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Editors Selection IGR 19-2

Refractive Errors and Glaucoma: Glaucoma Progression in Myopes

Comment by Zeynep Ozturker on:

75544 Impact of optic disc hemorrhage on subsequent glaucoma progression in mild-to-moderate myopia, Ha A; Kim YK; Jeoung JW et al., PLoS ONE, 2017; 12: e0189706

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Ha et al. performed a retrospective comparative study to evaluate the myopic patients' clinical disc hemorrhage implications for glaucoma progression. This paper provides the first evaluation of glaucomatous progression related to optic disc hemorrhage in myopic patients.

They enrolled 59 eyes of myopic open-angle glaucoma patients with disc hemorrhage (DH) and 59 eyes of patients without DH matched for age, axial length and visual field (VF) mean deviation. Only IOP stable, early glaucoma patients were included in the study. Three blinded observers reviewed each patient's optic disc photographs and visual field tests to assess structural and functional progression. They found that the structural glaucoma progression was significantly greater in the DH group than in the non-DH group (p = 0.001). The two groups did not significantly differ in terms of functional progression (p = 0.79).

As glaucoma diagnosis relies on progressive optic nerve damage and corresponding visual field loss, there are challenges due to the difficult assessment of optic nerve features in myopic eyes with regard to glaucoma.¹ Although the association between myopia and glaucoma is suggested, there are difficulties in differentiating between glaucomatous changes, particularly in the early stages of the disease, and normal myopia. Myopia may influence VF progression due to optic disc shape alterations.² Additionally, myopic visual field defects can be progressive even without glaucoma, which makes interpretation of the study's finding difficult.³

Optic disc hemorrhage in glaucoma has clinical value for disease progression. However, we still do not fully understand the impact of DH if it represents an ongoing progression or indicates a future progression. As the authors rightly point out, glaucomatous progression was evaluated only after the occurrence of DH, and deterioration before the event was not assessed in the study. Most studies in the literature focus on VF changes after DH and functional loss before their onset is rarely reported. A longitudinal analysis of visual field before and after the DH would help better understand whether a correlation exists between DH and future progression. In addition, indicating spatial consistency between the disc hemorrhage and the progressive damage to the optic nerve would be suggestive for a stronger connection between the two entities.

Further prospective studies, with standardized progression criteria are needed to validate optic disc hemorrhage as a prognostic sign for progression in myopic glaucoma.

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