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Study: Glaucoma symptoms in some Chinese men may be due to myopia
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Some Chinese men diagnosed with glaucoma or suspected glaucoma who do not show disease progression may actually have glaucoma-like symptoms caused by myopia, according to a study by Stanford University researchers.
"Patients in such a group should probably not be treated as aggressively as those with [primary open-angle glaucoma] and in some cases should probably not receive any IOP-lowering therapy," the study authors said. "Surgical therapy, in particular, should be avoided in such individuals."
Amish Doshi, MD, and colleagues reviewed medical records of 16 Chinese men who had ocular symptoms suggestive of glaucoma at an average age of 38.9 years.
Upon examination, average IOPs ranged from 13.5 mm Hg to 17.9 mm Hg, and 56.3% of patients were using IOP-lowering medications. Over 7 years mean follow-up, none of these patients showed either progressive optic nerve cupping or visual field loss, regardless of whether they used anti-glaucoma medications, according to the study.
However, researchers found that 43.8% of eyes had myopia greater than 6 D, 75% of eyes had tilted discs, and 81.3% of optic nerves had peripapillary atrophy. Cup-to-disc ratios averaged 0.56.
The most common visual field defect was an arcuate defect, found in 31.3% of eyes, according to the study.
"The majority of patients in our series had myopia, tilted discs or both characteristics, which can mimic or mask glaucomatous changes, making diagnosis and monitoring of these patients difficult," the study authors said. "Myopia is increasingly prevalent in Chinese populations, and the possibility exists that the individuals in our series developed visual field defects during the years when myopic progression was greatest."
Progressive myopia may have caused a strain gradient that affected susceptible axons in the prelaminar optic nerve head tissue, leading to vision loss, the authors suggested.
Co-author Kuldev Singh, MD, MPH, is currently investigating the condition further in a larger population sample, according to a press release from Stanford.
"Our suspicion is that this is an epidemic," Dr. Singh said in the release. "The next step is to try to learn more about the natural history and genetics of this condition, and see whether there are subsets of the population more prone to it."
The study is published in the March issue of Ophthalmology.