Ocular and Hemodynamic Factors Contributing to the Central Visual Function in Glaucoma Patients With Myopia

Abstract

Purpose The purpose of this study was to investigate the ocular and hemodynamic factors contributing to the central visual function in glaucoma patients with myopia. Methods This study was a prospective observational study, which included 236 eyes of 140 patients with normal-tension glaucoma (NTG), which includes 114 eyes with mild myopia (axial length ≥24 and <26 mm) and 122 eyes with moderate-to-severe myopia (axial length ≥26 mm). Ocular characteristics were axial length and posterior pole profiles, including peripapillary atrophy (PPA) to disc area ratio, disc tilt ratio, disc torsion, and disc-foveal angle. Hemodynamic factors included standard deviation of the mean of qualified normal-to-normal intervals (SDNN) of a heart rate variability (HRV) test and vessel density (VD) parameters from optical coherence tomography angiography (OCTA). The root mean square error was estimated as a measure of the VD fluctuation. Association between ocular characteristics and VD parameters of the OCTA with the central sensitivity of the 10-degree visual field or the presence of central scotoma were analyzed. Results Deep layer VD of the peripapillary and macular areas showed significant differences between mild and moderate-to-severe myopia ( P = 0.034 and P = 0.045, respectively). Structural parameters, especially PPA to disc area ratio, had significant correlation with peripapillary VD parameters in myopic eyes. Lower SDNN value (ß = 0.924, P = 0.011), lower deep VD of the macular area (ß = 0.845, P = 0.001), and greater fluctuation of deep VD in the peripapillary area (ß = 1.517, P = 0.005) were associated with the presence of central scotoma in patients with glaucoma with myopia in multivariate logistic regression analysis. Conclusions The structural changes by myopia, especially in the peripapillary region, affected VD parameters in myopic eyes. Lower deep VD and greater VD fluctuation in the peripapillary region showed association with central scotoma in patients with glaucoma with myopia, suggesting both structural and vascular changes by myopia may be related to central visual function in glaucoma patients with myopia.

Factors Associated with Elevated Tumor Necrosis Factor-α in Aqueous Humor of Patients with Open-Angle Glaucoma

“…Only central scotoma was statistically significant in the multivariate analysis. Central scotoma has been associated with vascular instability and increased risk of progression especially in NTG patients [ 25 , 26 , 27 , 28 ]. Glaucoma patients with central scotoma have been shown to have lower vascular density and greater fluctuation in vascular density as measured by OCT angiography [ 26 ].…”

“…Central scotoma has been associated with vascular instability and increased risk of progression especially in NTG patients [ 25 , 26 , 27 , 28 ]. Glaucoma patients with central scotoma have been shown to have lower vascular density and greater fluctuation in vascular density as measured by OCT angiography [ 26 ]. Central visual field deterioration was also associated with autonomic dysfunction reflecting vascular dysregulation in these patients [ 25 ].…”

Myopic tilted disc: Mechanism, clinical significance, and public health implication

“…Similarly, the optic tilt ratio negatively was correlated with vessel density in the deep retinal plexus of the macular region at the nasal and temporal sectors ( 15 ). Furthermore, the deep vessel density of the peripapillary area was correlated with the disc tilt ratio and not the disc torsion ( 16 ). The reduced vessel density could be related to the reduced blood supply around the optic disc and the FAZ, primarily due to mechanical stretching of the corresponding regions.…”

“…Myopic tilted disc could lead to alteration of the retinal nerve fiber layer (RNFL) peak locations, changes of the macular ganglion cell inner-plexiform layer (GCIPL) distribution (5)(6)(7)(8)(9). It can also cause structural changes of the sclera (10), choroid thickness (11)(12)(13), and microvasculature (14)(15)(16). It is also a mediator between the presence of peripapillary hyperreflective ovoid masslike structure (PHOMS) and myopic shifting in children (17,18).…”

Optical coherence tomography angiography features in patients with idiopathic macular holes before and after vitrectomy

“…This new modality can allow a three-dimensional and comprehensive analysis of retinal layers, vascular blood ow and anatomical structure in the macular region [19]. Although still in development, OCTA has been used to assess various fundus diseases such as glaucoma and age-related macular degeneration [20,21]. OCTA provides reliable, high resolution, and non-invasive images of the retinal vasculature.…”