Clinical features of high myopia with optic nerve head prelaminar schisis: Wuhan high myopia study

The global prevalence of high myopia is rising, posing a significant public health concern. Limited research exists on risk factors for prelaminar schisis (PLS) and its impact on visual field changes in highly myopic eyes. Herein, we investigated clinical features of prelaminar schisis (PLS) in highly myopic eyes.

This cross-sectional study included 245 eyes with high myopia and 64 eyes with emmetropia and low myopia. PLS was classified on a 3-point scale (0-2), and clinical characteristics were compared between two groups and three sub-groups. Factors associated with PLS presence and severity were evaluated in highly myopic eyes.

Highly myopic eyes had a higher frequency (P = 0.008) and severity (P = 0.001) of PLS than controls. Among them, 33.47% (82/245) had Grade 0, 56.33% (138/245) had Grade 1, and 10.20% (25/245) had Grade 2. The presence of Bergmeister papilla (OR = 2.181, 95% CI: 1.080-4.406, P = 0.030), larger Bruch's membrane opening (BMO) (OR = 1.927, 95% CI: 1.279-2.904, P = 0.002) and longer axial length (OR = 1.723, 95% CI: 1.186-2.499, P = 0.004) correlated with PLS severity. Eyes with Grade 2 PLS were more prone to visual field defect than eyes with Grade 0 (P = 0.005) and Gade 1 (P = 0.013) PLS.

Bergmeister papilla presence, larger BMO, and longer axial length were associated with the PLS severity, suggesting ONH prelaminar schisis may indicate traction and myopic deformation of the ONH. PLS with peripapillary retinoschisis suggests a possibility of functional damage.