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Predictive Factors Within the Optic Nerve Complex for Glaucoma Progression: Disc Hemorrhage and Parapapillary Atrophy

De Moraes, Carlos Gustavo MD*†; Liebmann, Jeffrey M. MD*†; Ritch, Robert MD*‡

The Asia-Pacific Journal of Ophthalmology: March/April 2012 - Volume 1 - Issue 2 - p 105–112
doi: 10.1097/APO.0b013e31824a65f8
Review Article
Editor's Choice

The optic nerve complex (ONC) is a new term we have created to describe the clinically and non–clinically visible portions of the optic nerve and surrounding tissues. Recent advances in imaging technologies have created a need to provide a unified and comprehensive view of the structure and function of the components of ONC to assess various risk factors for glaucoma development and progression. Despite a great deal remaining to elucidate their underlying pathogenesis, disc hemorrhages and β-zone parapapillary atrophy have been consistently shown in different study designs to be significant risk factors for glaucoma progression. Given their easy visibility as components of the ONC, disc hemorrhage and β-zone parapapillary atrophy are widely underscored glaucoma features that should be thoroughly investigated and documented with the purpose of stratifying patients under risk categories along with other intraocular pressure–dependent and –independent factors. This review provides an update on these 2 features and their relationship to glaucoma progression.

From the *Einhorn Clinical Research Center, New York Eye and Ear Infirmary; †Department of Ophthalmology, New York University School of Medicine; and ‡Department of Ophthalmology, New York Medical College, Valhalla, NY.

Received for publication November 16, 2011; accepted December 1, 2011.

Reprints: Carlos Gustavo De Moraes, MD, 310 E 14th St, New York, NY 10003. E-mail:

The study is supported by the Michael and Francesca Freedman Research Fund of the New York Glaucoma Research Institute, New York, NY, USA.

The authors have no funding or conflicts of interest to declare.

© 2012Asia-Pacific Academy of Ophthalmology
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