Consistency between optical coherence tomography and humphrey visual field for evaluating glaucomatous defects in high myopic eyes

Abstract

Background The study is to investigate the influence of high myopia on the consistency between optical coherence tomography (OCT) and visual field in primary open-angle glaucoma (POAG). Methods We enrolled 37 patients with POAG with high myopia (POAG-HM group), 27 patients with POAG without high myopia (POAG group), and 29 controls with high myopia (HM group). All subjects underwent Humphrey perimetry (30–2 and 10–2 algorithms). The peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell-inner plexiform layer (GCIPL) thicknesses were measured using Cirrus HD-OCT. Spearman’s rank correlation analysis was used to determine correlations between OCT and perimetric parameters. Agreement was analyzed by cross-classification and weighted κ statistics. Results In POAG group, the cross-classification analysis showed strong agreement between the inferior temporal GCIPL thickness and the mean sensitivity (MS) of 10–2 algorithms (κ = 0.5447, P = 0.0048), and good agreement between the superior and inferior RNFL thicknesses and 30–2 MS (κ = 0.4407 and 0.4815; P < 0.05). In the POAG-HM group, only the inferior temporal GCIPL thickness showed good agreement with 10–2 MS (κ = 0.3155, P = 0.0289) and none of the RNFL sectors were in good agreement with the corresponding MS. Conclusions In POAG patients with high myopia, changes in macular measurements were in accordance with visual field defects, and RNFL thickness did not consistently decline with visual field defects due to the effects of high myopia. This study suggests that during diagnosis and follow-up of glaucoma with high myopia, more attention need to be focused on structure and functional defects in macular areas.

The Diagnostic Value of Optical Coherence Tomography for Detecting Glaucoma in High Myopia

“…The poorer OCT scan quality obtained in myopic eyes and the greater circumference due to larger OCT scan may contribute to this condition 53. Third, various morphologic changes are commonly found in the optic disc in high myopia, including tilted or torsional disc, abnormal optic disc size, peripapillary atrophy, which will also interfere with the accuracy of RNFL thickness measured by OCT and the evaluation of glaucoma severity 54,55. Forth, most of the OCT instruments did not include high myopia in the internal normative database nowadays.…”

“…53 Third, various morphologic changes are commonly found in the optic disc in high myopia, including tilted or torsional disc, abnormal optic disc size, peripapillary atrophy, which will also interfere with the accuracy of RNFL thickness measured by OCT and the evaluation of glaucoma severity. 54,55 Forth, most of the OCT instruments did not include high myopia in the internal normative database nowadays. Therefore, when comparing the thickness in high myopia to that of a built-in normative database, non-glaucomatous myopia present false-positive results in OCT color probability codes, which is known as "red-disease".…”

Evaluations of aqueous humor protein markers in different types of glaucoma

“…The characteristic glaucomatous visual field defects were Bjerrum, Seidel, paracentral scotoma, or nasal step on Humphrey visual fields, with clusters of three or more adjacent points depressed by >5 dB or two adjacent points depressed by >10 dB. [ 7 , 8 ]…”

Glaucoma and Myopia: Diagnostic Challenges

“…Several previous studies have demonstrated that the ganglion cell complex (GCC) parameters are superior to RNFL at detecting glaucoma in the context of high myopia [ 77 , 78 , 79 , 80 , 81 ]. Vertical scans of the macula have also been shown to be useful for evaluating RNFL thickness in myopic eyes [ 82 ].…”

“…Vertical scans of the macula have also been shown to be useful for evaluating RNFL thickness in myopic eyes [ 82 ]. Whilst RNFL has been found to correlate with refractive error, GCC was found to have no significant relationship with refractive error, and furthermore may better agree with visual field defects as compared to RNFL [ 80 , 81 ]. While the results of a meta-analysis found no significant differences between the two parameters, a more recent longitudinal study found that highly myopic eyes with progressive macula ganglion–inner plexiform layer thinning had a significantly higher risk of developing visual field defects, while there was no correlation with RNFL thinning, in contrast to non-myopes [ 83 , 84 ].…”