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Glaucoma in myopia: diagnostic dilemmas
  1. Nicholas Y Q Tan1,2,
  2. Chelvin C A Sng1,3,4,
  3. Jost B Jonas5,
  4. Tien Yin Wong1,2,6,
  5. Nomdo M Jansonius7,
  6. Marcus Ang1,2,4,6
  1. 1 Singapore Eye Research Institute, Singapore, Singapore
  2. 2 Singapore National Eye Centre, Singapore, Singapore
  3. 3 Department of Ophthalmology, National University Hospital, Singapore, Singapore
  4. 4 Moorfields Eye Hospital, London, UK
  5. 5 Department of Ophthalmology, Ruprecht-Karls-University Heidelberg, Seegartenklinik Heidelberg, Mannheim, Germany
  6. 6 Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore, Singapore
  7. 7 Department of Ophthalmology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
  1. Correspondence to Dr Chelvin C A Sng, Department of Ophthalmology, National University Hospital, Singapore 119228, Singapore; chelvin{at}


Myopic eyes have an increased risk of glaucoma. However, glaucomatous changes in a myopic eye are often difficult to detect. Classic structural and functional investigations to diagnose glaucoma may be confounded by myopia. Here, we identify some of the common pitfalls in interpreting these structural parameters, and the possible solutions that could be taken to overcome them. For instance, in myopic eyes, we discuss the limitations and potential sources of error when using neuroretinal rim parameters, and retinal nerve fibre layer and ganglion cell-inner plexiform layer thickness measurements. In addition, we also review new developments and potential adjuncts in structural imaging such as the assessment of the retinal nerve fibre layer texture, and the examination of the microcirculation of the optic nerve head using optical coherence tomography angiography. For the functional assessment of glaucoma, we discuss perimetric strategies that may aid in detecting characteristic visual field defects in myopic glaucoma. Ultimately, the evaluation of glaucoma in myopia requires a multimodal approach, to allow correlation between structural and functional assessments. This review provides overview on how to navigate this diagnostic dilemma.

  • glaucoma
  • optic nerve
  • diagnostic tests/investigation
  • imaging
  • perimetry
  • myopia

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  • Contributors All authors met the ICJME criteria: (1) substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; (2) drafting the article or revising it critically for important intellectual content; and (3) final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.