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Editors Selection IGR 17-3
Glaucoma and myopia: Glaucoma progression and myopia
Comment by Chungkwon Yoo & Shan Lin on:
67575 Progression of primary open angle glaucoma in asymmetrically myopic eyes, Song MK; Sung KR; Han S et al., Graefe's Archive for Clinical and Experimental Ophthalmology, 2016; 254: 1331-1337
Although myopia is a well-established risk factor for development of open-angle glaucoma (OAG),1-3 there remains controversy regarding its role in glaucoma progression.4-7 Recent studies have negated its role as a risk factor, and some even demonstrated its protective role against progression.5-7Recent studies have negated myopia's role as a risk factor, and some even demonstrated its protective role against progression
Sung and colleagues explored this issue by comparing glaucoma progression in asymmetrically myopic eyes within the same subjects. They found no difference in glaucoma progression between the more myopic eye and the less myopic eye in visual field (VF) or retinal nerve fiber layer analyses in their 55 patients. This corroborates the authors' earlier observations that myopia was not associated with glaucoma progression. This information may have an important clinical implication because it helps clinicians make an appropriate treatment strategy for myopic eyes with glaucoma.
By assessing asymmetrically myopic eyes of the same patient, other risk factors could be controlled. However, this study is limited by a retrospective design, relatively small sample size, and lack of treatment information. Also, the low mean untreated IOP (16.1 mmHg) suggests inclusion of predominantly normal-tension glaucoma (NTG) patients. Notably, many of the recent studies on myopia and glaucoma progression were conducted in NTG-prevalent countries.5-7 Therefore, further studies are necessary in OAG with high IOP.
Another consideration worthy of note is the microscopic characteristics of peripapillary atrophy (PPA). Beta-zone PPA, which has been linked to glaucoma progression, can be classified into PPA+BM and PPA-BM, according to the presence of Bruch's membrane.8,9 PPA+BM has been associated with the progression, whereas PPA-BM (γ-zone PPA) has not. In this study, more myopic eyes had a higher PPA to disc area ratio, which may be attributed to possible inclusion of more PPA-BM. It would be interesting to study whether the microscopic characteristics of PPA had any influence on the study outcomes.
References
- Marcus MW, de Vries MM, Junoy Montolio FG, Jansonius NM. Myopia as a risk factor for open-angle glaucoma: a systematic review and meta-analysis. Ophthalmology 2011;118:1989-1994.
- Xu L, Wang Y, Wang S, et al. High myopia and glaucoma susceptibility the Beijing Eye Study. Ophthalmology 2007;114:216-220.
- Chon B, Qiu M, Lin SC. Myopia and glaucoma in the South Korean population. Invest Ophthalmol Vis Sci 2013;54:6570-6577.
- Chihara E, Liu X, Dong J, et al. Severe myopia as a risk factor for progressive visual field loss in primary open-angle glaucoma. Ophthalmologica 1997;211:66-71.
- Araie M, Shirato S, Yamazaki Y, et al. Risk factors for progression of normal-tension glaucoma under beta-blocker monotherapy. Acta Ophthalmol 2012;90:e337-e343.
- Sohn SW, Song JS, Kee C. Influence of the extent of myopia on the progression of normal-tension glaucoma. Am J Ophthalmol 2010;149:831-838.
- Lee JY, Sung KR, Han S, Na JH. Effect of myopia on the progression of primary open-angle glaucoma. Invest Ophthalmol Vis Sci 2015;56:1775-1781.
- Lee EJ, Kim T-W, Weinreb RN, et al. β -zone parapapillary atrophy and the rate of retinal nerve fiber layer thinning in glaucoma. Invest Ophthalmol Vis Sci 2011;52:4422-4427.
- Yamada H, Akagi T, Nakanishi H, et al. Microstructure of Peripapillary Atrophy and Subsequent Visual Field Progression in Treated Primary Open-Angle Glaucoma, Ophthalmology 2016;123(3):542-551.
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