PERIPAPILLARY FOCAL RETINAL ARTERIOLAR NARROWING IN OPEN-ANGLE GLAUCOMA

Purpose: Optic disc photographs of 750 patients attending a glaucoma p ractice were examined to identify focal peripapillary arteriolar narro wing. Methods: A subgroup of 110 of these patients' photographs, who h ad also had finger circulation tested for vasospasm to cold, were divi ded into patients with peripapillary focal narrowing and a control gro up without such a narrowing. These groups were compared with regard to their clinical status, optic disc morphology, and visual field charac teristics. Results: Patients with focal arteriolar narrowing were stat istically significantly older (p < 0.0001) and had greater cup/disc ra tio (p < 0.0001), suggesting more glaucomatous damage than those witho ut focal narrowing. Focal narrowing was statistically significantly mo re common in patients with glaucoma than in patients with ocular hyper tension (p < 0.0001) and were significantly more common when peripapil lary atrophy was present (p < 0.0012). The location of the focal narro wing correlated with the presence of a visual field defect in the corr esponding hemifield (p < 0.0001 for both upper and lower hemifields). There was no association between focal arteriolar narrowing and digita l vasospasm to cold in our study. Peripapillary focal arteriolar narro wings appear to be related to the severity of glaucoma, although the e ffects of age were not excluded. A patient is presented in whom the na rrowing disappeared within a few months suggesting focal vasoconstrict ion in her. Conclusion: Focal narrowing may be indicative of more wide spread vascular pathology in the same region; however, we do not know whether these changes precede glaucomatous damage or occur secondarily to glaucomatous damage.