Acquired peripapillary changes and progression in glaucoma

In a review of fundus photographs, changes in the degree of depigmentation or atrophy of the retinal pigment epithelium (RPE) were observed near the disc over time in 21% of cases with progressive glaucomatous cupping, but they also occurred as a natural phenomenon over time in 4% of eyes with nonprogressive glaucoma and in 3% of nonglaucomatous eyes. Thus, the peripapillary RPE shows some progressive alteration in normal individuals, but also may sometimes suffer along with the axons during glaucomatous damage. The acquired changes observed in the progressive glaucomatous eyes seem too small and too infrequent to account for the high prevalence of large haloes and crescents seen around the optic disc in glaucoma.