Classification of Visual Field Abnormalities in Highly Myopic Eyes without Pathologic Change

Glaucoma and Myopia: Diagnostic Challenges

“…Differentiating myopia-related optic neuropathy and normal tension glaucoma (NTG) can be very challenging due to the constellation of clinical findings particularly associated with high myopia. It has been well recognized that myopic patients with normal intraocular pressures (IOPs) can present with glaucomatous visual field defects, which can be attributed to myopia rather than to glaucoma [ 40 , 41 , 42 , 43 ]. Of the 894 unique visual fields from the Zhongshan Ophthalmic Center–Brian Holden Vision Institute High Myopia Registry Study classified at baseline, 16% of these in young high myopes were found to mimic classic glaucomatous defects and follow-up is ongoing to determine which proportion of these progress [ 41 ].…”

“…Given the many different types of visual field defects associated with the myopia described, most recently, a proposed classification system for highly myopic eyes without glaucoma or pathological changes was suggested as a way to standardize reporting [ 42 ]. Defects described included glaucoma-like (paracentral defects, nasal step, paracentral arcuate and arcuate), myopia-like (enlarged blind spot, vertical step, partial peripheral rim and non-specific) and combined, with approximately 10% of eyes demonstrating the glaucoma-like defects which tended to be associated with longer axial length [ 42 ]. Progression over time and age at progression both represent important factors in differentiating glaucoma-like visual field defects from true glaucoma [ 40 , 44 ].…”

The Diagnostic Value of Optical Coherence Tomography for Detecting Glaucoma in High Myopia

“…First, high myopia often has enlarged or stretching optic discs, peripapillary atrophy and some other fundus alteration which are similar to those seen in glaucoma, hence glaucomatous changes are often confused with myopic eyes 10. Second, the diagnosis of glaucoma relies on characteristic optic disc appearance and corresponding visual field loss such as nasal step, central visual field defect, arcuate visual field defect, which can also be found in myopic degeneration 11,12. Third, previous studies indicated that high myopia tend to have thinner retinal nerve fiber layer (RNFL) than the normal population and display a different RNFL distribution pattern 5.…”

“…10 Second, the diagnosis of glaucoma relies on characteristic optic disc appearance and corresponding visual field loss such as nasal step, central visual field defect, arcuate visual field defect, which can also be found in myopic degeneration. 11,12 Third, previous studies indicated that high myopia tend to have thinner retinal nerve fiber layer (RNFL) than the normal population and display a different RNFL distribution pattern. 5 Therefore, optical coherence tomography (OCT) color probability codes present false-positive results in high myopia, which is known as a "red-disease".…”

Standardization of High Myopia Optic Nerve Head Abnormalities May Help Diagnose Glaucoma in High Myopia

“…4 High myopia is of grave concern because it is associated with sight-threatening ocular comorbidities like myopic maculopathy, glaucoma, and retinal detachment.High myopia is generally defined as a refractive error of ≤ −6 D (spherical equivalent) in the context of axial length ≥ 26.5 mm. 5,6 Holden et al 5 estimated that 163 million people (2.7% of the world population) had high myopia in the year 2000 and was predicted to rise to 938 million (9.8% of the world population) by 2050. The development of myopia involves the progressive and excessive axial elongation of the globe.…”