High Myopia-Induced Optic Nerve Head Deformation and Glaucoma Progression: A Three-Year Follow-Up Study

Area of Science:

• Ophthalmology
• Biomechanics
• Glaucoma Research

Background:

• High myopia (HM) is associated with structural changes in the optic nerve head (ONH).
• These ONH alterations may influence the progression of glaucoma, particularly in highly myopic individuals.

Purpose of the Study:

• To investigate the biomechanical impact of HM-related ONH structural changes on glaucoma progression.
• To identify key predictive parameters for glaucoma progression in the context of high myopia.

Main Methods:

• Prospective cohort study of 242 eyes (97 highly myopic glaucoma, 145 open-angle glaucoma).
• Quantification of ONH parameters (BMO, ASCO, NCMCA, ASCO-BMO offset) using spectral-domain OCT.
• Monitoring of visual field (VF) defects and parapapillary retinal nerve fiber layer (pRNFL) thickness over 3 years.

Main Results:

• Highly myopic glaucoma (HMG) eyes showed larger BMO/ASCO areas, greater ASCO-BMO offset, and smaller NCMCA compared to open-angle glaucoma (OAG) eyes.
• HMG eyes exhibited faster temporal VF progression and pRNFL thinning.
• NCMCA was identified as an independent predictor of global glaucoma progression.

Conclusions:

• HM-induced ONH deformation, including nasal tilting and reduced NCMCA, accelerates glaucoma progression.
• NCMCA is a critical biomarker for predicting glaucoma progression risk in highly myopic patients.
• These findings support individualized glaucoma management strategies for patients with high myopia.