Glaucomatous, Glaucoma-Like, and Non-Glaucomatous Optic Neuropathy in High Myopia: The Two-Continent Study.
Jonas Jost B, Bikbov Mukharram M, Kazakbaeva Gyulli M, Wang Ya Xing, Nangia Vinay, Milea Dan, Lamirel Cédric, Jonas Rahul A, Panda-Jonas Songhomitra
AI Summary
This study found high myopia is linked to significant rates of non-glaucomatous and glaucomatous-like optic neuropathies, often with normal IOP, emphasizing diagnostic challenges and the need for careful monitoring.
Abstract
Purpose
The purpose of this study was to examine prevalences of glaucomatous (GON), glaucoma-like (GLON), and non-glaucomatous optic neuropathy (NGON) in highly myopic individuals.
Methods
The population-based investigations of the Ural Eye and Medical Study (UEMS; n = 5899 participants; aged = 40+ years), Ural Very Old Study (UVOS; n = 684 participants; aged = 85+ years), Ural Children Eye Study (UCES; n = 4933 participants; aged = 11.8 ± 3.2 years), Central India Eye and Medical Study (CIEMS; n = 4711 participants, aged = 30+ years), and Beijing Eye Study (BES; n = 4439 participants, aged = 40+ years) were conducted in Bashkortostan/Russia, Nagpur/India, and Beijing/China, respectively.
Results
Prevalences of NGON and GLON/GON in the UEMS (n = 116 highly myopic individuals), UVOS (n = 13), UCES (n = 101), CIEMS (n = 47), and BES (n = 149 eyes) were 34 of 116 (29.3%, 95% confidence interval [CI] = 21.0-38.0) and 10 of 116 (8.6%, 95% CI = 3.1-14.1), 4 of 13 (31%, 95% CI = 2-60), and 4 of 13 (31%, 95% CI = 2-60), 0 of 101 and 0 of 101, and 16 of 47 (34.0%, 95% CI = 20.0-48.1) and 14 of 47 (29.8%, 95% CI = 16-43), and 34 of 149 (22.8%, 95% CI = 16-30) and 20 of 149 (13.4%, 95% CI = 8-19), respectively. In all cohorts, higher NGON prevalence and degree were associated (most P < 0.01) with longer axial length and wider myopic parapapillary beta/gamma zone. Higher GLON/GON prevalence and degree were associated (most P < 0.01) with larger optic disc size and, less significantly, with longer axial length. The proportion of eyes with elevated IOP or anti-glaucomatous therapy was 3 of 10 (30%), 1 of 4 (25%), 0 of 14 (0%), and 1 of 20 (5%), respectively.
Conclusions
Highly myopic eyes had considerable prevalences of NGON and GLON/GON, usually higher than 20% and 10%, respectively. The single IOP reading was ≤21 millimeters of mercury (mm Hg) in ≥70% of the eyes with GLON/GON. NGON (associated with large parapapillary myopic beta/gamma zone) and GLON/GON (associated with large optic disc size) differed in their relationships. Prevalences of both optic neuropathies increased in a nonlinear manner with longer axial length, reaching values of 50% to 100% in extreme high myopia.
MeSH Terms
Shields Classification
Key Concepts6
In highly myopic individuals from the Ural Eye and Medical Study (UEMS; n = 116), the prevalence of non-glaucomatous optic neuropathy (NGON) was 29.3% (95% confidence interval [CI] = 21.0-38.0) and the prevalence of glaucoma-like/glaucomatous optic neuropathy (GLON/GON) was 8.6% (95% CI = 3.1-14.1).
In highly myopic individuals from the Central India Eye and Medical Study (CIEMS; n = 47), the prevalence of non-glaucomatous optic neuropathy (NGON) was 34.0% (95% CI = 20.0-48.1) and the prevalence of glaucoma-like/glaucomatous optic neuropathy (GLON/GON) was 29.8% (95% CI = 16-43).
In highly myopic individuals from the Beijing Eye Study (BES; n = 149 eyes), the prevalence of non-glaucomatous optic neuropathy (NGON) was 22.8% (95% CI = 16-30) and the prevalence of glaucoma-like/glaucomatous optic neuropathy (GLON/GON) was 13.4% (95% CI = 8-19).
In highly myopic eyes across all cohorts, a higher prevalence and degree of non-glaucomatous optic neuropathy (NGON) were associated with longer axial length and wider myopic parapapillary beta/gamma zone (most P < 0.01).
In highly myopic eyes across all cohorts, a higher prevalence and degree of glaucoma-like/glaucomatous optic neuropathy (GLON/GON) were associated with larger optic disc size (most P < 0.01) and, less significantly, with longer axial length.
The single intraocular pressure (IOP) reading was ≤21 millimeters of mercury (mm Hg) in ≥70% of the highly myopic eyes with glaucoma-like/glaucomatous optic neuropathy (GLON/GON).
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