RT Journal Article
SR Electronic
T1 Glaucoma in myopia: diagnostic dilemmas
JF British Journal of Ophthalmology
JO Br J Ophthalmol
FD BMJ Publishing Group Ltd.
SP 1347
OP 1355
DO 10.1136/bjophthalmol-2018-313530
VO 103
IS 10
A1 Nicholas Y Q Tan
A1 Chelvin C A Sng
A1 Jost B Jonas
A1 Tien Yin Wong
A1 Nomdo M Jansonius
A1 Marcus Ang
YR 2019
UL http://bjo.bmj.com/content/103/10/1347.abstract
AB 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.