How to diagnose glaucoma in myopic eyes by detecting structural changes?

Area of Science:

• Ophthalmology
• Public Health
• Medical Imaging

Background:

• Global myopia prevalence is rapidly increasing, especially in East and Southeast Asia, reaching 80-90% in young populations.
• High myopia is a significant risk factor for developing glaucoma later in life.
• Assessing the optic nerve head (ONH) in myopic eyes is challenging due to structural changes mimicking glaucoma.

Purpose of the Study:

• To review the challenges and advancements in diagnosing glaucoma in myopic patients.
• To highlight the importance of accurate optic nerve head assessment, especially before refractive surgery.
• To discuss the role of optical coherence tomography (OCT) in differentiating glaucomatous from myopic changes.

Main Methods:

• Review of current literature on myopia, glaucoma, and OCT imaging.
• Analysis of specific OCT parameters for distinguishing glaucomatous damage from myopic alterations.
• Discussion of advancements in OCT technology and myopia-specific normative databases.

Main Results:

• Myopic eyes exhibit unique ONH changes (e.g., peripapillary atrophy) that can be mistaken for glaucoma.
• Optical coherence tomography (OCT) has improved ONH microstructure examination but can yield false positives.
• Specific OCT metrics like minimum rim width and ganglion cell-inner plexiform layer thickness show potential for accurate differentiation.

Conclusions:

• Accurate glaucoma diagnosis in myopic patients requires a comprehensive approach integrating multiple OCT metrics.
• Advanced imaging techniques and myopia-specific data are crucial for navigating diagnostic complexities.
• Tailored strategies are needed to manage glaucoma risk in the growing population of myopic individuals.