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Editors Selection IGR 18-3

Myopia: Tilted disc

Comment by Tec Kuan Paul Chew & Jovina See & Maria Cecilia Aquino on:

16924 Nonprogressive glaucomatous cupping and visual field abnormalities in young Chinese males, Doshi A; Kreidl KO; Lombardi L et al., Ophthalmology, 2007; 114: 472-479

Find related abstracts

Optic nerve head findings of tilted discs and peripapillary atrophy are common features found in myopic eyes. Due to the increasing prevalence of myopia in Chinese individuals, the said characteristic optic disc appearance is frequently observed. Likewise, corresponding visual field defects may or may not be present. As a result, establishment of glaucomatous damage and progression monitoring becomes more difficult bringing about uncertainties in glaucoma diagnosis and management. The case series by Doshi et al. (182) reported 16 Chinese males mostly myopics with optic disc cupping and visual field abnormalities suggestive of glaucoma. Their condition was found to be stable during 7 years follow-up. This is not surprising, considering the fact that the subjects on the average belong to the young and middle aged group. It is also worth mentioning that 56% of the subjects (9 out of 16 ) received treatment (intraocular pressure lowering medications). This opens a question whether threshold for instituting treatment should be lowered or raised. For this particular group, withholding treatment is a good option. The case series presented are interesting cases, but, as the authors admitted, they are not representative or reflective of the true characteristics of the Chinese population, especially the myopic population.

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