Tilted disc syndrome (TDS): New hypotheses for posterior segment complications and their implications in other retinal diseases

Cohen, Salomon Y.; Vignal-Clermont, C.; Baudouin, C.; Ohno‐Matsui, Kyoko

doi:10.1016/j.preteyeres.2021.101020

Cited by 16 publications

(17 citation statements)

References 178 publications

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“…In eyes with a so-called “inversion situs papillae” or “inversion of the optic disc” with a primary exit of the retinal vessels into the nasal direction (before the vessel turns in the temporal direction), BM is overhanging into the temporal part of the intrapapillary compartment, with a corresponding absence of BM in the nasal parapapillary region (i.e., nasal gamma zone). It leads to a shortening of the horizontal disc diameter with a vertical ovalization of the optic disc shape (similar to eyes with a temporal shift of the BM opening) and a corresponding reduction in the optic disc size [ 119 ].…”

Section: Resultsmentioning

confidence: 99%

Anatomic Peculiarities Associated with Axial Elongation of the Myopic Eye

Jonas

Бикбов

Wang

et al. 2023

JCM

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Purpose: To describe anatomical peculiarities associated with axial elongation in the human myopic eye. Methods: Reviewing the results of previous histomorphometrical investigations of enucleated human globes, as well as reviewing findings obtained in population-based studies and hospital-based clinical investigations of myopic patients and non-myopic individuals. Results: Myopic axial elongation is associated with a change from a mostly spherical eye shape to a prolate ellipsoid form. It is combined with choroidal and scleral thinning, most pronounced at the posterior pole and less pronounced in the fundus midperiphery. In the fundus midperiphery, the retina and density of the retinal pigment epithelium (RPE) and photoreceptors decrease with a longer axial length, while in the macular region, retinal thickness, RPE cell density, and choriocapillaris thickness are not related to axial length. With axial elongation, a parapapillary gamma zone develops, leading to an enlargement of the optic disc-fovea distance and a decrease in angle kappa. Axial elongation is also correlated with an increase in the surface and volume of Bruch’s membrane (BM), while BM thickness remains unchanged. Axial elongation causes moderately myopic eyes to show a shift of BM opening to the foveal direction so that the horizontal disc diameter becomes shorter (with a consequent vertical ovalization of the optic disc shape), a temporal gamma zone develops, and the optic nerve exit takes an oblique course. Features of high myopia are an enlargement of the RPE opening (myopic parapapillary beta zone) and BM opening (secondary macrodisc), elongation and thinning of the lamina cribrosa, peripapillary scleral flange (parapapillary delta zone) and peripapillary choroidal border tissue, secondary BM defects in the macular region, myopic maculoschisis, macular neovascularization, and cobblestones in the fundus periphery. Conclusions: These features combined may be explained by a growth in BM in the fundus midperiphery leading to axial elongation.

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Section: Resultsmentioning

confidence: 99%

Anatomic Peculiarities Associated with Axial Elongation of the Myopic Eye

Jonas

Бикбов

Wang

et al. 2023

JCM

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“…Equatorial circularity and ocular sphericity were correlated in the eyes with a vertical-elliptical equator, indicating the contribution of equator to the global deformation. Vertical-elliptical equator may be due to the expansion of the inferior part of eye, which is considered to be weak and susceptible to pathological expansion . This may also explain the higher prevalence of coexisting inferior staphyloma (Curtin type V).…”

Section: Discussionmentioning

confidence: 99%

Assessment of Ocular Deformation in Pathologic Myopia Using 3-Dimensional Magnetic Resonance Imaging

et al. 2023

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IMPORTANCEOcular deformation in pathologic myopia can affect the entire globe. However, few studies have investigated the equatorial pattern of ocular shape. In addition, the correlation between equatorial and posterior morphology needs to be further explored.OBJECTIVETo assess global ocular deformation in pathologic myopia.DESIGN, SETTING, AND PARTICIPANTSThis hospital-based, cross-sectional study included 180 pathologic myopic eyes with atrophic maculopathy grading C2 (diffuse chorioretinal atrophy) or more from 180 participants who underwent comprehensive ophthalmic examination, including high-resolution 3-dimensional magnetic resonance imaging. In addition, 10 nonpathologic myopic eyes of 10 participants were set as the control group.Main Outcomes and MeasuresAccording to the cross-sectional view of equator, equatorial shape was classified as round, rectangular, pyriform (noncircular and more protruded in 1 direction), vertical-elliptical, or horizontal-elliptical; according to the nasal and inferior views, the posterior shape was categorized as spheroidal, conical, bulb-shaped, ellipsoidal, multidistorted, and barrel-shaped. Equatorial circularity and ocular sphericity were used to quantitatively assess the morphological variability of the equatorial and posterior regions, respectively. The association between ocular morphology and ocular parameters and myopic maculopathy was also investigated.ResultsThe mean (SD) age of 180 participants with pathologic myopia was 55.14 (10.74) years, 127 were female (70.6%), and the mean (SD) axial length of studied eyes was 30.22 (2.25) mm. The predominant equatorial shape was pyriform (66 eyes [36.7%]), followed by round (45 eyes [25.0%]). The predominant posterior shape was bulb-shaped (97 eyes [52.2%]), followed by multidistorted (46 eyes [24.7%]). Equatorial circularity and equatorial shapes were correlated (r = −0.469; 95% CI, −0.584 to −0.346; P &lt; .001) and ocular sphericity was correlated with posterior shapes (r = −0.533; 95% CI, −0.627 to −0.427; P &lt; .001). In eyes with a vertical-elliptical equator, equatorial circularity and ocular sphericity were positively linearly correlated (R2 = 0.246; 95% CI, 0.050-0.496; P = .002) and the prevalence of inferior staphyloma was higher (27.8%; P = .04). Eyes with a horizontal-elliptical equator have the most horizontally oriented axis of corneal flat keratometry (median, 43.55 [interquartile range, 43.84] degrees; P = .01) and tended to present with multidistorted posterior shape (21.7%; P = .04).Conclusions and RelevanceThese findings suggest ocular deformation is common in pathologic myopia and can affect the entire eye, including the equatorial and posterior regions. The morphological classification may enhance the understanding of the diverse patterns of ocular shape in pathologic myopia.

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“…Choroidal neovascularization (CNV) and polypoidal choroidal vasculopathy (PCV) were also found at the edge of inferior staphyloma in eyes with tilted disc ( 80 – 82 ). It is possible that the difference of curvature across the staphyloma leads to microrupture of the BM and disturbance of blood flow, causing RPE changes and the development of CNV and PCV ( 83 ). Indeed, macular serous retinal detachments were present in 17.3 to 29.5% of eyes with myopic tilted discs associated with CNV and PCV ( 82 , 84 ); most of the cases happened in eyes with inferior staphyloma ( 85 ).…”

Section: Structural Changes Related To Myopic Tilted Discmentioning

confidence: 99%

“…In another study, they reported that 16.6% of eyes with tilted disc had retinoschisis, commonly located outside the bending area of the macula ( 86 ). These were likely due to “container-content” imbalance ( 83 ). During the elongation process of the eyeball, progressive growth of the staphyloma can induce tractional force on the BM-RPE-outer retinal layers while the inner retina remains attached to the internal limiting membrane and retinal vessels ( 83 ).…”

Section: Structural Changes Related To Myopic Tilted Discmentioning

confidence: 99%

“…These were likely due to “container-content” imbalance ( 83 ). During the elongation process of the eyeball, progressive growth of the staphyloma can induce tractional force on the BM-RPE-outer retinal layers while the inner retina remains attached to the internal limiting membrane and retinal vessels ( 83 ). Hence, separating the retinal layers.…”

Section: Structural Changes Related To Myopic Tilted Discmentioning

confidence: 99%

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

2023

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Myopic tilted disc is a common structural change of myopic eyes. With advancing ocular imaging technology, the associated structural changes of the eye, particularly the optic nerve head, have been extensively studied. These structural changes may increase patients’ susceptibility to axonal damage and the risk of developing serious optic neuropathies including glaucoma. They also lead to diagnostic difficulties of disease suspects and treatment dilemmas of patients, which implicate clinical practice and subsequently the health care system. In the context of the mounting prevalence of myopia worldwide and its implications to irreversible visual impairment and blindness, it is essential to gain a thorough understanding of the structural changes of myopia. Myopic tilted disc has been extensively investigated by different study groups. However, generalizing the knowledge could be difficult because of the variable definitions of myopic tilted disc utilized in these studies and the complexities of the changes. The current review aimed to clarify the concepts and discuss various aspects of myopic tilted disc, including the definitions, association with other myopia-related changes, mechanism of tilted disc development, structural and functional changes, and clinical implications.

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Tilted disc syndrome (TDS): New hypotheses for posterior segment complications and their implications in other retinal diseases

Cited by 16 publications

References 178 publications

Anatomic Peculiarities Associated with Axial Elongation of the Myopic Eye

Anatomic Peculiarities Associated with Axial Elongation of the Myopic Eye

Assessment of Ocular Deformation in Pathologic Myopia Using 3-Dimensional Magnetic Resonance Imaging

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

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