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. 2022 Jul;129(7):803-812.
doi: 10.1016/j.ophtha.2022.03.001. Epub 2022 Mar 12.

Classification of Visual Field Abnormalities in Highly Myopic Eyes without Pathologic Change

Fengbin Lin  1 , Shida Chen  1 , Yunhe Song  1 , Fei Li  1 , Wei Wang  1 , Zhenni Zhao  2 , Xinbo Gao  1 , Peiyuan Wang  1 , Ling Jin  1 , Yuhong Liu  1 , Meiling Chen  1 , Xiaohong Liang  1 , Bin Yang  3 , Guili Ning  4 , Ching-Yu Cheng  5 , Paul R Healey  6 , Ki Ho Park  7 , Linda M Zangwill  8 , Tin Aung  9 , Kyoko Ohno-Matsui  10 , Jost B Jonas  11 , Robert N Weinreb  12 , Xiulan Zhang  13 ; Glaucoma Suspects with High Myopia Study Group
Collaborators, Affiliations

Classification of Visual Field Abnormalities in Highly Myopic Eyes without Pathologic Change

Fengbin Lin et al. Ophthalmology. 2022 Jul.

Abstract

Purpose: To develop a classification system of visual field (VF) abnormalities in highly myopic eyes with and without glaucoma.

Design: Secondary analysis of VF data from a longitudinal cohort study.

Participants: One thousand eight hundred ninety-three VF tests from 1302 eyes (825 individuals).

Methods: All participants underwent VF testing (Humphrey 24-2 Swedish interactive threshold algorithm standard program; Carl Zeiss Meditec) and detailed ophthalmic examination. A comprehensive set of VF defect patterns was defined via observation of the 1893 VF reports, literature review, and consensus meetings. The classification system comprised 4 major types of VF patterns, including normal type, glaucoma-like defects (paracentral defect, nasal step, partial arcuate defect, arcuate defect), high myopia-related defects (enlarged blind spot, vertical step, partial peripheral rim, nonspecific defect), and combined defects (nasal step with enlarged blind spot). A subset (n = 1000) of the VFs was used to evaluate the interobserver and intraobserver agreement and weighted κ values of the classification system by 2 trained readers. The prevalence of various VF patterns and their associated factors were determined.

Main outcome measures: The classification of VF in highly myopic eyes and its associated risk factors.

Results: We found that normal type, glaucoma-like defects, high myopia-related defects, and combined defects accounted for 74.1%, 10.8%, 15.0%, and 0.1% of all unique VF tests, respectively. The interobserver and intraobserver agreements were > 89%, and the corresponding κ values were 0.86 or more between readers. Both glaucoma-like and high myopia-related VF defects were associated with older age (odds ratios [ORs], 1.07 [95% confidence interval (CI), 1.04-1.10; P < 0.001] and 1.06 [95% CI, 1.04-1.10; P < 0.001]) and longer axial length (ORs, 1.65 [95% CI, 1.32-2.07; P < 0.001] and 1.37 [95% CI, 1.11-1.68; P = 0.003]). Longer axial length showed a stronger effect on the prevalence of glaucoma-like VF defects than on the prevalence of high myopia-related VF defects (P = 0.036).

Conclusions: We propose a new and reproducible classification system of VF abnormalities for nonpathologic high myopia. Applying a comprehensive classification system will facilitate communication and comparison of findings among studies.

Trial registration: ClinicalTrials.gov NCT04302220.

Keywords: Classification system; High myopia; Visual field abnormalities.

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Figures

Figure 1.
Figure 1.
Flowchart showing inclusion and exclusion of eyes in this study. META-PM = Meta-Analysis for Pathological Myopia; VF = visual field.
Figure 2.
Figure 2.
Examples of the visual field abnormality classification with the corresponding fundus photographs.
Figure 3.
Figure 3.
Pie chart showing the frequency distribution of each visual field type in highly myopic eyes.
See this image and copyright information in PMC

References

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