Intraocular pressure reduction and progression of highly myopic glaucoma: a 12-year follow-up cohort study

Evaluating glaucoma in myopic eyes: Challenges and opportunities

The increasing global prevalence of myopia presents a significant public health concern, and growing evidence has demonstrated that myopia is a major risk factor for the development of open-angle glaucoma. Therefore, timely detection and management of glaucoma in myopic patients are crucial; however, identifying the structural alterations of glaucoma in the optic nerve head (ONH) and retinal tissues of myopic eyes using standard diagnostic tools such as fundus photography, optical coherence tomography (OCT), and OCT angiography (OCTA) presents challenges. Additionally, myopia-related perimetric defects can be confounded with glaucoma-related defects. We comprehensively examine the challenges encountered in evaluating glaucoma in myopic eyes through various diagnostic tools, including fundus photography, OCT of the ONH, retinal nerve fiber layer, and macular ganglion cell layer, OCTA, and perimetry. We also explore potential opportunities to address these challenges, providing insights for clinicians to effectively manage myopic glaucoma patients in clinical practice.

How to diagnose glaucoma in myopic eyes by detecting structural changes?

Myopia is rapidly escalating globally, especially in East and Southeast Asia, where its prevalence among younger populations reaches alarming levels of 80-90 %. This surge contributes to a myopia epidemic linked to several ocular complications, including glaucoma. As myopic individuals age, the risk of developing glaucoma increases, and an additional concern arises from the growing frequency of refractive surgeries among younger individuals, making precise optic nerve assessments critical before surgery. Evaluating the optic nerve head (ONH) in myopic eyes is challenging, as structural changes due to myopia often resemble glaucomatous alterations. Techniques such as optical coherence tomography (OCT) have improved the examination of ONH microstructures, but interpreting results remains complex due to potential false-positive findings. Myopic eyes exhibit unique changes, such as peripapillary atrophy and altered neuroretinal rim configurations, making it crucial to distinguish these from true glaucomatous signs. Recent advancements in OCT technology and the establishment of myopia-specific normative databases have enhanced diagnostic accuracy. Parameters such as minimum rim width, ganglion cell-inner plexiform layer thickness and temporal raphe sign show promise in differentiating between glaucomatous and nonglaucomatous changes. Ultimately, a comprehensive approach incorporating multiple OCT metrics is essential for accurately diagnosing glaucoma in myopic patients. By integrating various structural evaluations and leveraging advanced imaging techniques, clinicians can better navigate the complexities of glaucoma diagnosis amidst the challenges posed by myopia. This review highlights the need for increased attention and tailored strategies in managing glaucoma risk within this increasingly affected population.