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Central visual field damage in glaucoma eyes with choroidal microvasculature dropout with and without high axial myopia
  1. Eleonora Micheletti1,
  2. Nevin El-Nimri1,
  3. Takashi Nishida1,
  4. Sasan Moghimi1,
  5. Jasmin Rezapour1,2,
  6. Massimo A Fazio1,3,
  7. Min Hee Suh1,4,
  8. Christopher Bowd1,
  9. Akram Belghith1,
  10. Mark Christopher1,
  11. Jost B Jonas5,
  12. Robert N Weinreb1,
  13. Linda M Zangwill1
  1. 1Department of Ophthalmology at the Shiley Eye Institute, University of California at San Diego, La Jolla, California, USA
  2. 2Department of Ophthalmology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
  3. 3Department of Ophthalmology and Visual Sciences, University of Alabama at Birmingham, Birmingham, Alabama, USA
  4. 4Department of Ophthalmology, Inje University Busan Paik Hospital, Busan, Korea (the Republic of)
  5. 5Department of Ophthalmology, University of Heidelberg Faculty of Medicine Mannheim Institute of Public Health, Mannheim, Germany
  1. Correspondence to Dr Linda M Zangwill, University of California at San Diego Department of Ophthalmology at the Shiley Eye Institute, La Jolla, California 92093, USA; lzangwill{at}


Purpose To characterise the relationship between a deep-layer microvasculature dropout (MvD) and central visual field (VF) damage in primary open-angle glaucoma (POAG) patients with and without high axial myopia.

Design Cross-sectional study.

Methods Seventy-one eyes (49 patients) with high axial myopia and POAG and 125 non-highly myopic POAG eyes (97 patients) were enrolled. Presence, area and angular circumference of juxtapapillary MvD were evaluated on optical coherence tomography angiography B-scans and en-face choroidal images.

Results Juxtapapillary MvD was detected more often in the highly myopic POAG eyes (43 eyes, 86%) than in the non-highly myopic eyes (73 eyes, 61.9%; p=0.002). In eyes with MvD, MvD area and angular circumference (95% CI) were significantly larger in the highly myopic eyes compared with the non-highly myopic eyes (area: (0.69 (0.40, 0.98) mm2 vs 0.31 (0.19, 0.42) mm2, p=0.011) and (angular circumference: 84.3 (62.9, 105.8) vs 74.5 (58.3, 90.9) degrees, p<0.001), respectively. 24-2 VF mean deviation (MD) was significantly worse in eyes with MvD compared with eyes without MvD in both groups (p<0.001). After adjusting for 24-2 MD VF, central VF defects were more frequently found in eyes with MvD compared with eyes without MvD (82.7% vs 60.9%, p<0.001). In multivariable analysis, higher intraocular pressure, worse 24-2 VF MD, longer axial length and greater MvD area and angular circumference were associated with worse 10-2 VF MD.

Conclusions MvD was more prevalent and larger in POAG eyes with high myopia than in non-highly myopic POAG eyes. In both groups, eyes with MvD showed worse glaucoma severity and more central VF defects.

  • Glaucoma
  • Choroid
  • Imaging
  • Optic Nerve
  • Intraocular pressure

Data availability statement

Data are available on reasonable request. Not Applicable.

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Data availability statement

Data are available on reasonable request. Not Applicable.

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  • Contributors Concept design: EM, NE-N, TN, JR and LMZ; acquisition and reviewing data: EM, NE-N, TN, CB, SM, JR, MHS, MAF and RW; analysis or interpretation of data: EM, TN, SM, MHS, CB, MC, RW and LMZ; drafting of the manuscript: EM, NE-N, TN and MAF; critical revision of the manuscript: all authors; obtained funding: SM, MAF, LMZ and RW; supervision: RW, JBJ and LMZ. Guarantor: LMZ

  • Funding National Institutes of Health/National Eye Institute Grants R01EY011008, R01EY19869, R01EY014267, R01EY027510, R01EY026574, K99EY030942, R01EY02905 and P30EY022589; an unrestricted grant from Research to Prevent Blindness (New York, New York); a Research Fellowship Grant German Research Foundation (RE 4155/1-1) and participant retention incentive grants in the form of glaucoma medication at no cost from Novartis/Alcon Laboratories Inc, Allergan, Akorn and Pfizer Inc.

  • Disclaimer The sponsor or funding organisations had no role in the design or conduct of this research.

  • Competing interests Financial disclosures: EM: none; NE-N: none; TN: none; SM: none; JR: none; MAF: National Eye Institute (F), Heidelberg Engineering (F), Topcon (F); MHS: none; CB: none; AB: none; MC: none; JBJ: European patent EP 3 271 392, JP 2021-119187 and US 2021 0340237 A1: agents for use in the therapeutic or prophylactic treatment of myopia or hyperopia; RW: Abbvie (C), Alcon (C), Amydis (C), Eyenovia (C), Topcon (C), Nicox (C), Topcon (C), Heidelberg Engineering (F), Implandata (C), IOPtic (C), Carl Zeiss Meditec (F), Konan Medical (F), OptoVue (F), Topcon (F), Centervue (F), National Eye Institute (F), National Institute of Minority Health (F); LMZ: National Eye Institute (F), Carl Zeiss Meditec Inc. (F), Heidelberg Engineering GmbH (F), OptoVue Inc. (F, R), Topcon Medical Systems Inc (F, R) and Abbvie (C).

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

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