Multimodal imaging of optic nerve head abnormalities in high myopia

Area of Science:

• Ophthalmology
• Medical Imaging
• Optic Neuropathy

Background:

• High myopia is associated with significant axial elongation, leading to stretching of optic nerve head (ONH) structures.
• Morphological changes include disk tilting, progressive hemifields of myopic staphyloma (PHOMS), and peripapillary atrophy (PPA).
• Tissue defects such as focal lamina cribrosa defects (FLDs) and acquired pits of the optic nerve (APON) can occur.

Purpose of the Study:

• To review the spectrum of optic nerve head abnormalities in high myopia.
• To highlight the role of multimodal imaging in the diagnosis and classification of these conditions.
• To provide insights into optic neuropathy in high myopia for disease monitoring and treatment.

Main Methods:

• Review of current literature on high myopic ONH abnormalities.
• Discussion of various imaging modalities including color fundus photography (CFP), optical coherence tomography (OCT), OCT angiography (OCTA), fundus autofluorescence (FAF), and indocyanine green angiography (ICGA).
• Emphasis on the diagnostic utility of advanced imaging techniques.

Main Results:

• Morphological changes in high myopic ONH include disk tilting, PHOMS, PPA, FLDs, peripapillary intrachoroidal cavitations (PICCs), and APON.
• Anterior vitreous/vascular traction and posterior scleral protrusion can lead to prelaminar schisis and paravascular cysts/holes.
• Traditional CFP is often insufficient; advanced imaging like OCT and OCTA significantly improves visualization and quantification.

Conclusions:

• A comprehensive understanding of multimodal imaging features is essential for effective diagnosis and classification of ONH abnormalities in high myopia.
• These insights are valuable for understanding optic neuropathy in high myopia.
• This review establishes a foundation for future disease monitoring and treatment guidance.