Glaucoma and Myopia: Diagnostic Challenges

Abstract

The rising global prevalence of myopia is a growing concern for clinicians, as it predisposes patients to severe ocular pathologies including glaucoma. High myopia can be associated with clinical features that resemble glaucomatous damage, which make an accurate glaucoma diagnosis challenging, particularly among patients with normal intraocular pressures. These patients may also present with established visual field defects which can mimic glaucoma, and standard imaging technology is less useful in disease detection and monitoring due to the lack of normative data for these anatomically unique eyes. Progression over time remains the most critical factor in facilitating the detection of early glaucomatous changes, and thus careful longitudinal follow-up of high-risk myopic patients is the most important aspect of management. Here, we review our current understanding of the complex relationship between myopia and glaucoma, and the diagnostic challenges and limitations of current testing protocols including visual field, intraocular pressure, and imaging. Furthermore, we discuss the clinical findings of two highly myopic patients with suspected glaucoma.

Keywords: IOP; POAG; glaucoma; high myopia; intraocular pressure; myopia; primary open angle glaucoma; review.

Figure 1

Optical coherence tomography (OCT) and visual field examination of patient 1 at baseline (top) and 5-year follow-up (bottom). (A) Retinal nerve fiber layer demonstrates stable mild right inferior thinning and more pronounced left superior thinning, with progression more pronounced in the left eye over time (B). (C,D) Bilateral superior–temporal ganglion–cell complex defects, worse in the left eye. (E) Visual field shows a mild early inferior nasal arcuate defect in the right eye and a denser inferior arcuate in the left eye, which progressed over time (F).

Figure 2

Color fundus imaging, optical coherence tomography (OCT) and visual field examination of patient 2. (A) Optic nerves are tilted and ovoid in shape, with pronounced peripapillary atrophy. (B) OCT demonstrates inferior retinal nerve fiber layer (RNFL) thinning and bilateral diffuse ganglion cell complex (GCC) thinning with staphylomatous changes. (C) Visual field shows bilateral enlarged blind spots.