This study was undertaken in order to determine the value of measuring peripapillary atrophy for the diagnosis and follow-up of patients with glaucoma, and to evaluate how closely peripapillary atrophy is related to structural and functional optic nerve damage in glaucoma. Magnification-corrected morphometry of photographs using a computer graphic program and automated static threshold perimetry were performed in 234 eyes of 141 patients with primary open-angle glaucoma and 139 eyes of 86 normal subjects. The groups were not significantly different in age, refractive error or disc area. Zones α and β were significantly larger, total peripapillary atrophy was significantly more extensive, and zone β occurred more often in the glaucoma group than in the normal group. The frequency of zone β increased with advancing glaucoma stage. The areas of zones α and β and total peripapillary atrophy increased significantly with decreasing rim/disc area ratio, rim area, and mean deviation, and with increasing vertical and horizontal cup-to-disc ratios and cup area. Correlation coefficients were generally higher for zone β than for zone α. Peripapillary atrophy was greater in a sector in which the neuroretinal rim loss was more marked. These findings suggest that increases in the extent of peripapillary atrophy are related to the severity of glaucomatous optic nerve damage and visual field defects, and that peripapillary atrophy is useful for the diagnosis and progression of glaucomatous nerve damage.