Visual Field Progression Pattern Associated With Optic Disc Tilt Morphology in Myopic Open-Angle Glaucoma

Abstract

To understand the long-term characteristics of visual field (VF) progression in myopic open-angle glaucoma (OAG) according to the morphology of optic disc tilt. Retrospective, comparative, longitudinal cohort study. Myopic OAG eyes were divided into temporally tilted disc and inferiorly tilted disc groups according to optic disc torsional degrees. Kaplan-Meier survival analysis was used to compare the survival rates between nonmyopic OAG, myopic OAG with temporally tilted disc, and myopic OAG with inferiorly tilted disc. The hazard ratio (HRs) for the associations between risk factors and progression were analyzed using Cox proportional hazards modeling. In the inferiorly tilted disc group, subgroups were classified into progression, stationary, and progression-to-stationary groups, and the clinical characteristics of VF progression were compared among the subgroups. A total of 82 eyes in 82 nonmyopic OAG patients and 150 eyes in 150 myopic OAG patients were included. Myopic OAG with inferiorly tilted disc showed significantly more baseline and final 1-hemifield-involvement cases compared with myopic OAG with temporally tilted disc (P < .001, P < .001, respectively). The cumulative probability of progression was shown to be faster for myopic OAG with inferiorly tilted disc compared with temporally tilteddisc and nonmyopic OAG (P= .002, P= .038, respectively). A larger number of medications (HR= 1.339; P= .004), earlier-stage VF defect (HR= 1.217; P < .001), and inferiorly tilted disc (HR= 2.378; P < .001) were predictive of progression. In the analysis of myopic OAG with inferiorly tilted disc, the progression group had younger age and earlier-stage VF defect at baseline compared with the stationary group (P= .01, P < .001, respectively). It is likely that VF progression in myopic OAG is associated with the morphology of the optic disc tilt. Especially in OAG with inferiorly tilted disc, VF is likely not to progress after terminating VF progression at the region associated with optic disc tilt.