Is high myopia a risk factor for visual field progression or disk hemorrhage in primary open-angle glaucoma?
Authors Nitta K, Sugiyama K, Wajima R, Tachibana G
Received 30 December 2016
Accepted for publication 1 March 2017
Published 4 April 2017 Volume 2017:11 Pages 599—604
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Amy Norman
Peer reviewer comments 3
Editor who approved publication: Dr Scott Fraser
Koji Nitta,1 Kazuhisa Sugiyama,2 Ryotaro Wajima,1 Gaku Tachibana1
1Department of Ophthalmology, Fukui-ken Saiseikai Hospital, Fukui, 2Department of Ophthalmology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
Purpose: The purpose of this study was to clarify differences between highly myopic and non-myopic primary open-angle glaucoma (POAG) patients, including normal-tension glaucoma patients.
Patients and methods: A total of 269 POAG patients were divided into two groups: patients with ≥26.5 mm of axial length (highly myopic group) and patients with <24.0 mm of axial length (non-myopic group).
Results: We analyzed 53 highly myopic and 93 non-myopic POAG patients. Age at first visit of the highly myopic group was significantly less than that of the non-myopic group (P<0.0001). Baseline intraocular pressures (IOPs) showed no significant differences. Follow-up IOPs of the non-myopic group were significantly lower than those of the highly myopic group (P=0.0009). According to the mean deviation definition of progression, the cumulative probability of non-progression of visual field (VF) loss was significantly greater in the highly myopic group (10-year survival rate, 73.7%±6.8%) than in the non-myopic group (10-year survival rate, 46.3%±5.8%; log-rank test, P=0.0142). The occurrence of disk hemorrhage (DH) in the non-myopic group (1.60±3.04) was significantly greater than that in the highly myopic group (0.93±2.13, P=0.0311). The cumulative probability of DH was significantly lower in the highly myopic group (10-year survival rate, 26.4%±5.4%) than in the non-myopic group (10-year survival rate, 47.2%±6.6%, P=0.0413).
Conclusion: Highly myopic POAG is considered as a combination of myopic optic neuropathy and glaucomatous optic neuropathy (GON). If GON is predominant, it has frequent DH and more progressive VF loss. However, when the myopic optic neuropathy is predominant, it has less DH and less progressive VF loss.
Keywords: myopic glaucoma, disk hemorrhage, open-angle glaucoma, visual field defect progression, high myopia
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