Abstract
PurposeTo identify important variables associated with visual field (VF) defects in open-angle glaucoma (OAG) with myopia.Materials and methodsA total of 105 OAG with myopia were enrolled in this cross-sectional study. The disc tilt ratio, disc torsion degree, disc-foveal angle, and area of peripapillary atrophy (PPA) were measured from red-free fundus photographs. Patients underwent Swept-source optical coherence tomography to measure peripapillary retinal nerve fiber layer (RNFL), subfoveal choroidal, and sufoveal scleral thicknesses. Functional evaluation was performed using 24–2 standard automated perimetry. For statistical analyses, logistic regression, artificial neural networks (ANN), and hierarchical cluster analysis were performed.ResultsLogistic regression demonstrated peripapillary RNFL thickness as a significant variable for the presence of VF defects, otherwise ANN identified PPA area, peripapillary RNFL thickness, disc-foveal angle, and disc torsion degree as significant clinical variables in OAG with myopia. Two clusters were made after a hierarchical cluster analysis. Cluster 2 showed significantly worse VF damage than cluster 1 (MD = -5.20±5.25 dB for cluster 2 and -1.84±3.02 dB for cluster 1, P < .001). Cluster 2 had significantly greater disc tilt ratio, disc-foveal angle, and PPA area compared with cluster 1 (P < .001, 0.005, and < .001, respectively).ConclusionsGenerally peripapillary RNFL thickness is considered as an important variable associated with visual field defects in glaucoma patients. ANN identified parameters associated with posterior scleral deformations around optic disc induced by myopic change including PPA area, disc torsion degree, and disc-foveal angle as significant clinical variables for visual field damage in OAG with myopia.
Highlights
Myopia has been shown to be a risk factor for the development of glaucoma in meta-analyses of epidemiological surveys [1,2,3]
Peripapillary retinal nerve fiber layer (RNFL) thickness is considered as an important variable associated with visual field defects in glaucoma patients
artificial neural networks (ANN) identified parameters associated with posterior scleral deformations around optic disc induced by myopic change including peripapillary atrophy (PPA) area, disc torsion degree, and disc-foveal angle as significant clinical variables for visual field damage in open-angle glaucoma (OAG) with myopia
Summary
Myopia has been shown to be a risk factor for the development of glaucoma in meta-analyses of epidemiological surveys [1,2,3]. Glaucoma specialists have great challenges to evaluate glaucoma patients with myopia, since many of the optic discs of myopic patients are accompanied by posterior architecture deformation showing disc tilt, torsion, or peripapillary atrophy (PPA). Another assault in myopic glaucoma patients is to interpret the discordance between optic disc change and visual field damage. We often face myopic glaucoma patients with visual field defects, even though they have small cup-disc ratio and retinal nerve fiber layer defect To overcome this hurdle, we investigated the important clinical variables associated with visual field defects in open-angle glaucoma (OAG) patients with myopia. We have published that posterior scleral thickness and PPA area are significantly related with glaucomatous VF defects in OAG eyes with myopia [6,7,8]
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