Myopic eyes with untreated NTG may progress slowly
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The progression rate of normal tension glaucoma with myopia may be slow even without the uses of glaucoma medications, according to findings published in the American Journal of Ophthalmology.
Jong Chul Han, MD, PhD, and colleagues investigated the natural clinical course and the risk factors of visual field progression in untreated normal tension glaucoma (NTG) with myopia with follow up of a minimum of 3 years.
“Several earlier reports have suggested possible risk factors for glaucomatous progression in myopic glaucoma,” Han and colleagues wrote. “In particular, optic nerve head morphologies such as disc tilt or parapapillary atrophy were suggested to be associated with progression in glaucomatous eyes.”
The researchers used a Kaplan-Meier survival analysis and a log-rank test to compare survival experiences between the groups in the retrospective cohort study.
Han and colleagues determined that over an average follow-up period of 71.1 months, 32 eyes showed progression.
In untreated patients with NTG and myopia, the Kaplan-Meier survival curve showed progression cases in 10.3% at 36 months and 24.8% at 60 months, the researchers wrote. Age and disc tilt direction were classified into two groups, with a higher cumulative probability of progression observed in patients 50 years and under compared with patients older than 50 years of age (P = .001) and in patients with a disc tilt direction less than 45 degrees compared with a disc tilt direction of 45 degrees or greater (P = .002).
To predict visual field progression in untreated NTG with myopia, age and disc morphology should be considered, the researchers concluded. – by Earl Holland Jr.
Disclosures: The authors report no relevant financial disclosures.
Perspective
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Derek MacDonald, OD, FAAO
Some things just belong together. Peanut butter and jam… mac and cheese… glaucoma and myopia…
Well, in the words of an artist named after another comfort food, “Two out of three ain’t bad.”
Myopia has long been recognized as both a risk factor and a confounding comorbidity in the diagnosis of open-angle glaucoma (OAG). The incidence of OAG increases with myopic refractive error, and myopia can present with static structural and functional deficits that mimic those of OAG. The role of myopia in the progression of OAG remains uncertain, however, with studies reaching contradictory conclusions.
Han and colleagues followed untreated patients with myopic normal-tension glaucoma, documenting relatively slow functional visual progression in only one of three after 5 years. Baseline visual field defects were overwhelmingly superior (in keeping with significant myopic optic nerve head tilt [ONH]), with nearly 50% of individuals manifesting paracentral loss. Risk factors for progression included younger age, presence of disc hemorrhage and smaller degree of ONH tilt.
This study highlights the challenge in differentiating stationary myopia with glaucoma-like defects from progressive myopic glaucoma. It suggests that time is on our side, but that particular vigilance is required in younger patients with less ONH tilt and, not surprisingly, disc hemorrhage.
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