Managing Myopic Glaucoma-Beyond Structural Fragility and Diagnostic Challenges: Review Article

Area of Science:

• Ophthalmology
• Glaucoma Research
• Myopia Studies

Background:

• Myopic glaucoma is an underrecognized optic neuropathy, particularly in young patients with normal intraocular pressure (IOP).
• High myopia presents unique structural and biomechanical challenges complicating diagnosis and management.
• Increasing global myopia prevalence heightens the risk of glaucoma, especially in Asian populations.

Purpose of the Study:

• To review current evidence on myopic glaucoma's pathophysiology, clinical presentation, and diagnostic limitations.
• To outline tailored therapeutic strategies for improved management of myopic glaucoma.
• To establish a practical clinical framework for identifying and treating myopic glaucoma.

Main Methods:

• This study is a narrative review synthesizing current clinical and basic science evidence.
• A comprehensive literature search was conducted on myopic glaucoma.
• The review focuses on pathophysiology, clinical presentation, diagnostic challenges, and therapeutic strategies.

Main Results:

• High myopia causes structural alterations, increasing vulnerability to glaucomatous damage even with normal IOP.
• Diagnostic limitations include tilted optic discs, peripapillary atrophy, and standard OCT issues; advances like AI and WF-OCTA improve accuracy.
• Management requires lower IOP targets and may involve combined medical therapy or surgery, with careful consideration of risks like hypotony maculopathy.

Conclusions:

• Early identification and management of myopic glaucoma are vital to prevent vision loss.
• Awareness of myopia's challenges and emerging technologies can improve patient outcomes.
• Optimized management strategies are essential for this high-risk population.