurial cell hyperplasia with a sensory-motor polyneuropathy and the first in the English literature.

Chronic infantile neurological cutaneous and articular/neonatal onset multisystem inflammatory disease syndrome: ocular manifestations in a recently recognized chronic inflammatory disease of childhood

OBJECTIVE

To report on the ocular manifestations of the Chronic Infantile Neurological Cutaneous and Articular/Neonatal Onset Multisystem Inflammatory Disease (CINCA/NOMID) syndrome, a rare, recently identified, pediatric multisystem inflammatory disease with chronic cutaneous, neurological, and articular manifestations.

DESIGN

Descriptive case-report study.

SETTING

International collaborative study based on a questionnaire.

RESULTS

We included 31 patients. The mean age at onset of eye manifestations was 4.5 years. Optic disc changes were the most common feature, occurring in 26 patients (83%), including optic disc edema, pseudopapilledema, and optic atrophy. Anterior segment manifestations varying from mild to severe were seen in 13 patients (42%); chronic anterior uveitis, in 17 patients (55%). Moderate to severe visual acuity loss in at least 1 eye was seen in 8 patients (26%) as a consequence of the disease. Posterior synechia, glaucoma, and white iritis were not observed in any patient.

CONCLUSION

Ocular manifestations with potentially sight-threatening complications occur commonly in the CINCA/NOMID syndrome. The distinctive nature of these complications may assist the ophthalmologist in recognizing this rare disorder and distinguishing it from juvenile rheumatoid arthritis.

Optic atrophy in association with cobalamin C (cblC) disease

PURPOSE

To report the association of optic atrophy with cobalamin C (cblC) disease.

METHODS

Descriptive case reports on three patients, two of whom were siblings.

RESULTS

All three patients with cblC disease exhibited bilateral optic atrophy with decreased visual acuity. Of the two siblings, the younger sister had received cobalamin supplements from birth and the mother had been given cobalamin supplements prenatally.

CONCLUSION

These three cases confirm the association of optic atrophy with cblC disease. Early treatment with cobalamin supplements does not appear to prevent the development of optic atrophy.

Complicated hereditary spastic paraplegia with peripheral neuropathy, optic atrophy and mental retardation

An 8-year old girl with a not previously described type of complicated hereditary spastic paraplegia (HSP) is presented. Spasticity in her lower limbs had already been recognized during infancy and worsened progressively. Severe delay in mental development was observed. Peripheral neuropathy and optic atrophy developed at 5 years of age. On brain magnetic resonance imaging, an abnormally thin corpus callosum was observed. Involvement of the fasciculus gracilis was suggested by somatosensory evoked potentials. To our knowledge, there has been no reported case of complicated HSP with peripheral neuropathy, optic atrophy and mental retardation so far. We postulate that our patient is a sporadic case of not previously described complicated HSP.

A DIDMOAD syndrome family with juvenile glaucoma and myopia findings

We present here two DIDMOAD syndrome cases (Diabetes Mellitus, Diabetes Insipidus, Optic Atrophy, Deafness) in a Turkish family. In the examination of the propositus who had consanguineous parents, diabetes mellitus, diabetes insipidus, optic atrophy, and deafness were observed in addition to myopia, juvenile glaucoma, posterior polar cataract, and dilatation of the urinary tract. Diabetes mellitus, diabetes inspidus, optic atrophy, deafness, myopia, and ventricular septal defect were observed in his elder brother. Juvenile onset diabetes mellitus, congenital glaucoma, deafness, and heart disease were the other remarkable findings observed in relatives to this family. Juvenile glaucoma, posterior polar cataract observed in our propositus, and myopia in both our DIDMOAD syndrome cases are the first ophthalmic manifestations described in the DIDMOAD syndrome.

Concordance of parapapillary chorioretinal atrophy in ocular hypertension with visual field defects that accompany glaucoma development

OBJECTIVE

To determine whether the extent and location of progressive parapapillary chorioretinal atrophy noted in some patients with ocular hypertension are correlated with the extent and location of visual field defects that occur with progression to glaucoma.

STUDY DESIGN

Retrospective cohort study.

PARTICIPANTS

Thirty patients with ocular hypertension who had progressive changes of parapapillary atrophy develop before clinically detectable optic disc or visual field damage.

MAIN OUTCOME MEASURES

Assessment of changes in the parapapillary atrophy and visual field parameters.

METHODS

Baseline and follow-up optic disc photographs and visual field test results were retrospectively analyzed. The relationship between the extent of parapapillary atrophy observed during the ocular hypertension period and initial visual field abnormalities detected after glaucoma development, as well as their spatial relationship, was statistically analyzed.

RESULTS

The extent of progressive changes of the parapapillary atrophy detected during the ocular hypertension period was correlated with the extent of changes in the visual field parameters, including corrected pattern standard deviation and mean deviation measured after glaucoma development (Mantel-Haenszel chi-square test, P = 0.026, P = 0.037, respectively). In addition, the visual field abnormalities occurred in the corresponding quadrants of the progressive parapapillary atrophy. Analysis of the spatial relationship revealed that the location of progressive changes of the parapapillary atrophy was concordant with the location of visual field abnormalities in 78% of the quadrants (94 of 120 quadrants) (chi-square test, P = 0.001).

CONCLUSIONS

The extent and location of visual field abnormalities that develop in ocular hypertensive eyes with progression to glaucoma exhibit a concordance with the extent and location of progressive parapapillary atrophy noted in the ocular hypertension period. This suggests the importance of detailed examination of the parapapillary area in ocular hypertensive eyes.

[Sensory heterotropias: epidemiological aspects at Douala General Hospital (Cameroon)]

The aim of this retrospective study was to determine the epidemiological characteristics of the sensory heterotropia cases seen in the Opthamology Department of Douala General Hospital between November 1991 and November 1999. Sensory heterotropia accounted for 22.5% of the cases of strabismus reported. Onset was before the age of one year in 80.4% of cases and after the age of one year in 19.6% of cases. All cases of esotropia were apparent before the age of one year. Sensory heterotropia was associated with amblyopia in 89.3% of cases, with eccentric fixation in 78.6% of cases and with nystagmus in 53.6% of cases. Etiology was diverse, the most frequent causes being: albinism (19.6%), chorioretinal scars (16.1%), unilateral cataracts (16.1%), atrophy of the optic nerve (16.1%) and ametropia (8.9%). We recommend preventive measures for some etiologies.

Conradi-Hünermann syndrome with ocular anomalies

We report a Japanese girl with the Conradi-Hünermann form of chondrodysplasia punctata and anterior segment malformations characteristic of Axenfeld-Rieger syndrome. The patient also had cataracts and unilateral optic atrophy. A possible role for homeobox-containing genes in the etiology of this type of chondrodysplasia punctata is suggested as an explanation for the coincidence of these two syndromes.

[Use of visual aids for vision of disabled children]

OBJECTIVE

To discuss the effect of using distance and near optical low vision devices for children in low vision clinic.

METHOD

139 subjects from age 6 to 14 years were provided with 2.5 X telescopes and + 8.00D to + 40.00D glasses for improving far and near sight respectively.

RESULT

22.3% subjects' distance visual acuity was >or= 0.5 and 53.2% subjects' near visual acuity was >or= 0.5 after using distance and near low vision aids.

CONCLUSIONS

Low vision aid is essential and effective in low vision clinic. It not only improves the visual acuity of visual disabled children, but also helps the development of special education through visual rehabilitation.

Parapapillary atrophy in patients with focal visual field loss

PURPOSE

To examine parapapillary atrophy in normal subjects and patients with primary open-angle glaucoma with focal visual field loss.

METHODS

Twenty-nine patients with repeatable early focal visual field loss according to standard automated perimetry (Humphrey program 24-2) and 29 matched (age and disk area) normal subjects were included. Parapapillary atrophy area and optic disk topography were evaluated with a confocal scanning laser ophthalmoscope. The difference in parapapillary atrophy area between normal subjects and patients with glaucoma was examined. Optic disk topography was evaluated by means of the rim-disk area ratio in 36 10-degree sectors and classified into diffuse and focal patterns of neuroretinal rim thinning. In patients with a focal pattern, the locations of rim thinning and parapapillary beta zone atrophy were compared.

RESULTS

Beta zone atrophy was detected more frequently in patients with glaucoma (45% [13/29]) than in normal subjects (7% [2/29]), and it was located both superiorly and inferiorly in 92% (12/13) of the glaucoma patients. Alpha zone atrophy was significantly larger in patients with glaucoma than normal subjects (P = .009) but not more frequent (97% [28/29] in both groups). Sixty-one percent (8/13) of glaucoma patients with beta atrophy had diffuse thinning and 31% (4/13) had focal thinning. Eight percent (1/13) did not have neuroretinal rim thinning. In the four patients with both focal rim thinning and beta zone atrophy, the location of rim thinning corresponded to the location of the beta zone atrophy (100% [4/4]).

CONCLUSIONS

In patients with early focal glaucomatous visual field loss, the presence and location of parapapillary beta zone atrophy and neuroretinal rim thinning are in good correspondence. Observation of localized parapapillary beta zone atrophy in clinical practice should direct one to more closely examine the optic disk in this region, as it may reveal localized rim thinning in a disk previously considered to be normal. Moreover, diffuse structural change in an eye with only focal functional change, as determined by standard automated perimetry, is consistent with the possibility that structural damage may be more widespread than functional damage in these patients.