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Editors Selection IGR 12-1

Myopia and Glaucoma: Effects of high myopia on RNFL

Comment by Kuldev Singh on:

51150 Retinal nerve fiber layer defects in highly myopic eyes with early glaucoma, Kimura Y; Hangai M; Morooka S et al., Investigative Ophthalmology and Visual Science, 2012; 53: 6472-6478

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Kimura and colleagues have provided evidence that glaucomatous individuals with high myopia typically d emonstrate visual field abnormalities that are distinct from those commonly found in glaucoma patients without high myopia. In particular, the papillomacular bundle is damaged earlier in high myopes resulting in visual field defects more often involving the central ten degrees than is seen in non high myopes. This study reminds us that what we define as glaucomatous optic neuropathy in one patient may be the result of a very different disease process, at the optic nerve level, than the same definition in another patient.

The distinction between glaucomatous and non glaucomatous visual field defects in high myopes, which are often impossible to delineate on cross sectional examination, may remain very difficult to discern with longitudinal follow up

It is well known that high myopia may be associated with visual field defects that are not glaucomatous. The distinction between glaucomatous and non-glaucomatous visual field defects in high myopes, which are often impossible to delineate on cross-sectional examination, may remain very difficult to discern with longitudinal follow up. The work by Kimura et al., despite the limitations acknowledged by the authors, is important not only with regard to the novel findings, but also in that it leads to several questions requiring further study. What is the natural history of glaucomatous disease in high myopes with and without IOP lowering therapy? Is the disease more or less amenable to successful treatment with IOP lowering in high myopes relative to those without myopia? Given the epidemic of myopia in several regions of the world, future work from these authors and others addressing such questions should be given high priority.

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