High Axial Myopia Research Articles

Prospective evaluation of posterior capsule opacification in myopic eyes 4 years after implantation of a single-piece acrylic IOL

To determine whether axial myopia affects posterior capsule opacification (PCO) in eyes with high myopia (axial length [AL] > or = 26.00 mm) 4 years after implantation of an AcrySof single-piece intraocular lens (IOL). Clinical practice, Ahmedabad, India. In a prospective masked trial, consecutive eyes with high axial myopia (myopia group) and age-matched eyes with a normal AL (21.00 to 23.99 mm) (control group) had phacoemulsification and in-the-bag IOL implantation. Postoperatively, PCO was documented by standardized digital retroillumination images. The PCO area behind the IOL optic was scored (scale 0% to 100%) using the POCO software system. The presence of PCO within the central 3.0 mm of the optic was assessed with the Evaluation of Posterior Capsule Opacification software system. The incidence of neodymium:YAG (Nd:YAG) capsulotomy was determined. The median PCO in the myopia group and control group, respectively, was 3.2% and 5.6% at 1 month (P = .2), 2.2% and 1.6% at 12 months (P = .079), 7.0% and 2.3% at 24 months (P = .079), 3.7% and 3.6% at 36 months (P = .78), and 10.0% and 2.3% at 48 months (P = .61). By 4 years, PCO had encroached onto the central 3.0 mm of the optic in 38% in the myopia group and 20% in the control group (P = .04). One eye (2%) in each group had an Nd:YAG capsulotomy, at 3.2 years and 3.9 years, respectively. Axial myopia did not significantly increase the area or incidence of PCO at 4 years.

Acquired restrictive strabismus and high axial myopia: diagnosis and management

Objective: This paper documents the clinical, ultrasound, magnetic resonance imaging (MRI), and anatomic characteristics of 6 patients with esohypotropia and high axial myopia. The results of strabismus surgery performed on these patients are evaluated. Study Design: Retrospective cohort study. Participants: Six patients with esohypotropia and high axial myopia were selected from the practice of the second author (Michael Flanders). Methods: We extracted the history and data from the preoperative and postoperative ophthalmic and orthoptic examinations, recorded the surgical procedures, and tabulated the postoperative results. A- and B-scans, orbital MRI images, and photo documentation were obtained for all patients. Supramaximal recession and resection on the horizontal rectus muscles, using adjustable sutures, was performed in all patients. A surgical outcome was deemed successful if, in primary position, postoperative horizontal ocular alignment measured 15 prism diopters (PD) or less and (or) if diplopia was eliminated. Results: Echographic and MRI findings demonstrated an enlarged globe in all cases. Globe flattening on the orbital walls was found in 5 cases. Lateral rectus depression was visualized on MRI images in 4 cases. Surgical success was obtained in all patients. The average preoperative primary position esotropia measured 60 PD (25 to 90 PD) and the esodeviation after surgery was 7.0 PD (0 to 15 PD). Ductions were also improved. Conclusions: Different surgical approaches to realignment of eyes with high myopia and esohypotropia have been attempted. In this study, supramaximal amounts of recession and resection on the rectus muscles provided satisfactory results.

The efficacy and safety of posterior pole buckles in the control of progressive high myopia

Degenerative myopia is a significant cause of vision loss; yet there is no accepted way of controlling its causative phenotype--progressive high axial myopia. Scleral reinforcement, introduced over 50 years ago, was discredited as a useful technique. This 5-year 'proof of concept' study examines buckling of the posterior pole for myopia control and follows the course of untreated fellow eyes. A total of 59 adult eyes, with myopic refractive corrections ranging from -9 to -22 D and axial lengths from 27.8 to 34.6 mm, were studied. A 1-cm-wide flexible buckle of donor sclera was positioned over the posterior pole and secured, under positive tension, to the anterior globe. The eyes were monitored for 5 years, as were unsupported fellow eyes. The axial lengths, visual acuities, and optical coherence tomography macular scans were collected and all complications were noted. Over 5 years, axial length control was achieved by scleral buckling, whereas axial extension progressed in the untreated group. No serious complication occurred and no eye lost visual acuity from the procedure. Temporary intra-ocular pressure elevation, small choroidal effusions, and variable periods of abduction limitation occurred after surgery. In one case of tractional myopic macular schisis, a full correction was achieved by buckling and visual acuity improved.

Congenital Axial High Myopia Detected by Prenatal Ultrasound

High-resolution prenatal ultrasound can allow for early detection and monitoring of many fetal anomalies, including those involving the globe and orbit. The authors present a case of congenital axial high myopia that was diagnosed at 33 gestational weeks and monitored by prenatal ultrasonography. Some systemic abnormalities that can be associated with congenital high myopia are reviewed. High ammetropias, anisometropia, and either axial myopia or axial hyperopia can be detected in utero and give this early detection a greater chance of treating and reversing the devastating effects of amblyopia.

Myopic macular degeneration: classification and treatment

Abstract Purpose There is no accepted method for the control of progressive high axial myopia, the phenotype of Degenerative Myopia. Myopic Macular Degeneration was studied and classified by clinical presentation, structural features and responses to certain natural and therapeutic changes. Methods Two hundred eyes, with 9.0 D to 24.O D of axial myopia, were evaluated in terms of their clinical presentations, axial length and Optical Coherence Tomography images. The changes occurring with vitreous detachment, macular buckling, vitrectomy and the treatment of exudative complications were also evaluated. Results Vision loss progressed with the length of the eye, the shape of the posterior pole and the age of the patient. The macular degeneration was classifiable into: Atrophic, Exudative, Cicatricial and Neural‐disruptive stages. Macular buckling stabilized axial length and corrected some features of macular traction. Vitrectomy and membrane peeling relieved other aspects of macular traction, but gave no restraint to axial myopia progression. Photo‐dynamic‐therapy and intra‐vitreous anti‐VEGF injections controlled exudative macular complications. Conclusion The stages of Myopic Macular Degeneration were: Atrophic, Exudative, Cicatricial and Neural‐disruptive. Progression was related to time, axial length, posterior pole anatomy and vitreous detachment. Macular buckling limited axial myopia progress and modified schisis and other neural‐disruptive features. It remains to be shown that such surgery can prevent myopic macular degeneration and preserve macular function. Additional vitreous surgery may be required for macular holes, detachments and pre‐retinal fibrosis. Exudative changes were found to respond to treatments for the comparable stage of age‐related macular degeneration.

Orbital Plexiform Neurofibroma and High Axial Myopia

To report a group of children with neurofibromatosis type 1 and orbital plexiform neurofibroma who developed axial myopia in the associated eye. The clinical records and imaging of 3 patients with neurofibromatosis type 1 and orbital plexiform neurofibromas were reviewed. Three patients were identified who were diagnosed with orbital plexiform neurofibromas at the ages of 10 months, 9 months, and 16 years old. In all cases the axial length of the eye associated with the neurofibroma increased with length compared with the unaffected eye over time. Accordingly, the affected eye became increasing myopic with age, while the unaffected eye remained emmetropic. Eyes affected with orbital plexiform neurofibroma, a hallmark of neurofibromatosis type 1, appear to be associated with increased axial length and myopia. This is of particular importance in children, to diagnose and treat unilateral high myopia early and prevent anisometropic amblyopia.

Ciliary body thickness in unilateral high axial myopia

To compare the thickness of the ciliary bodies of eyes with unilateral high axial myopia with their relatively normal fellow eyes. A total of 19 patients with unilateral high axial length (AL) were included in the study. Mean patient age was 28.4+/-10.4 (11-44) years. All eyes underwent ultrasound biometry to measure the AL, and ultrasound biomicroscopy to measure the anterior chamber depth, ciliary body thickness (CBT), and ciliary process thickness (CPT), ciliary muscle thickness (CMT). The results were compared between each subject's high myopic eye and relatively normal fellow eye. The mean AL was 27.24+/-1.52 mm (range: 25.16-30.21 mm) in high myopic eyes and 23.64+/-0.86 mm (range: 22.47-25.10 mm) in normal fellow eyes. The median +/-95% confidence interval of CBT, CPT, and CMT was 1.350+/-0.034, 0.626+/-0.072, and 0.698+/-0.057 mm, respectively, in high myopic eyes and 1.211+/-0.050, 0.535+/-0.064, and 0.644+/-0.065 mm, respectively, in normal fellow eyes. The anterior chamber depth, CBT, CPT, and CMT were significantly higher in myopic eyes compared with their relatively normal fellow eyes (P<0.05). CMT significantly increased with age in both groups (P<0.05). There was no significant correlation between age and CBT in both the groups (P>0.05). The CBT, CMT, and CPT are significantly higher in eyes with unilateral high axial myopia than in their relatively normal fellow eyes.

Posterior capsulorhexis combined with optic buttonholing: an alternative to standard in-the-bag implantation of sharp-edged intraocular lenses? A critical analysis of 1000 consecutive cases

BackgroundCurrent after-cataract prevention relies on optimizing the natural barrier effect of the optic rim against lens epithelial cell (LEC) migration. However, deficiencies in circumferential capsular bag closure caused by the intraocular lens (IOL) haptic or delayed secondary re-division of the fused capsules by Soemmering´s ring formation lead to primary or secondary barrier failure. Consequently, surprisingly high posterior laser capsulotomy rates have been reported long-term, even with optimal capsular surgery and the most widespread hydrophobic acrylic IOLs, considered to be the most advanced. Intraoperative removal of the central posterior capsule has been shown to be effective in further reducing LEC immigration. However, efficacy has turned out to be limited because of the propensity of LECs to use the posterior optic surface as an alternative scaffold.Material and methodsTechnique: in pediatric cataract surgery, buttoning-in of the optic into an adequately-centered posterior capsulorhexis opening has been described previously. This technique was further elaborated and applied as the standard technique in a large series of adult eyes. In general, the diameter aimed at was 5–6 mm for the anterior, and 4–5 mm for the posterior capsulorhexis. Between September 2004 and June 2007, 1000 consecutive cases have thus been performed and systematically evaluated. One hundred and fifty eyes additionally underwent extensive anterior LEC abrasion. Another sub-series investigated the option of further reducing capsular fibrosis by creating an anterior capsulorhexis larger than the optic.Evaluation: special scrutiny was applied to detect postoperative vitreous entrapment. Regeneratory and fibrotic after-cataract formation were both meticulously followed-up. Postoperative pressure course, anterior segment inflammation, macular thickness and morphology, as well as axial optic stability and optic centration, were evaluated in intraindividual comparison studies.ResultsA low rate of vitreous complications was found, which can be avoided by appropriate surgery. Vitreous entanglement occurred in six eyes, and vitreous herniation after PPCCC over-sizing in two. In three, anterior vitrectomy was performed. There was only one single case of retinal detachment—supposedly unrelated to the technique itself—and no case of cystoid macular edema. Retro-optical regenerate formation was completely abolished, while fibrosis was drastically reduced by the posterior capsule sandwiched in between the anterior LEC layer on the backside of the anterior capsule and the anterior optic surface, thereby blocking contact-mediated myofibroblastic LEC transdifferentiation. Additional capsular polishing further reduced residual fibrosis emerging from the anterior capsule contacting the optic adjacent to the haptic junction, as well as regeneratory LEC re-proliferation on the posterior capsule overlying the optic. Postoperative pressure course was almost identical to that found after standard in-the-bag implantation of the IOL, as was flare, and macular thickness and morphology. As opposed to bag-fixated IOLs, no axial movement of the optic was detected. IOL optics always perfectly centered even when the capsular opening was not optimally centered. Due to the exquisite stretchability and elasticity of the posterior capsule, the 6-mm IOL optic could safely be buttoned-in in a posterior capsulorhexis of 4 mm and smaller.ConclusionsPosterior optic buttonholing (POBH) is a safe and effective technique which not only excludes retro-optical opacification, but also withholds capsular fibrosis by obviating direct contact between the anterior capsular leaf and the optic surface. Anterior LEC abrasion significantly reduced both the residual fibrosis and regeneratory LEC proliferation. Apart from pediatric cataract, POBH is currently recommended for eyes with pseudoexfoliation syndrome, high axial myopia, peripheral retinal disease, and multifocal IOL implantation. Toric IOLs and magnet-driven accommodative IOL systems are other potential applications. Generally, POBH holds promise for becoming a routine alternative to standard in-the-bag IOL implantation in the future.

Anterior dislocation of a sulcus fixated posterior chamber intraocular lens in a high myope

A 31-year-old man with high axial myopia and strabismus fixus convergens underwent bilateral refractive lens exchange followed by a squint surgery (bilateral superior partial Jensen's procedure and medial rectus recession). After one year he presented with traumatic anterior dislocation of the sulcus fixated posterior chamber polymethyl methacrylate lens. The lens was dialed back into the ciliary sulcus without any complications. This case highlights the importance of implanting an intraocular lens (IOL) in-the-bag. If the IOL needs to be implanted in the sulcus, a larger diameter of the IOL with larger optic size and overall length is desirable, especially in highly myopic eyes.

Prevalence of Cataract Type in Relation to Axial Length in Subjects with High Myopia and Emmetropia in an Indian Population

To compare the prevalence of different types and densities of age-related cataract in subjects with high myopia and emmetropia in an Indian urban clinic-based population. Prospective, observational, clinic-based case-control study. An observational case-control study of 800 healthy eyes was undertaken at Iladevi Cataract & IOL Research Center, Ahmedabad, India. Subjects with high myopia (axial length [AXL], > or = 26.0 mm; n = 400 eyes) and those with emmetropia (AXL, 21.0 to 23.99 mm) were examined (n = 400 eyes). The type of cataract was categorized as: nuclear, cortical, or posterior subcapsular cataract (PSC). Nuclear density was measured based on the Emery and Little classification. In all the age groups (40 years of age or more), nuclear cataract was encountered more often in subjects with high myopia (odds ratio, 3.8; 95% confidence interval, 2.9 to 5.2; P < .001); PSC and mixed cataracts were encountered frequently in subjects with emmetropia (P < .001). Prevalence of nuclear cataract was higher in subjects with high myopia with increasing AXL when compared with other types of cataract (P < .001). In all the age groups, the nuclear density was significantly higher than grade 3 in subjects with high myopia when compared with those with emmetropia (P < .001 in those younger than 70 years; P = .003 in those older than 70 years). Nuclear cataract was associated strongly with high axial myopia. The density of the cataract was higher in the high myopia group. No association was observed between PSC or cortical cataract and high axial myopia.

Model-Based Improvements in the Treatment of Patients with Strabismus and Axial High Myopia

Eye motility disorders with axial high myopia and an enlarged globe are often characterized by a hypotropia of the affected eye, usually referred to as heavy-eye syndrome. Based on an intuitive interpretation of magnetic resonance (MR) images, the cause of the hypotropia has typically been assigned to the rectus muscles. In this study, the hypothesis that the oblique muscles play an important role in the underlying biomechanical disorder of this type of strabismus was investigated. The hypothesis was tested by (1) a retrospective analysis of surgical results in one patient with unilateral axial high myopia; and (2) MR images of orbital tissues in two further patients with unilateral axial high myopia. MR images demonstrated a pattern of extraocular muscle path displacements similar to those described previously, but also a uniform decrease in the cross-sectional area of the inferior oblique muscles. Computer modeling required decreased inferior oblique contractility in addition to displaced extraocular muscle paths to recreate the observed motility pattern accurately. Patients with axial high myopia regularly show a reduction in the diameter of the inferior oblique. The resultant reduction in muscle-strength is important for the correct explanation of this complex eye movement disorder.

Visual outcome after cataract surgery in extremely high axial myopia

We retrospectively investigated visual outcome after cataract surgery with implantation of zero or negative-power intraocular lenses (IOL) in 110 eyes with extremely high axial myopia. Extremely high axial myopes can benefit from cataract surgery and implantation of zero or negative-power IOLs with few complications. Factors associated with visual outcome included preoperative best-corrected visual acuity, gender, and age. Method of surgery did not influence the visual outcome.

Traumatic rupture of the posterior capsule resulting in complete posterior prolapse of the lens with subsequent resolution of high myopia

Uncomplicated isolated breach of the posterior capsule following a blunt forehead trauma has rarely been reported. We report the first case of a patient with high myopia who, after minor forehead trauma, developed an isolated rupture of the posterior capsule with probable complete prolapse of the crystalline lens into the vitreous cavity, leading to spontaneous correction of the patient's high axial myopia.

Clear lens extraction in high axial myopia

Several ophthalmologists, during these past 20 years, supported by the great improvement in the surgical techniques of cataract extraction, proposed again the surgical procedure of clear lens extraction (CLE) to correct high axial myopia. However, we have to remember that vitreous and retinal changes in high myopic eyes can lead to retinal detachment (RD), in some cases with a poor visual outcome even after successful surgery. Moreover, it is well known that cataract extraction is a major cause of later RD with a further significant increase of the incidence of RD after Nd:YAG laser capsulotomy. The increased risk rates of RD for high myopia and cataract extraction are probably to be additive; therefore, high myopic eyes are significantly more exposed to postoperative complications. The greater incidence of RD in these eyes can be explained considering the anomalous vitreous changes occurring in high myopia, precipitated by the molecular and structural changes of the vitreous following cataract surgery. There are anomalous vitreo-retinal separation that are most frequently observed in very high myopic eyes: anomalous posterior vitreous detachment (PVD) and posterior vitreous schisis (PVS), the latter generally observed in association with a prominent posterior stafiloma. Intraoperative observations and recent studies of the macular area by means of optical coherence tomography (OCT) allowed the detection in these eyes of a thin layer of epiretinal tissue strictly adherent to the retina involved by the staphyloma; in these cases tractional retinal detachment, macular schisis or holes can occur. There are only few reports on the vitreo-retinal complications of CLE; for this reason, most conclusions have been derived from studies on RD occurred after cataract extraction in high myopic eyes. These data suggest that the risk/benefit ratio for this operation is probably too high to be recommended.

Intraocular lens power calculation formulas in Chinese eyes with high axial myopia

Purpose To compare the accuracy of intraocular lens (IOL) power calculation formulas in Chinese eyes with high axial myopia. Setting Department of Ophthalmology, Tuen Mun Hospital, Hong Kong, China. Methods This retrospective study reviewed 125 Chinese patients with high myopia and axial lengths (ALs) longer than 25.0 mm who had cataract surgery during the year 2000. Eyes with pathology or operative complications affecting the refractive status and those with missing data were excluded. In each case, the power of the implanted IOL was used to calculate the predicted postoperative refractive error by 4 IOL power calculation formulas: SRK II, SRK/T, Holladay 1, and Hoffer Q. The predictive accuracy of the formulas was analyzed by comparing the difference between the “actual” and “predicted” postoperative refractive errors. The Student t test was used for statistical analysis. The performance of the formulas in subcategories of long AL was also tested. Results One hundred twenty-five eyes (110 patients) were studied. Thirty-seven eyes (29.6%) were excluded. The Hoffer Q, Holladay 1, and SRK/T formulas showed a slight tendency toward resultant hyperopia, with a mean of +0.36 diopters (D), +0.53 D, and +0.74 D, respectively. The SRK II caused the largest hyperopic error, with a mean of +1.47 D. All 4 formulas caused a refractive error shift toward myopia in the subcategories of AL >28.0 mm, minus-power IOL, and extracapsular cataract extraction (ECCE). Conclusions In Chinese eyes with high axial myopia with an AL longer than 25.0 mm, the 4 formulas caused a slight postoperative hyperopic refractive error that was less in eyes with a minus-power IOL or an AL longer than 28.0 mm and in those that had ECCE. The Hoffer Q formula provided the best predictive result, and Holladay 1 and SRK/T were comparable in IOL power calculation. The SRK II was the least accurate in all subgroups.

Quantification of recti eye muscle paths in high myopia

PURPOSE To elucidate the etiology of an acquired, restrictive motility disorder in patients with high myopia. METHODS Thirty-three orbits were imaged using a Siemens Magnetom or Siemens Vision (both 1.5 Tesla) MRI (magnetic resonance imaging) scanner, applying a head coil. Coronal T1-weighted, spin-echo images were obtained. Orbits of three different patient groups were analyzed. Group 1 (n = 14): patients with high axial myopia and restricted eye motility (average axial length = 31.4mm; refractive error more than –15D). Group 2 (n = 8): subjects with high axial myopia and normal eye motility (average axial length = 29.2mm). Controls (n = 11): emmetropic subjects with normal eye motility. RESULTS Highly myopic patients showed significant displacements of recti EOMs in comparison to the controls. Mean displacements as measured in the plane 3mm anterior to the globe-optic nerve junction in primary gaze were, in group 1: lateral rectus (LR) 2.9mm (2.5 downward, 1.4 medial), medial rectus (MR) 1.3mm downward. In group 2: LR 1.4mm (1.3 downward, 0.6 medial) and MR 1.2mm downward. In both groups 1 and 2, the inferior rectus (IR) was displaced 1.3mm medially and upwards. In both groups of myopic patients the superior rectus (SR) was displaced 1.5mm medially and downwards. CONCLUSIONS In patients with high axial myopia, displacements of all recti EOMs can be detected by MRI. However, displacement of the LR into the lateral and inferior quadrant of the orbit is significantly greatest. We therefore assume LR displacement to be a major pathophysiological factor for the restrictive motility disorder in high myopia. EOM dislocations can be explained by myopia-associated alterations in the orbital connective tissues confining EOM positions in relation to the orbital wall.

Cataract surgery in highly myopic eyes corrected by phakic anterior chamber angle-supported lenses

Purpose To assess the incidence of cataract, potential causes of its development, and the outcome of cataract surgery after previous implantation of phakic angle-supported anterior chamber intraocular lenses (AC IOLs) in highly myopic patients. Setting Instituto Oftalmológico de Alicante, Department of Refractive Surgery, Spain. Methods Two hundred sixty-three highly myopic phakic eyes of 160 patients had implantation of a phakic AC IOL. Follow-up was up to 8 years (range 38.4 to 103.2 months). Eyes that subsequently developed cataract had cataract extraction and were studied during follow-up for clinical association to other preoperative or postoperative data. Cataract surgery was performed after phakic IOL explantation by phacoemulsification and posterior chamber IOL (PC IOL) implantation (Domilens-Chiron AL3). Results Nuclear cataract developed in 9 cases (3.42%) a mean of 42.91 months ± 17.7 (SD) after phakic AC IOL implantation. Final best spectacle-corrected visual acuity (BSCVA) was not significantly different from that after phakic AC IOL implantation ( P = .25, paired Student t test). Mean endothelial cell loss after cataract surgery was 6.87% ± 0.42% cells/mm 2. Age at implantation of older than 40 years and axial length greater than 30.0 mm were the 2 factors significantly related to nuclear cataract development ( r = 1.69 and 1.98, respectively; P < .05). Conclusions There is a potential risk of nuclear cataract development after phakic AC IOL implantation to correct high myopia in patients older than 40 years and with very high (greater than 30.0 mm) axial myopia. Phakic IOL explantation, phacoemulsification, and PC IOL implantation successfully resolved this complication. The benefits in terms of BSCVA and spherical equivalent obtained after phakic AC IOL implantation were preserved after cataract surgery.

Excimer laser photorefractive keratectomy in myopic eyes with corectopia

Corectopia, the eccentric displacement of the pupil, may be associated with other abnormalities such as axial high myopia or ectopia lentis. We report the case of a patient presenting for surgery to correct bilateral myopia of 6.50 diopters (D) associated with corectopia. Excimer laser ablation was decentered and performed on the center of the abnormal pupils. After a 2 year follow-up, best corrected visual acuity was 20/20 with −1.00 D correction in each eye. To our knowledge, this is the first report of excimer laser photorefractive keratectomy for myopia associated with corectopia. The satisfactory results suggest that in abnormally eccentric pupils, excimer laser treatment of myopia may be successful when it is centered on the deviated pupil.

Intraocular lens power calculation after decentered photorefractive keratectomy

A 56-year-old patient who had pliotorefractive keratectomy (PRK) to correct highunilateral myopia developed a progressive nuclear cataract.. Phacoemulsification an and , intraocular lens (IOL) implantation were performed: However,: determination of IOL power using automated keratometry and computerized videokeratography was not successful il in this case of high axial myopia because of a decentered ablation zone, resulting in too-steep keratometric readings: Postoperative hyperopia could only be corrected by an IOL exchange. Because it may not be possible to determine the exact keratometric values for IOL calculation after PRK,: subtracting the change in refraction induced by PRK from the preoperative keratometric readings, might have been more accurate in this patient.

Factors Affecting Image Acquisition During Scanning Laser Polarimetry

To illustrate artifacts that may be encountered during measurement of the peripapillary retinal nerve fiber layer (RNFL) using scanning laser polarimetry (SLP). A total of 426 patients with a variety of ocular diagnoses underwent RNFL measurements using SLP from June 1996 to April 1997. Scanning was performed by two operators whose reproducibility of measurements had been previously validated. Images were selected to illustrate clinical features that adversely affected measurement of the thickness of the RNFL. Image acquisition was difficult in eyes with corneal grafts or edema, keratic precipitates, anterior uveitis, posterior subcapsular cataract, vitreous opacity, peripapillary atrophy, posterior staphyloma, and high axial myopia. These scans resulted in poor clinical correlation with visual field tests and optic nerve examination, poor reproducibility of images, and unreadable images. Anterior and posterior segment pathologies, particularly those localized to the cornea and lens, may produce spurious RNFL measurements and should be carefully considered prior to clinical decision making.