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Editors Selection IGR 13-4
Refractive Errors: Optic disc changes in myopic children
Comment by Peter Netland on:
48011 Cytomegalovirus-associated anterior segment infection, Jap A; Chee S-P, Expert Review of Ophthalmology, 2011; 6: 517-528
Most glaucoma subspecialists, at least in part, 'make a living' by judging the clinical appearance of the optic disc. In certain patients, we may believe that the diagnosis of myopia is associated with a risk for glaucoma, or we may believe that the presence of myopia makes identification of glaucomatous changes more difficult. This study by Kim et al. (1920) has greatly enhanced our understanding of the development of disc changes associated with myopia. In this retrospective comparative study, 118 eyes of 118 children with suspected optic disc problems were followed by serial photographs at least yearly for an average of 38 months. Changes in the optic disc appearance and peripapillary atrophy were classified into two groups: changed and unchanged. In these two groups, the ratio of the horizontal to vertical disc diameter (HVDR) and the ratio of the maximum peripapillary atrophy width to vertical disc diameter (PVDR) were quantitatively measured using imaging software and compared. The change group was found to have a significantly decreased HVDR and significantly increased PVDR, and was significantly associated with myopic shift of the cycloplegic refraction during the follow-up period. The conclusions were supported by the data: progressive tilting of the disc and increased peripapillary atrophy occur in children who exhibit a myopic shift, suggesting that these disc changes can be acquired due to scleral stretching. It is interesting to consider the relationship of the findings of this study to glaucomatous optic nerve changes. As described in the AAO PPP for POAG (2010) and LALES (2010), large cross-sectional epidemiologic studies in a variety of ethnic groups have suggested that individuals with myopia have a higher prevalence of open-angle glaucoma than those without myopia. Is this association due, at least in part, to mechanical stress arising from scleral stretching, as suggested by the authors of this study? Is the peripapillary atrophy observed in glaucoma due to vascular factors, or due to mechanical stretching of the retinal pigment epithelial layer? We are grateful to Kim et al. for elucidating the changes that occur in the disc in myopia, and look forward to other studies that will be stimulated by their findings.
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