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Association of progressive optic disc tilt with development of retinal nerve fibre layer defect in children with large cup-to-disc ratio
  1. Ahnul Ha1,2,
  2. Sung Uk Baek3,
  3. Jin-Soo Kim4,
  4. Jin Wook Jeoung5,
  5. Ki Ho Park5,6,
  6. Young Kook Kim5,6
  1. 1Ophthalmology, Jeju National University Hospital, Jeju-si, Jeju-do, Korea (the Republic of)
  2. 2Ophthalmology, Jeju National University, Jeju-si, Jeju-do, South Korea
  3. 3Department of Ophthalmology, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do, Korea (the Republic of)
  4. 4Ophthalmology, Chungnam National University Sejong Hospital, Sejong, Korea (the Republic of)
  5. 5Ophthalmology, Seoul National University Hospital, Jongno-gu, Seoul, Korea (the Republic of)
  6. 6Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  1. Correspondence to Professor Young Kook Kim, Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of); md092{at}naver.com

Abstract

Background/aims Whereas myopic optic disc deformation has been posited as a risk factor for glaucomatous damage, longitudinal studies evaluating their association have been sparse. We investigated whether the optic nerve head (ONH)’s morphological alteration during myopia progression play any role in development of retinal nerve fibre layer defect (RNFLD) in children with a large vertical cup-to-disc ratio (vCDR).

Methods Sixty-five normotensive eyes of 65 children aged under 8 years with (1) vCDR ≥0.5 but no additional signs of glaucoma and (2) who could be tracked at young adulthood (18–28 years) were included. Children’s spherical equivalent (SE), intraocular pressure, vCDR and optic disc tilt ratio were recorded. Rare events logistic regression analysis was employed to identify factors associated with RNFLD-development risk.

Results The study group’s mean age was 5.4±1.3 years, its average vCDR was 0.62±0.07, and the average SE was −0.3±1.4 dioptres ((D), range −3.15 to 2.75D) at the baseline. After an average follow-up of 16.1±3.0 years, the mean vCDR was 0.64±0.09, and the mean SE, −3.2±2.2D (range −7.25 to 0.00 D). Among the 65 eyes, 12 (18.5%) developed RNFLD. A greater SE change (OR=1.737, p=0.016) and a greater increase in tilt ratio (OR=2.364, p=0.002) were both significantly associated with higher RNFLD-development risk.

Conclusion In this cohort of Korean children with large vCDR, progressive optic disc tilt in the course of myopia progression was associated with higher RNFLD-development risk. This finding suggests that morphological alterations in the ONH during axial elongation might represent an underlying susceptibility to glaucomatous damage in large-vCDR children.

  • optic nerve
  • child health (paediatrics)
  • glaucoma
  • imaging

Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Not applicable.

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Data availability statement

All data relevant to the study are included in the article or uploaded as online supplemental information. Not applicable.

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Footnotes

  • Contributors Study design: AH, KHP and YKK. Writing the article: AH and YKK. Data collection: AH, SUB, J-SK and JWJ. Analysis and interpretation of the data: AH, SUB, J-SK and JWJ. Literature search: AH, SUB and J-SK. Critical revision of the article: AH, KHP and YKK. Final approval of the article: AH, SUB, J-SK, JWJ, KHP and YKK. For this article, YKK is the Guarantor.

  • Funding This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP; Ministry of Science, ICT & Future Planning) grant number 2018R1C1B504336113.

  • Competing interests None declared.

  • 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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