Myopic glaucomatous eyes with or without optic disc shape alteration: a longitudinal study

Area of Science:

• Ophthalmology
• Glaucoma Research
• Optic Nerve Imaging

Background:

• Myopic primary open angle glaucoma (POAG) presents unique challenges in diagnosis and management.
• Optic disc shape alterations, such as tilt and rotation, are common in myopic eyes and may influence glaucoma progression.

Purpose of the Study:

• To compare the clinical progression of myopic POAG in patients with and without optic disc shape alterations.
• To investigate the impact of optic disc tilt and rotation on the rate and pattern of glaucomatous damage.

Main Methods:

• A longitudinal retrospective study of 146 eyes with myopic POAG (axial length >24 mm).
• Eyes were classified based on optic disc shape alterations (tilt and/or rotation).
• Glaucomatous progression was assessed using serial optic disc/retinal nerve fiber layer imaging and visual field (VF) testing, with progression rates calculated from VF mean deviation (MD) and visual field index.

Main Results:

• Eyes with non-tilted optic discs exhibited a faster rate of glaucoma progression compared to those with tilted discs (-0.30 dB/year vs. 0.05 dB/year).
• A higher percentage of eyes with non-tilted discs showed significant VF progression in both superior and inferior hemifields (21.3% vs. 1.9%).
• Less optic disc tilt and worse initial VF MD were significantly associated with progression in both VF hemifields.

Conclusions:

• Significant differences in glaucomatous progression exist between myopic POAG eyes with and without optic disc shape alterations, particularly disc tilt.
• Optic disc tilt appears to be a protective factor, associated with more localized and stable glaucoma progression.
• These findings highlight the importance of considering optic disc morphology in the management of myopic POAG.