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Review
. 2025 May-Jun;70(3):563-582.
doi: 10.1016/j.survophthal.2024.12.003. Epub 2024 Dec 17.

Evaluating glaucoma in myopic eyes: Challenges and opportunities

Anuwat Jiravarnsirikul  1 , Akram Belghith  2 , Jasmin Rezapour  3 , Christopher Bowd  2 , Sasan Moghimi  2 , Jost B Jonas  4 , Mark Christopher  2 , Massimo A Fazio  5 , Hongli Yang  6 , Claude F Burgoyne  6 , Robert N Weinreb  2 , Linda M Zangwill  7
Affiliations
Review

Evaluating glaucoma in myopic eyes: Challenges and opportunities

Anuwat Jiravarnsirikul et al. Surv Ophthalmol. 2025 May-Jun.

Abstract

The increasing global prevalence of myopia presents a significant public health concern, and growing evidence has demonstrated that myopia is a major risk factor for the development of open-angle glaucoma. Therefore, timely detection and management of glaucoma in myopic patients are crucial; however, identifying the structural alterations of glaucoma in the optic nerve head (ONH) and retinal tissues of myopic eyes using standard diagnostic tools such as fundus photography, optical coherence tomography (OCT), and OCT angiography (OCTA) presents challenges. Additionally, myopia-related perimetric defects can be confounded with glaucoma-related defects. We comprehensively examine the challenges encountered in evaluating glaucoma in myopic eyes through various diagnostic tools, including fundus photography, OCT of the ONH, retinal nerve fiber layer, and macular ganglion cell layer, OCTA, and perimetry. We also explore potential opportunities to address these challenges, providing insights for clinicians to effectively manage myopic glaucoma patients in clinical practice.

Keywords: Fundus photograph; Glaucoma; High myopia; Myopia; Optic nerve head; Optical coherence tomography; Optical coherence tomography angiography; Visual field.

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Conflict of interest statement

Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests Jasmin Rezapour reports financial support was provided by German Research Foundation. Jasmin Rezapour reports financial support was provided by Heidelberg Engineering GmbH. Jasmin Rezapour reports financial support was provided by SANTEN. Jasmin Rezapour reports financial support was provided by Bausch & Lomb Americas Inc. Jost B. Jonas has patent Agents for use in the therapeutic or prophylactic treatment of myopia or hyperopia issued to European patent EP 3 271 392, JP 2021–119187, and US 2021 0340237 A1. Jost B. Jonas has patent EGFR Antagonists for the treatment of diseases involving unwanted migration, proliferation, and metaplasia of retinal pigment epithelium (RPE) cells issued to European patent application 23196899.1. Mark Christopher reports financial support was provided by AISight health. Mark Christopher reports financial support was provided by National Eye Institute. Mark Christopher reports financial support was provided by Glaucoma Foundation. Mark Christopher reports a relationship with AISight health that includes: board membership and equity or stocks. Massimo A. Fazio reports financial support was provided by National Eye Institute. Massimo A. Fazio reports financial support was provided by Heidelberg Engineering GmbH. Massimo A. Fazio reports financial support was provided by Topcon Healthcare. Hongli Yang reports financial support was provided by Heidelberg Engineering GmbH. Robert N. Weinreb reports financial support was provided by National Eye Institute. Robert N. Weinreb reports financial support was provided by National Institute on Minority Health and Health Disparities Division of Intramural Research. Robert N. Weinreb reports financial support was provided by Research to Prevent Blindness. Robert N. Weinreb reports equipment, drugs, or supplies was provided by centervue. Robert N. Weinreb reports a relationship with AbbVie Inc that includes: consulting or advisory. Robert N. Weinreb reports a relationship with Alcon Laboratories Inc that includes: consulting or advisory. Robert N. Weinreb reports a relationship with Amydis that includes: consulting or advisory. Robert N. Weinreb reports a relationship with Balance that includes: consulting or advisory. Robert N. Weinreb reports a relationship with Editas Medicine that includes: consulting or advisory. Robert N. Weinreb reports a relationship with Eyenovia, Inc. that includes: consulting or advisory. Robert N. Weinreb reports a relationship with Iantrek that includes: consulting or advisory. Robert N. Weinreb reports a relationship with implandata that includes: consulting or advisory. Robert N. Weinreb reports a relationship with iSTAR Medical that includes: consulting or advisory. Robert N. Weinreb reports a relationship with Nicox that includes: consulting or advisory. Robert N. Weinreb reports a relationship with Tenpoint Therapeutics Limited that includes: consulting or advisory. Robert N. Weinreb reports a relationship with Toku that includes: consulting or advisory. Robert N. Weinreb reports a relationship with Topcon Healthcare that includes: consulting or advisory. Robert N. Weinreb reports a relationship with Toromedes that includes: equity or stocks. Linda M. Zangwill reports financial support was provided by National Eye Institute. Linda M. Zangwill reports financial support was provided by Glaucoma Foundation. Linda M. Zangwill reports financial support was provided by Research to Prevent Blindness. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. (Anuwat Jiravarnsirikul, Akram Belghith, Christopher Bowd, Sasan Moghimi, Claude F. Burgoyne)

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