Bikbov Mukharram M, Iakupova Ellina M, Gilmanshin Timur R, Bikbova Guzel M, Kazakbaeva Gyulli M, Panda-Jonas Songhomitra, Gilemzianova Leisan I, Jonas Jost B
Ufa Eye Research Institute, Ufa, Russia.
Ufa Eye Research Institute, Ufa, Russia; Ufa Eye Institute, Ufa, Russia.
Ophthalmology. 2023 Nov;130(11):1174-1181. doi: 10.1016/j.ophtha.2023.07.014. Epub 2023 Jul 17.
To assess the prevalence of nonglaucomatous optic nerve atrophy (NGOA) in highly myopic individuals.
Population-based study.
The Ural Eye and Medical Study included 5899 (80.5%) of 7328 eligible individuals (80.5%).
Nonglaucomatous optic nerve atrophy, graded into 5 arbitrary stages, was characterized by decreased visibility of the retinal nerve fiber layer (RNFL) on photographs, neuroretinal rim pallor, abnormally thin retinal arteriole diameter, and abnormally thin peripapillary RNFL as measured by OCT.
Nonglaucomatous optic nerve atrophy prevalence and degree.
Of 5709 participants (96.9%) with axial length measurements, 130 individuals (2.3%) were highly myopic, of whom 116 individuals (89.2%; age, 57.8 ± 11.1 years; axial length, 27.0 ± 1.2 mm) had available fundus photographs and OCT images and were included into the study. Nonglaucomatous optic nerve atrophy prevalence was 34/116 individuals (29.3%; 95% confidence interval [CI], 21.0-38.0), and mean NGOA degree in eyes with NGOA was 1.7 ± 1.0 arbitrary units. Higher NGOA degree correlated (multivariable analysis; regression coefficient, r = 0.59) with longer axial length (β, 0.22; P = 0.007), wider temporal parapapillary γ zone width (β, 0.50; P < 0.001), higher prevalence of diabetes (β, 0.20; P = 0.005), and higher systolic blood pressure (β, 0.15; P = 0.03). Higher NGOA prevalence was associated with longer axial length (odds ratio [OR], 7.45; 95% CI, 2.15-25.7), wider temporal parapapillary γ zone (OR, 6.98; 95% CI, 2.61-18.7), and higher systolic blood pressure (OR, 1.05; 95% CI, 1.01-1.10).
In this ethnically mixed population from Russia with an age of 40 years or more, high axial myopia showed a relatively high prevalence of NGOA, increasing with longer axial length and wider temporal parapapillary γ zone. For each 1 mm of axial elongation and γ zone widening, the odds for NGOA increased 7.45-fold and 6.98-fold, respectively. The axial elongation-associated and γ zone-related increase in the distance between the retinal ganglion cells and the optic disc may lead to a lengthening and stretching of the retinal ganglion cell axons and may be of importance pathogenetically. In highly myopic eyes, NGOA may be a reason for visual field and central visual acuity loss, unexplainable by myopic macular pathologic features.
FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.
评估高度近视人群中非青光眼性视神经萎缩（NGOA）的患病率。
基于人群的研究。
乌拉尔眼与医学研究纳入了7328名符合条件个体中的5899名（80.5%）。
非青光眼性视神经萎缩分为5个任意阶段，其特征为眼底照片上视网膜神经纤维层（RNFL）可见度降低、神经视网膜边缘苍白、视网膜动脉直径异常变细以及经光学相干断层扫描（OCT）测量的视乳头周围RNFL异常变薄。
非青光眼性视神经萎缩的患病率和程度。
在5709名有眼轴长度测量值的参与者（96.9%）中，130名个体（2.3%）为高度近视，其中116名个体（89.2%；年龄57.8±11.1岁；眼轴长度27.0±1.2mm）有可用的眼底照片和OCT图像并纳入研究。非青光眼性视神经萎缩的患病率为34/116名个体（29.3%；95%置信区间[CI]，21.0 - 38.0），患有NGOA的眼中NGOA的平均程度为1.7±1.0个任意单位。更高的NGOA程度与更长的眼轴长度（β，0.22；P = 0.007）、更宽的颞侧视乳头周围γ区宽度（β，0.50；P < 0.001）、更高的糖尿病患病率（β，0.20；P = 0.005）以及更高的收缩压（β，0.15；P = 0.03）相关（多变量分析；回归系数，r = 0.59）。更高的NGOA患病率与更长的眼轴长度（比值比[OR]，7.45；95% CI，2.15 - 25.7）、更宽的颞侧视乳头周围γ区（OR，6.98；95% CI，2.61 - 18.7）以及更高的收缩压（OR，1.05；95% CI，1.01 - 1.10）相关。
在这个来自俄罗斯的40岁及以上的种族混合人群中，高度轴性近视显示出相对较高的NGOA患病率，随着眼轴长度增加和颞侧视乳头周围γ区变宽而升高。眼轴每延长1mm和γ区每增宽1mm，NGOA的发生几率分别增加7.45倍和6.98倍。视网膜神经节细胞与视盘之间距离的眼轴延长相关和γ区相关增加可能导致视网膜神经节细胞轴突的延长和拉伸，在发病机制上可能具有重要意义。在高度近视眼中，NGOA可能是视野和中心视力丧失的一个原因，而近视性黄斑病理特征无法解释这一点。
在本文末尾的脚注和披露中可能会找到专有或商业披露信息。
