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Editors Selection IGR 15-2

Myopia: Disc hemorrage

Comment by Don Budenz on:

51863 Comparison of myopic and nonmyopic disc hemorrhage in primary open-angle glaucoma, Kim HS; Park KH; Jeoung JW et al., Japanese Journal of Ophthalmology, 2013; 57: 166-171

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The study by Kim and colleagues looked at stereoscopic optic disc photographs of 76 eyes of 76 patients with primary open-angle glaucoma and optic disc hemorrhages. They divided the eyes into myopic (spherical equivalent less than -1 diopter, N = 34) and nonmyopic (spherical equivalent -1 diopter or greater, N = 42) groups. The two groups differed with respect to age, pattern standard deviation, and mean deviation, which may affect the results and conclusions. Two masked investigators then looked at the location of optic disc hemorrhages, both in terms of location around the optic disc and proximity of the hemorrhage to the lamina cribrosa. The results showed no difference in terms of the location of hemorrhages around the optic disc, but myopic eyes had more hemorrhages that crossed into the region of the lamina cribrosa. The authors offer several explanations for this finding. They conclude that the pathogenesis of optic disc hemorrhages is different in myopic vs. nonmyopic eyes and that the lamina cribrosa of myopic eyes has a higher vulnerability to glaucomatous damage than nonmyopic eyes. They acknowledge the study's limitations, including other difference between myopic and nonmyopic eyes (younger age and more severe glaucoma in myopes) and the small sample size. A limitation that is not discussed is the fact that the observers could not truly be masked as to myopic vs. nonmyopic eyes since myopic discs have a typical appearance compared to nonmyopic discs. Despite these limitations, this represents a new and interesting observation that may or may not further our understanding of the pathogenesis of glaucoma if confirmed in larger and more diverse populations. There is no real application of this finding to clinical practice, however.

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