Patients with both myopia and glaucoma are at a greater risk for progressively declining vision loss than patients with only glaucoma, particularly in regions surrounding the central visual field. Photo: Mark Dunbar, OD. Click image to enlarge.
The greater attention given to myopia in recent years has helped to reinforce for clinicians the condition’s confounding effects on glaucoma, and researchers continue to work on clarifying the relationships between the two. A recent study whose findings will be presented this morning at ARVO 2023 in New Orleans found that patients with myopia and glaucoma experience greater visual field (VF) loss in the paracentral region. The ARVO abstract also noted that patients with both myopia and glaucoma are at a greater risk for progressively declining vision loss than patients with only glaucoma. The study team comprised researchers and clinician scientists from Harvard, Mass. Eye & Eye, Brown University and New York’s Mr. Sinai.
Reliable SITA Standard 24-2 VFs were selected from a large academic institution. Cross-sectional linear regression analysis was performed to quantify the impact of myopia measured by spherical equivalent (SE) on regional visual field loss. Logistic regression analysis was conducted by correlating SE with four different field progression outcomes:
(1) mean deviation (MD) progression: slope <zero
(2) VF index progression: slope <zero
(3) total deviation pointwise progression: at least three total deviation locations with total deviation slope ≤-1.0dB/year
(4) MD fast progression: slope ≤-1.0dB/year
The sample consisted of 55,321 eyes from 55,321 patients (mean MD: -5.2dB; mean SE: 0.4D; mean age: 57.2; female sex: 57.7%). Participants were either of Caucasian (69.7%), Asian (6.2%), African American (10.7%) or other/unknown (13.4%) origin. The researchers also analyzed 8,037 patients with at least five reliable 24-2 fields over four years for longitudinal analysis.
Cross-sectional analysis revealed that more negative SE values were associated with more negative total deviation values in the paracentral VF region. These results remained after MD adjustment. Longitudinal analysis revealed that with MD adjustment, three of the four measures of VF progression had a higher likelihood of deterioration with more negative SE: MD progression (odds ratio [OR] = 0.97), VF index progression (OR = 0.97) and total deviation pointwise progression (OR = 0.97). Similar results were seen without MD adjustment.
“More severe baseline myopia in the context of glaucoma is associated with a higher likelihood of VF progression,” the researchers concluded in their abstract. “Patients with myopia and glaucoma experience greater visual loss in the region of the field of vision that borders their central vision.”
Original abstract content © Association for Research in Vision and Ophthalmology 2023.
Lokhande A, Luo Y, Shi M, et al. The impact of myopia on regional visual field loss and progression in glaucoma. ARVO 2023 annual meeting.