ABSTRACT
As well as ONH alterations, peripapillary changes have been described in glaucoma, but seem not to occur in other optic neuropathies.16 Peripapillary atrophy is characterized by a region of atrophy of the retinal pigment epithelium, centrally, adjacent to the scleral ring, the beta zone, and a region of pigment mottling, lying more peripherally, the alpha zone (Figure 1.1). Many studies have confirmed that peripapillary atrophy, especially the beta zone, can increase in glaucomatous optic neuropathy17 and that peripapillary alterations may even precede functional loss in patients with ocular hypertension converting to glaucoma.18,19 It may also be helpful in differentiating normal-tension glaucoma from glaucoma-like discs.20 Even in experimental glaucoma, the development of peripapillary atrophy has been described.21 Careful scrutiny of the published figures in the latter study suggests, however, that the zone where peripapillary atrophy develops can already be outlined on baseline pictures. A possible interpretation hereto is that peripapillary atrophy
Figure 1.1 Peripapillary atrophy is characterized by a central region of total atrophy of the retinal pigment epithelium (the beta zone), and a peripheral zone of pigment mottling (the alpha zone). 1 optic cup; 2 rim of the optic disc; 3 beta zone; 4 alpha zone; 5 scleral ring.
