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Clinical implications of peripapillary atrophy in glaucoma Jost B. Jonas Purpose of review Introduction To elucidate peripapillary atrophy in glaucomatous optic Around the beginning of the 20th century, ophthalmolo- neuropathy; its ranking in the morphologic diagnosis of the gists such as Elschnig and Bu¨cklers [1–3] turned attention glaucoma, and its value for the differentiation of various to an association between glaucoma and peripapillary cho- types of chronic open-angle glaucoma, for the separation of rioretinal atrophy. It was called ‘halo glaucomatosus’ when glaucomatous eyes from nonglaucomatous eyes, and for it totally encircled the optic disc in eyes with end-stage the detection of progression of glaucoma. glaucoma. Later, Primrose, Hayreh, Wilensky and Kolker, Recent findings Anderson, Airaksinen, and other investigators confirmed Recent studies showed an association of peripapillary the observations describing the occurrence of peripapillary atrophy with glaucoma and the eventual development of atrophy in eyes with glaucoma [4–26]. Heijl and Samander glaucomatous disc hemorrhages independent of a small [11] found a spatial correlation between the peripapillary neuroretinal rim area, and an association between increasing chorioretinal atrophy and the location of the most marked peripapillary atrophy and progressive glaucoma. A ranking of visual field loss. Anderson [8] described that the presence optic disc parameters to detect glaucomatous damage or extent of a crescent correlated with the glaucomatous revealed that the alpha and beta zones of per