The Impact of Myopia on Regional Visual Field Loss and Progression in Glaucoma

The purpose of this study was to investigate the impact of myopia on regional visual field (VF) loss and progression in glaucoma.

We included 112,633 24-2 VFs; longitudinal analyses comprised patients with at least 5 reliable VFs over 4 years. The degree of myopia was measured by spherical equivalent (SE) extracted from VF testing. Linear and Cox regressions determined the impact of myopia on regional VF loss and progression, respectively. We calculated three VF progression outcomes: (1) mean deviation (MD) progression: MD slope <0; (2) total deviation (TD) pointwise progression: at least 3 TD locations with TD slope ≤-1 decibels (dB)/year; (3) MD fast progression: MD slope ≤-1 dB/year (P value < 0.05). Longitudinal analyses were conducted for all subjects and with exclusion of patients with high myopia (SE ≤-6.00 diopters [D]).

More negative SE values were associated with worse TD values in the paracentral VF region (up to -0.14 dB/D). A more negative SE is associated MD (odds ratio [OR] = 0.95), TD pointwise (OR = 0.96), and MD fast progression (OR = 0.94; P < 0.001). Results were comparable when excluding patients with high myopia (P < 0.001): MD (OR = 0.95), VFI (OR = 0.95), and MD fast progression (OR = 0.94).

Lower SE values are associated with worse paracentral VF loss. Worse myopia is associated with functional progression, even when excluding patients with high myopia.

We provide evidence for the relationship between SE and VF progression and inform clinical practice by highlighting even mild myopia as a highly prevalent possible risk factor for glaucoma progression.