Implications of Optic Disc Tilt in the Progression of Primary Open-Angle Glaucoma

Abstract

PURPOSE.To evaluate the effect of optic disc tilt on the progression of glaucoma in myopic glaucomatous eyes.METHODS. The disc tilt ratio was estimated on disc photographs. Glaucomatous progression was determined either by stereoscopic optic disc/retinal nerve fiber layer photographs or serial visual field data. All participants were categorized into two groups according to tilt ratio (nontilted [<1.3] or tilted [ ‡1.3]). Kaplan-Meier life-table analysis was used to compare the survival experiences (time to confirmed glaucomatous progression) between groups. The hazard ratios (HRs) for the associations between potential risk factors and progression were determined by using Cox proportional hazards modeling. RESULTS.A total of 85 eyes in 85 myopic glaucoma patients (axial length > 24 mm; mean follow-up, 4.1 years) were included. Among them, 42 eyes (49.4%) demonstrated progression and 43 eyes (50.6%) were stable on follow-up. The mean disc tilt ratio was significantly smaller, and the prevalence of disc hemorrhage higher, in the progression than the stable group (P ¼ 0.032, P ¼ < 0.001, respectively). The cumulative probability of progression was 24.7% in the tilted group and 68.7% in the nontilted group (P ¼ 0.005). Disc hemorrhage (HR ¼ 3.317; P ¼ 0.001) and the tilt ratio (HR ¼ 0.110; P ¼ 0.046) were predictive of progression. CONCLUSIONS.Myopic eyes with tilted disc demonstrated a smaller probability of glaucomatous progression. Optic disc tilt may be protective against glaucoma progression, or tilted myopic glaucomatous eyes may have less progressive characteristic by nature.

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

“…A previous study reported a smaller probability of glaucoma progression in the eyes with tilted disc compared to those with non-tilted disc [7]. The result of the present study appears to be contradictive to the results of the previous study; however, the discrepancy might be explained by many differences between two studies, mostly in methodology.…”

Myopic glaucomatous eyes with or without optic disc shape alteration: a longitudinal study

“…A greater extent and faster rate of VF progression were observed in eyes with non-tilted discs than in eyes with tilted discs. This finding was in accordance with a previous report from our group 24. A study by Han et al 23 found that eyes with an inferiorly tilted disc tended to show no VF progression after terminating VF progression at the region associated with the optic disc tilt; this suggested that optic disc tilt may act as a positive prognostic factor after a certain level of damage has been reached.…”

Greater Severity of Glaucomatous Damage in Eyes With Than Without Choroidal Microvasculature Dropout in Open-Angle Glaucoma

“…3,17 The optic disc center was determined to be the point where the long and short axes of the disc crossed, as described in previous studies. [18][19][20][21][22] The two aforementioned glaucoma specialists independently assessed the presence and angular circumference of CMvD; any disagreements between these two specialists were resolved by a third adjudicator (M.S.K.). The average values from the two measurements were used in the analysis to minimize interobserver variation.…”