Rothschild Foundation Hospital, Institut Français de Myopie, Paris, France.
Singapore Eye Research Institute, Singapore National Eye Center, Singapore.
J Glaucoma. 2024 Aug 1;33(Suppl 1):S45-S48. doi: 10.1097/IJG.0000000000002407. Epub 2024 Aug 19.
A large disk, a large parapapillary delta zone and a long axial length may be used as screening criteria to detect glaucomatous optic neuropathy in highly myopic eyes.
To describe aspects for screening of glaucomatous optic neuropathy in dependence of refractive error, under special consideration of high myopia.
METHODS/RESULTS: Studies on the anatomy of the myopic optic nerve head and results of investigations on the relationship between glaucomatous optic neuropathy and axial myopia were included.
In the range from hyperopia to moderate myopia, refractive error is not a strong glaucoma risk factor and may not be included in glaucoma screening strategies. Care should be taken, that in moderate myopia, a shift of Bruch´s membrane opening usually into the temporal direction leads to parapapillary gamma zone and a corresponding shortening of the horizontal disk diameter. In these moderately myopic eyes, a secondarily small optic disk with a correspondingly small optic cup should not lead to an overlooking of intrapapillary glaucomatous changes. Prevalence of glaucomatous or glaucoma-like optic nerve atrophy (GOA) steeply increases with longer axial length in highly myopic eyes (cutoff approximately -8 diopters/axial length 26.5 mm), with prevalences higher than 50% in extremely high myopia. Besides longer axial length, morphological parameters associated with GOA in highly myopic eyes are a secondarily enlarged disk and large parapapillary delta zone. Both parameters, together with long axial length, may be used as screening criteria in high myopia for GOA. The latter is characterized by an abnormal neuroretinal rim shape, that is, vessel kinking close to the intrapapillary disk border. Factors associated with nonglaucomatous optic neuropathy are larger gamma zone and longer axial length, potentially due to an axial elongation-related retinal nerve fiber stretching.
大视盘、大视盘旁 delta 区和长眼轴可作为筛查高度近视患者青光眼视神经病变的指标。
描述与近视相关的青光眼视神经病变的筛查指标，特别关注高度近视。
方法/结果：纳入了近视性视神经头解剖研究和青光眼视神经病变与轴性近视关系的研究结果。
在远视至中度近视范围内，近视度数不是一个强烈的青光眼危险因素，可能不包括在青光眼筛查策略中。需要注意的是，在中度近视中，Bruch 膜开口通常向颞侧移位，导致视盘旁 gamma 区和相应的水平视盘直径缩短。在这些中度近视眼中，由于视盘相对较小和视杯相对较小，不应忽视视乳头内的青光眼性改变。在高度近视眼中，随着眼轴的延长，青光眼或类似青光眼的视神经萎缩（GOA）的患病率急剧增加（截断值约为-8 屈光度/眼轴 26.5 毫米），在超高度近视中患病率高于 50%。除了眼轴较长外，与高度近视患者 GOA 相关的形态学参数还有继发增大的视盘和大视盘旁 delta 区。这两个参数，连同长眼轴，可作为高度近视患者 GOA 的筛查标准。后者的特征是神经视网膜 rim 形状异常，即血管在视乳头内边界附近扭曲。与非青光眼性视神经病变相关的因素是更大的 gamma 区和更长的眼轴，可能是由于轴向延长相关的视网膜神经纤维拉伸。
