A multimodal approach with papillary optical coherence tomography angiography (OCT-A) and circumpapillary microperimetry (cpMP) could provide a new method for both diagnosing and determining prognosis of glaucomatous damage in high myopia — despite the fact that a papillary vascular study seemed superior, according to a study published in Clinical Ophthalmology

The cross-sectional study was designed to compare optic disc structure and peripapillary retinal function in 60 eyes of 30 patients with high myopia — 15 with glaucoma (GG) and 15 without glaucoma (NGG). , The team reviewed the potential  role papillary OCT-A imaging and cpMP testing might have in the diagnosis and prognosis of these patients.

Researchers collected demographic and clinical data based on patient records. They assessed papillary structures — peripapillary retinal nerve fiber layer thickness (ppRNFLT) and small vessel densities (SVD) — using OCT and cpMP.


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They found that the GG patients were older, had lower best-corrected visual acuities, and higher intraocular pressures and axial lengths (P <.001). They also had lower values in all ppRNFLTs (P <.05), lower values in all SVDs (P <.001) — with the exception of the SVD-inside disc (P =.638) and lower retinal sensitivities within all cpMPs (P <.001). In addition, adjusted analysis in the best 2 parameters per exam found the anatomical model (including the ppRNFLT- inferior and ppRNFLT-temporal) and the vascular model (including SVD-inferior and SVD- superior) had the best discrimination power between groups, with cross-validated AUROCs of 0.9599 and 0.9921, respectively.

“The glaucomatous damage is prevalent in [patients with high myopia], but is difficult to distinguish from the myopic-associated optic disc dysgenesis and the standard structural and functional analysis…commonly fail in this differentiation,” according to investigators. “Despite the apparent superiority of the papillary vascular study, a multimodal approach including the papillary anatomic and circumpapillary microperimetric assessments can be the new way on the diagnosis and prognosis of glaucoma in [high myopia].”

The study’s limitations include the age disparity between groups, because most high patients with myopia develop glaucoma at a later age, making it tough to locate age-matched non-glaucomatous high myopia controls. But it appears that the findings in the study are largely attributable to myopia severity — not age. Another limitation is the study’s small sample size. “However, given the nature of the disease and the exploratory aim of this study, our sample is considered adequate for the purpose.”

Reference

Baptista PM, Vieira R, Ferreira A, et al. The role of multimodal approach in the assessment of glaucomatous damage in high myopes. Clin Ophthalmol. 2021;15(2):1061–1071. doi:10.2147/OPTH.S301781