Myopic (Peri)papillary Changes and Visual Field Defects

Abstract

Purpose Myopic eyes combining gamma peripapillary atrophy and peripapillary staphyloma were sorted according to the presence of intrachoroidal cavitation (PICCs) or its absence (combinations). Visual field defects (VFDs) and factors discriminating these groups were analyzed. Methods These groups were sorted by optical coherence tomography. VFDs were assessed using the Humphrey ® Field Analyzer 3, SITA standard. Ovality index (OI) was the ratio between the shortest and longest diameters of the disc. The proportions of PICCs, lamina cribrosa defects (LCDs) and clusters in each Garway-Heath’s sector (A—F) were analyzed. All variables were compared between PICCs and combinations. A multivariate logistic regression analysis was performed ultimately. Results Of the 93 eyes, we obtained, 20 PICCs and 73 combinations. The prevalence of VFDs and LCDs in PICCs were 65% (13/20) and 30% (6/20), respectively. PICCs 85% (17/20) and LCDs 12% (11/93) predominated in sector B (inferotemporal) and clusters 9.7% (9/93) in the corresponding sector. The proportion of VFDs was significantly higher in PICCs than combinations ( p < 0.001 ). In sector B, the proportion of LCDs was significantly higher in PICCs than combinations ( p = 0.011 ). The mean OI was significantly lower ( p < 0.001 ) in PICCs than combinations. Multivariate logistic regression analysis concluded that mean OI ( p < 0.001 ) was the only statistically significant factor discriminating PICCs and combinations. Conclusion Mean OI discriminating PICCs from combinations is further evidence of a gradation of structural changes between them. It could be related to the higher proportion of VFDs in PICCs. The predominant distribution of PICCs infero-temporally supports PICC as a cause of uncertainty in glaucoma diagnosis in high myopia. Furthermore, the highest proportion of PICCs and LCDs in this sector highlights its vulnerability to damage in myopic eyes and deserves further investigation as it is also primarily involved in glaucoma.

The usefulness of routine photography in a myopic patient treated for glaucoma: 36‐year follow‐up

“…Figure 3 of the right eye, using Enhanced Depth Imaging (EDI) with optical coherence tomography (OCT) (Spectralis, Heidelberg Engineering GmbH, Heidelberg, Germany) (Spaide et al., 2008) demonstrates how the ONH has sunk posteriorly into peripapillary staphyloma. The scleral changes appear to be the main cause of the peripapillary deformation resulting in the intrachoroidal cavitation (Ehongo et al., 2023), also known as choroidal schisis around the termination of Bruch's Membrane Opening.…”

“…(a) The ONH has sunken posteriorly into peripapillary staphyloma. (b) While Bruch's membrane appears to remain relatively stable, the scleral changes seem to be the main cause of the peripapillary deformation resulting in the intrachoroidal cavitation (Ehongo et al., 2023), also known as choroidal schisis, around the termination of the Bruch's Membrane Opening. (c) The yellow arrows point to the scleral flange (Hong et al.…”

Understanding Posterior Staphyloma in Pathologic Myopia: Current Overview, New Input, and Perspectives

“…63 A correlation was noted between the distribution of these defects and the location of PICC. [63][64][65] However, the mechanism underlining these deficits is not established and is suggested to be related to the degree of disc tilt. 64 These VFD raise concerns in clinical practice as they mimic glaucomatous VFD.…”

“…[63][64][65] However, the mechanism underlining these deficits is not established and is suggested to be related to the degree of disc tilt. 64 These VFD raise concerns in clinical practice as they mimic glaucomatous VFD. [63][64][65]…”