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Clinical science
Macula structural and vascular differences in glaucoma eyes with and without high axial myopia
  1. Jasmin Rezapour1,2,
  2. Christopher Bowd1,
  3. Jade Dohleman1,
  4. Akram Belghith1,
  5. James A Proudfoot1,
  6. Mark Christopher1,
  7. Leslie Hyman3,
  8. Jost B Jonas4,
  9. Rafaella C Penteado1,
  10. Sasan Moghimi1,
  11. Huiyuan Hou1,
  12. Nevin W. El-Nimri1,
  13. Eleonora Micheletti1,
  14. Massimo A Fazio5,
  15. Robert N Weinreb1,
  16. Linda M Zangwill1
  1. 1 Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, California, USA
  2. 2 Department of Ophthalmology, University Medical Center Mainz, Mainz, Germany
  3. 3 Wills Eye Hospital, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  4. 4 Department of Ophthalmology, Medical Faculty Mannheim, Ruprecht-Karls-University Heidelberg, Mannheim, Germany
  5. 5 Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
  1. Correspondence to Dr Linda M Zangwill, Hamilton Glaucoma Center, Shiley Eye Institute and Viterbi Family Department of Ophthalmology, University of California San Diego, La Jolla, CA 92093, USA; lzangwill{at}ucsd.edu

Abstract

Aims To identify clinically relevant parameters for identifying glaucoma in highly myopic eyes, an investigation was conducted of the relationship between the thickness of various retinal layers and the superficial vessel density (sVD) of the macula with axial length (AL) and visual field mean deviation (VFMD).

Methods 270 glaucoma patients (438 eyes) participating in the Diagnostic Innovations in Glaucoma cross-sectional study representing three axial myopia groups (non-myopia: n=163 eyes; mild myopia: n=218 eyes; high myopia (AL>26 mm): n=57 eyes) who completed macular optical coherence tomography (OCT) and OCT-angiography imaging were included. Associations of AL and VFMD with the thickness of the ganglion cell inner plexiform layer (GCIPL), macular retinal nerve fibre layer (mRNFL), ganglion cell complex (GCC), macular choroidal thickness (mCT) and sVD were evaluated.

Results Thinner Global GCIPL and GCC were significantly associated with worse VFMD (R2=34.5% and R2=32.9%; respectively p<0.001), but not with AL (all p>0.1). Thicker mRNFL showed a weak association with increasing AL (R2=2.4%; p=0.005) and a positive association with VFMD (global R2=19.2%; p<0.001). Lower sVD was weakly associated with increasing AL (R2=1.8%; p=0.028) and more strongly associated with more severe glaucoma VFMD (R2=29.6%; p<0.001). Thinner mCT was associated with increasing AL (R2=15.5% p<0.001) and not associated with VFMD (p=0.194). mRNFL was thickest while mCT was thinnest in all sectors of high myopic eyes.

Conclusions As thinner GCIPL and GCC were associated with increasing severity of glaucoma but were not significantly associated with AL, they may be useful for monitoring glaucoma in highly myopic eyes.

  • Glaucoma
  • Macula

Data availability statement

Data are available upon reasonable request. Data that underlie the results reported in the article and data dictionaries will be made available upon reasonable request and signed data use agreement.

https://doi.org/10.1136/bjophthalmol-2021-320430

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    Data availability statement

    Data are available upon reasonable request. Data that underlie the results reported in the article and data dictionaries will be made available upon reasonable request and signed data use agreement.

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    Footnotes

    • Contributors LMZ provided overall supervision of all aspects of this work. JR and LMZ designed the study and are accountable for all aspects of the work. LMZ, RNW and MC provided funding. JR, LMZ, JAP and CB contributed to the drafting of the manuscript. JD, AB, MAF and MC contributed to the image analysis. JR, RCP, SM, HH, NEN and EM contributed to the acquisition of the data.

    • Funding JR: German Research Foundation research fellowship grant recipient (RE 4155/1-1) and German Ophthalmological Society Grant; MC: EY030942, K99EY030942; SM: Tobacco-Related Disease Research Program T31IP1511; RNW: National Eye Institute R01EY029058, an Unrestricted grant from Research to Prevent Blindness (New York, NY); LMZ: National Eye Institute R01EY011008, R01EY019869, R01EY027510, P30EY022589.

    • Competing interests RNW: Consulting: Eyenovia, Aerie Pharmaceuticals, Allergan; Research Funding or Equipment: Bausch & Lomb, Heidelberg Engineering, Carl Zeiss Meditec, Konan Medical, Optovue, Centervue; Patent: Toromedes, Carl Zeiss Meditec-Zeiss. LMZ: Research Funding and Equipment: Heidelberg Engineering; Research Equipment: Optovue Inc, Carl Zeiss Meditec Inc, Topcon Medical Systems Inc; Patent: Carl Zeiss Meditec.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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