Association of Myopic Deformation of Optic Disc with Visual Field Progression in Paired Eyes with Open-Angle Glaucoma

Abstract

PurposeThe influence of myopia on glaucoma progression remains unknown, possibly because of the multifactorial nature of glaucoma and difficulty in assessing a solo contribution of myopia. The purpose of this study is to investigate the association of myopia with visual field (VF) progression in glaucoma using a paired-eye design to minimize the influence of confounding systemic factors that are diverse among individuals.MethodsThis retrospective study evaluated 144 eyes of 72 subjects with open-angle glaucoma, with similar intra-ocular pressure between paired eyes, spherical equivalent (SE) ≤ -2 diopter (D), and axial length ≥ 24 mm. Paired eyes with faster and slower VF progression were grouped separately, according to the global VF progression rate assessed by automated pointwise linear regression analysis. The SE, axial length, tilt ratio and torsion angle of optic discs, Bruch’s membrane (BM) opening area, and gamma zone parapapillary atrophy (PPA) width were compared between the two groups. Factors associated with faster VF progression were determined by logistic regression analysis.ResultsThe mean follow-up duration was 8.9 ± 4.4 years. The mean value of SE and axial length were -6.31 ± 1.88 D and 26.05 ± 1.12 mm, respectively. The mean global visual field progression rate was -0.32 ± 0.38 dB/y. Tilt ratio, BM opening area, and gamma zone PPA width were significantly greater in the eyes with faster VF progression than those with slower progression. In multivariate analysis, these factors were significantly associated with faster VF progression (all P < 0.05), while SE and axial length were not associated with it.ConclusionIn myopic glaucoma subjects, tilt of the optic disc and temporal shifting and enlargement of the BM opening were associated with faster rate of VF progression between paired eyes. This suggests that myopia influences VF progression in glaucomatous eyes via optic disc deformations rather than via refractive error itself.

Multiple Temporal Lamina Cribrosa Defects in Myopic Eyes with Glaucoma and Their Association with Visual Field Defects

“…The present findings demonstrating a significant association between the optic disc tilt and the number of LC defects are in accordance with this hypothesis. The present results further confirmed the findings of our recent studies, where we described the association of optic disc tilt with the severity 18 and progression 19 of VF defects in myopic glaucoma and provided evidence that optic disc tilt affects VF defects by way of an increased number of temporal LC defects. In addition, a previous study demonstrated development of PCS from the early stage of glaucoma in highly myopic eyes.…”

“…15e17 The association between myopia and glaucoma has been studied intensively, and it gradually becomes clear that myopia influences glaucomatous damage not through refractive error itself, but through deformation of the parapapillary region. 18,19 Myopic eyes present characteristic deformations of the parapapillary region, including optic disc tilt and torsion and parapapillary atrophy. Because LC is a deep component of the optic nerve head, it is reasonable to think that the LC, too, is deformed in myopic eyes and that it affects axonal injury in glaucoma.…”

Topographic Relationship with a Retinal Nerve Fiber Layer Defect Differs betweenβ-Zone andγ-Zone Parapapillary Atrophy

“…is may cause distortion of the optic nerve structure at an early age, [15,16], and exert a tensile or shearing stress on the axons passing through the lamina pores. Long-standing stress from an early age could generate axonal damage by itself [17] or increase the susceptibility of the axons to IOP-related mechanical stress [18]. is could explain why eyes with c-zone PPA have an RNFL defect of similar extent at an earlier age compared to those with β-zone PPA.…”

Increased Incidence of Visual Field Abnormalities as Determined by Frequency Doubling Technology Perimetry in High Computer Users Among Japanese Workers: A Retrospective Cohort Study

“… 21 A recent study found that myopia might worsen glaucomatous visual field impairment via myopic optic disk deformation, rather than directly via refractive error or axial length. 22 In addition to this glaucoma-susceptible eye condition, long-time computer use might interactively increase the risk of glaucoma. Myopia might also be associated with a bias toward educational factors that lead to differences in lifestyles or working habits, as intelligence and education appear to be important triggers of this condition.…”