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.
Highlights
The association of myopia with glaucoma is a focus of interest in the field of glaucoma
Bruch’s membrane (BM) opening area, and gamma zone parapapillary atrophy (PPA) width were significantly greater in the eyes with faster visual field (VF) progression than those with slower progression
Their medical records were reviewed for data regarding the following: refraction test, best-corrected visual acuity, central corneal thickness (CCT) and axial length measured by ultrasound pachymetry (Tomey Corporation, Nagoya, Japan), Goldmann applanation tonometry, slit-lamp biomicroscopy, gonioscopy, dilated fundus stereoscopic examination, color fundus stereo photography (Canon, Tokyo, Japan), spectral domain-optical coherence tomography (SD-OCT; Spectralis, Heidelberg Engineering GmbH, Heidelberg, Germany), and standard automated perimetry (Humphrey Field Analyzer II 750; 24–2 Swedish interactive threshold algorithm; Carl Zeiss Meditec, Dublin, CA, USA)
Summary
The association of myopia with glaucoma is a focus of interest in the field of glaucoma. Previous studies have reported a high incidence of myopia in patients with glaucoma [1, 2]. The authors concluded that myopia was a risk factor for the development of glaucoma. Despite its evident association with the development of glaucoma, the association of myopia with the progression of glaucoma remains controversial. Chihara et al reported that severe myopia was a risk factor for visual field (VF) progression in patients with open-angle glaucoma (OAG) [3]. An evidence-based review of 85 articles reporting risk factors for glaucomatous VF progression found myopia to be an unlikely risk factor [8]
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