The relationship of retinal nerve fiber layer thickness and visual field parameter in eight sectors of primary open-angle glaucoma with high myopia based on spectral-domain OCT

doi:10.21203/rs.3.rs-4931901/v1

To assess the structure-function relationship of retinal nerve fiber layer (RNFL) thickness in eight sectors based on spectral-domain optical coherence tomography (OCT) with visual field deviation in primary open-angle glaucoma(POAG) patients with high myopia. 225 eyes of 128 patients all diagnosed with POAG were enrolled and stratified by axial length(AL) into moderate ( 25mm ≤ AL < 25.99mm, n = 70 eyes), high (26mm ≤ AL < 26.99mm, n = 76 eyes) and super-high (27mm ≤ AL < 30mm, n = 79 eyes) myopia POAG groups. Data of RNFL thickness and visual field parameters was separated in eight sectors: superotemporal(ST), superonasal(SN), nasal-up(NU), nasal-low(NL), inferonasal(IN), inferotemporal(IT), temporal-low(TL), temporal-up(TU). The Pearson correlation coefficient analysis showed strong structure-function correlation in ST/IT (R = 0.654 to 0.741, p < 0.001) sectors despite AL elongation from 25mm to 30mm in myopia POAG. Also we found decreasing correlation in TL/TU/IN/SN (R = 0.264 to 0.595, p < 0.01) sectors with AL elongation in myopia POAG, with the changed node occurred in 27mm for IN/SN and in 26mm for TL/TU. Specially in NU/NL, the weak correlation(R = 0.233 to 0.381, p < 0.05) became no correlation(p > 0.05) when AL elongated from 25mm to 27mm and above. These descriptions may be helpful to observe and monitor the progression in POAG with high myopia.

Health sciences/Diseases/Eye diseases

Health sciences/Diseases/Eye diseases/Optic nerve diseases

high myopia

axial length

primary angle-open glaucoma

retinal nerve fiber layer

optical coherence tomography

visual field

Myopia is a growing public health problem that is expected to affect 5 billion people globally (~ 50% of the world's population), while high myopia is expected to affect 9.8% of the global population by 2050 ¹. The effects of high myopia are broad and significant both structurally and functionally, but the definition used to grade myopia varies from study to study whether depends on axial length or diopter.

Primary open angle glaucoma (POAG) is a chronic, progressive, irreversible, multifactorial optic neuropathy characterized by an open anterior chamber angle, optic nerve head changes, and progressive visual field defects². Risk factor, such as patients with high myopia has been reported to be six times more likely to develop glaucoma ³. Like myopia, POAG is a disease with a rising prevalence, affecting approximately 111.8 million people worldwide by 2040⁴.

The increased prevalence of these two diseases, coupled with the association between POAG and myopia, suggests the need to improve the understanding of both diseases, especially in the diagnosis of early stage in POAG with high myopia. Diagnosis of POAG is based on the structural changes of optic nerve head (ONH) and retinal nerve fiber layer (RNFL), and corresponding visual field defects. Most high myopia is accompanied by axial elongation, which can cause pathological changes located at the posterior pole, such as myopic maculopathy, Bruch’s membrane defects and posterior staphyloma⁵. The clinical challenge to diagnose glaucoma in (highly) myopic eyes is that the appearance of the ONH can mimic changes that are pathognomonic for glaucoma. Those changes include optic disc ovality/tilt, rotation and peripapillary atrophy^6,7. These characteristics may lead to poor relationship between RNFL thickness and visual field (VF) deviation in POAG with high myopia. Firstly, the high myopia regularly has temporal atrophy arc, whose image shown on optical coherence tomography (OCT) as temporal RNFL injury, similarly to the change of early POAG, may interfere the judgement of early POAG in high myopia whether or not. Secondly, the progression of POAG is often based on the RNFL thickness deviation, but for POAG in high myopia, whether the progression is caused by the high myopia or not, may also interfere the judgement of progression of POAG. Thirdly, in clinic, we often face myopic glaucoma patients with visual field defects, even though they have small cup-disc ratio and low retinal nerve fiber layer defect. Many researchers have tried to find significant ocular parameters associated with VF defects in glaucoma patients with myopia, but few focus on the relationship of detailed sectoral RNFL thickness of neuro-retinal rim and VF defect.

Structural damage in glaucoma, as RNFL and GCC, is frequently quantified by measurements of the area of the neuro-retinal rim from magnification-corrected measurements of OCT. Functional damage in glaucoma, as VF, tested by standard automated perimetry, is a ubiquitous test of the visual function in glaucoma patients. The neuro-retinal rim is usually separated into six or eight parts as shown in the OCT RNFL test more particularly. The precise relationship between visual field locations and corresponding regions of the ONH in POAG is established anatomically by Garway-Health⁸,using a Humphrey standard automated perimetry,24 − 2 test pattern and its RNFL image both aligned to the fovea. This result is highly acknowledged by following studies⁹.

In glaucomatous patients, the thinning of RNFL thickness usually begins in the inferior and superior sectors followed by the nasal and temporal sectors. However, in high myopia patients the RNFL is thinner in non-temporal sectors, but thicker in the temporal sector, this may be led by the retina being dragged toward the temporal horizon and myopic optic tilt during the process of myopic elongation. The different characteristics may help clinicians identify whether the change of RNFL is glaucomatous or myopic¹⁰.

For this concern, we designed this study to indicate relationship of sectoral RNFL thickness with VF parameter in POAG with myopia, which may help its clinical judgement of diagnosis and treatment.

Study participants

225 eyes of 128 patients all diagnosed with POAG were enrolled. The study received approval from the Ethical Review Committee of EENT Hospital and adhered to the Declaration of Helsinki. Signed informed consent was obtained from all the participants before conducting any examination or operation. Patients were separated into three groups according to axial length(AL), including moderate ( 25mm ≤ AL < 25.99mm, n = 70 eyes), high (26mm ≤ AL < 26.99mm, n = 76 eyes) and super-high (27mm ≤ AL < 30mm, n = 79 eyes) myopia POAG groups. Diagnostic criteria of POAG include: elevated intraocular pressure, an open anterior chamber angle, optic nerve head changes, and corresponding progressive visual field defects. In this study, myopia is defined by axial length rather than refractive error since the ocular axis causes structural changes in the eye that are more related to optic nerve parameters. Inclusion criteria were best correct visual acuity ≥ 0.4(20/50, Snellen) and no history of macular disease, neurological disease, refractive or retinal surgery, no large choroidal atrophy foci excluding the temporal atrophy arc at the time of recruitment. All study participants were diagnosed POAG by a glaucoma specialist from EENT Hospital of Fudan University. The data was gained between 2019 to 2024. All participants had complete ophthalmological examination by a glaucoma specialist, including history, visual acuity testing, refraction, non-contact intraocular pressure(IOP) measurement, slit lamp biomicroscopy, gonioscopy, ultrasonic pachymetry, axial length(AL) and central corneal thickness(CCT) (Lenstar LS 900 biometer, Haag-Streit, Inc. Koeniz, Switzerland), stereo disc photography (cannon NM; Carl Zeiss Meditec, Inc. Germany), VF testing (OCTOPUS 900, Haag-Streit, Inc. Koeniz, Switzerland), and ONH scans obtained from the Spectral-domain OCT (RTVue OCT, Optovue Inc., Fremont, California, USA).

VF examination

Standard 30-degree white-on-white automated perimetry (OCTOPUS 900, Haag-Streit, Inc. Koeniz, Switzerland) was performed in G1 program and Dynamic strategy. Quantitative VF data were collected: quality data (false positive and negative response, and time duration, reliability factor (RF)) and results of mean deviation (MD) and square root of loss variance (sLV). Included VF tests had catch trials false-positive errors ≤ 15% and false-negative errors ≤ 15% and RF ≤ 10. VF total sensitivity values were recorded for 58 points in 30 degree, among which 48 points were selected and grouped into eight sections. Through physical structure comparison analysis with plots of Humphrey Field Analyzer (HFA) 24–2, 48 points in the OCTOPUS perimeter were finally included in this study, and they were divided into eight parts: superotemporal square, superonasal square, nasal-up square, nasal-low square, inferonasal square, inferotemporal square, temporal-low square, and temporal-up square, and their average sensitivity thresholds were calculated.

RNFL acquisition

Patients underwent spectral-domain OCT (RTVue OCT, Optovue Inc., Fremont, California, USA). RNFL thickness were analyzed as global and sectoral means, which included the superotemporal(ST, 326°-360°), superonasal(SN, 1°−45°), nasal-up(NU, 46°-90°), nasal-low(NL,91°-135°), inferonasal(IN,136°-180°), inferotemporal(IT, 181°-225°), temporal-low(TL, 226°-270°), temporal-up(TU, 271°-325°), all eight sectors, according to the ONH axis. Average GCC thickness and average RNFL thickness data was also collected.

Mapping RNFL to VF

The precise relationship between visual field locations and corresponding regions of the ONH in POAG is established anatomically by Garway-Health⁸,using a Humphrey 24 − 2 test pattern and its RNFL image both aligned to the fovea. Octopus G1 program and Dynamic strategy are existing and widely used instruments which together offer a favorable compromise. Study located plots of Humphrey Field Analyzer (HFA) 24–2 and plots of the 30-degree Octopus G1 program in the same grid¹¹. In our study, we mapped the plots of 30-degree Octopus G1 program to RNFL of Optovue OCT as Fig. 1. Eight sectors of function-structure relationship were analyzed.

Statistical analysis

The statistical analysis was performed using SPSS version 23.0 (SPSS, Chicago, IL, USA). Normal distribution of the data was investigated with the Shapiro-Wilk test. Since all variables showed a normal distribution, mean ± SD was used for descriptive statistics. The statistical significance of comparisons between patient-level characteristics across myopia groups was determined by analysis of variance (ANOVA) for continuous variables and chi-squared tests for categorical variables. The two-tail t-test was used to test the pearson correlation of function-structure relationship in eight sectors of RNFL and VF. A p value less than 0.05 was considered statistically significant.

1. Characteristics of the moderate, high and super-high myopia POAG groups

225 eyes of 128 patients were included in the study. The demographic data of study population are reported in Table 1.

Table 1

Demographic Characteristics of the Glaucoma with myopia Participants. Results are presented as mean (mean ± SD) or percentage. Categorical variables were compared using a chi-squared test. Continuous variables were compared using ANOVA.
	25mm ≤ AL < 25.99mm	26mm ≤ AL < 26.99mm	27mm ≤ AL < 30mm	p value
Number of eyes	70	76	79
Number of right eyes/left eyes	35/35	36/40	43/36	0.673
Age (years)	45.96 ± 12.96	42.86 ± 13.46	41.42 ± 10.14	0.074
Gender (female/male)	32/38	40/36	18/61	0.000
Best corrected visual acuity	0.74 ± 0.21	0.77 ± 0.23	0.73 ± 0.21	0.497
Center corneal thickness	549.33 ± 30.66	542.34 ± 30.63	541.79 ± 31.80	0.267
Intraocular pressure	15.71 ± 3.06	15.25 ± 3.05	15.39 ± 2.95	0.655
Visual field*
Mean sensitivity (dB)	22.66 ± 4.24	22.64 ± 5.25	20.22 ± 6.18	0.006
Number rate of Mean deviation (dB) ≤ 6	0.57(40/70)	0.62(47/76)	0.49(39/79)	0.044
Number rate of 6 < Mean deviation (dB) ≤ 12	0.33(23/70)	0.24(18/76)	0.22(17/79)	0.044
Number rate of 12 ≤ Mean deviation (dB)	0.10(7/70)	0.14(11/76)	0.29(23/79)	0.044

70 eyes ( 25mm ≤ AL < 25.99mm) were included in moderate myopia POAG group, and 76 eyes (26mm ≤ AL < 26.99mm) were included in high myopia POAG group, and 79 eyes (27mm ≤ AL < 30mm) were included in super-high myopia POAG group. Three groups showed no significant difference in eye laterality, age, IOP, BCVA,CCT (p > 0.05). Since mean deviation(MD) is the main index to evaluate the severity of POAG, the weighting of different MDs within the group was also included in the analysis, which showed no significant difference between low-moderate myopia POAG and high myopia POAG group, but in super-high myopia POAG group more severe POAG were included.

2. Correlation Between SD-OCT Structural Parameters and Visual Field function data of the moderate, high and super-high myopia POAG groups

Eight sectors of function-structure relationship were analyzed as superotemporal(ST), superonasal(SN), nasal-up(NU), nasal-low(NL), inferonasal(IN), inferotemporal(IT), temporal-low(TL), temporal-up(TU) sectors in Table 2. The Pearson correlation coefficient for sectoral RNFL thickness and corresponding VF sensitivities showed high-moderate correlation in ST/SN//IN/IT/TL/TU(R = 0.455 to 0.699 p < 0.001), weak correlation in NU/NL(R = 0.321 to 0.381, p < 0.01) in moderate myopia POAG group. And it showed high-moderate correlation in ST/SN/IN/IT(R = 0.408 to 0.741, p < 0.001), weak correlation in NU/NL/TL/TU(R = 0.233 to 0.389, p < 0.01) in high myopia POAG. And it showed moderate correlation in ST/IT(R = 0.654 to 0.674, p < 0.001), weak correlation in SN/IN/TL/TU(R = 0.264 to 0.359, p < 0.01), no correlation in NU/NL(p > 0.05) in super-high myopia POAG group. The correlation coefficients for global RNFL and GCC thicknesses and corresponding VF sensitivities showed moderate correlation in all three myopia POAG groups( R = 0.511 to 0.716, p < 0.001). The regression analysis showed good goodness of fit in ST/IT in three groups, but with the AL elongation, goodness of fit got worse in TL/TU/SN/IN, especially in NU/NL.

Table 2

Correlation Between Spectral-domain Optical Coherence Tomography Structural Parameters and Octopus Visual Field Mean Total Deviation for moderate, high, super-high myopia in primary open-angle glaucoma
	25mm ≤ AL < 25.99mm		26mm ≤ AL < 26.99mm		27mm ≤ AL < 30mm
Region	R value^a	P value	R value^a	P value	R value^a	P value
superotemporal(ST)	0.693**	0.000	0.718**	0.000	0.654**	0.000
superonasal(SN)	0.455**	0.000	0.408**	0.000	0.358**	0.001
nasal-up(NU)	0.321**	0.007	0389**	0.001	-0.018	0.877
nasal-low(NL)	0.381**	0.001	0.233*	0.043	-0.019	0.341
inferonasal(IN)	0.570**	0.000	0.595**	0.000	0.357**	0.001
inferotemporal(IT)	0.699**	0.000	0.741**	0.000	0.679**	0.000
temporal-low(TL)	0.438**	0.000	0.271*	0.018	0.264*	0.019
temporal-up(TU)	0.512**	0.007	0.356**	0.002	0.359**	0.001
average RNFL thickness	0.680**	0.000	0.716**	0.000	0.593**	0.000
average GCC thickness	0.511**	0.000	0.596**	0.000	0.649**	0.000
^a Pearson correlation coefficients. *There was a significant correlation at the level of p < 0.01. There was a significant correlation at the level of p < 0.05.
RNFL = retinal nerve fiber layer; GCC = ganglion cell complex

Comparison Between sectoral RNFL Thickness Correlation Coefficients in moderate, high and super-high myopia POAG

RNFL thickness had weak correlation coefficients in NU/NL sectors in moderate myopia POAG and high myopia POAG, while RNFL thickness had no correlation coefficients in NU/NL sectors in super-high myopia POAG.

For three myopia POAG groups, RNFL thickness had high-moderate correlation coefficients in ST/IT sectors despite AL elongation from 25mm to 30mm in myopia POAG. Also we found decreasing correlation in TL/TU/IN/SN sectors with AL elongation in myopia POAG, with the changed node occurred in 27mm for IN/SN and in 26mm for TL/TU.

3. Regression Between SD-OCT Structural Parameters and Visual Field Data i of the moderate, high and super-high myopia POAG groups

Figure 2 and Fig. 3 and Fig. 4 are scatterplots of visual field sensitivity (in dB scale) and RNFL thickness in moderate myopia and high myopia POAG and super-high myopia POAG, respectively. The graphs suggest a linear relationship between the structural and functional measurements with linear fit. Linear regression models showed that all structure-function relationships were statistically significant, except for NU/NL sectors in super-high myopia POAG (Table 3). The more R2 got close to 1, the better goodness of fit is, which mean the RNFL thickness can explain and predict the VF more reliably.

Table 3

Regression Equations Between Spectral-Domain Optical Coherence Tomography Structural Parameters and Visual Field Sensitivity in moderate, high, super-high myopia in primary open-angle glaucoma
	25mm ≤ AL < 25.99mm			26mm ≤ AL < 26.99mm			27mm ≤ AL < 30mm
Region	R²	regression	P value	R²	regression	P value	R²	regression	P value
superotemporal(ST)	0.4803	y = 0.1866*x + 2.794	P < 0.0001	0.5148	y = 0.1732*x + 4.181	P < 0.0001	0.4272	y = 0.1732*x + 4.181	P < 0.0001
superonasal(SN)	0.2072	y = 0.1099*x + 13.87	p < 0.0001	0.1661	y = 0.1315*x + 11.45	P < 0.0001	0.1278	y = 0.1349*x + 8.943	P < 0.0001
nasal-up(NU)	0.1032	y = 0.09411*x + 17.95	P = 0.0067	0.1515	y = 0.1347*x + 14.92	P < 0.0001	0.0003	y = 0.007*x + 23.11	P = 0.8769
nasal-low(NL)	0.1454	y = 0.1485*x + 15.06	P = 0.0001	0.0544	y = 0.0812*x + 19.33	P < 0.0001	0.0117	y =-0.0051*x + 25.01	P = 0.3411
inferonasal(IN)	0.3252	y = 0.229*x + 0.4749	P < 0.0001	0.3542	y = 0.2418*x -0.524	P < 0.0001	0.1273	y = 0.1954*x + 2.486	P = 0.0012
inferotemporal(IT)	0.4881	y = 0.1617*x + 4.59	P < 0.0001	0.5495	y = 0.1783*x + 3.042	P < 0.0001	0.4613	y = 0.2009*x + 0.2844	P < 0.0001
temporal-low(TL)	0.1916	y = 0.1321*x + 18.83	P = 0.0002	0.07325	y = 0.09609*x + 21.03	P = 0.0178	0.06983	y = 0.08847*x + 20.13	P < 0.0001
temporal-up(TU)	0.2618	y = 0.1272*x + 18.46	p < 0.0001	0.1269	y = 0.08341*x + 21.05	P = 0.0016	0.1286	y = 0.1192*x + 16.93	P < 0.0001
average RNFL thickness	0.4623	y = 0.2230*x + 4.977	P < 0.0001	0.5123	y = 0.2624* x + 1.735	P < 0.0001	0.3519	y = 0.2747*x -0.2064	P < 0.0001
average GCC thickness	0.2615	y = 0.1916*x + 7.099	P < 0.0001	0.3547	y = 0.2362*x + 4.032	P < 0.0001	0.4211	y = 0.3659*x -6.691	P < 0.0001

To our knowledge, this study provided the first account investigating the eight sectoral correlation of RNFL thickness and VF sensitivity based on spectral-domain OCT for detection and monitoring of glaucoma in high myopia. Among the eight sectors examined, superotemporal(ST) and inferotemporal(IT) RNFL thickness exhibited the highest sensitivity and specificity combination to detect and monitor glaucoma in high myopia despite axial elongation. Surprisingly, nasal-up(NU) and nasal-low(NL) RNFL thickness assessment could fail to reveal abnormality even in eyes with confirmed VF defects in super-high myopia POAG(27mm ≤ AL < 30mm). Superonasal (SN) and inferonasal (IN) RNFL thickness is secondary reliable sectoral index to monitor glaucoma progression in high myopia POAG but its performance reduced when axial length came to 27mm and above. Temporal-low (TL) temporal-up (TU) is terdiary reliable sectoral index to monitor glaucoma progression with a decreasing performance when axial length came to 26mm and above, which may infected by its choroidal atrophy foci. Integrating average RNFL thickness assessment and average GCC thickness assessment increased the sensitivity of detecting and monitoring POAG performance. Our finding underscores the importance of RNFL imaging and measurement in the diagnostic evaluation of glaucoma.

The reduction of peripapillary RNFL (pRNFL) thickness in glaucoma and its value for detecting and monitoring glaucoma progression is widely known ^12–14. For POAG, only structure reduction develop to certain degree, can function defect appear. And in the progression of POAG, structure defect usually begins in partial optic nerve head. For each sector, the classic pattern of RNFL thinning in patients with POAG appears to be preferential superior and inferior pRNFL loss, with the temporal sector affected last^15,16. With the typical structure-function corresponding defect based on IOP and gonioscopy of chamber angle examination, POAG is not hard to diagnose.

High myopia, usually accompanied with multiple ONH anatomical changes, may show different sectoral RNFL thickness defect in OCT image. Especially with the axial elongation, this variation has become more diverse and unpredictable. Several research has found in high myopia patients the RNFL is thinner in non-temporal sectors, but thicker in the temporal sector, but in clinic, individual difference is observed. This characteristic may interfere the judgement of POAG in high myopia.

Nowadays, with the update of the inspection technology equipment, the RNFL can be divided into more detail parts, which allow early and precise analysis of structure defect. RNFL analyzed by Optovue OCT is divided into eight sectors as superotemporal(ST, 326°-360°), superonasal(SN, 1°−45°), nasal-up(NU, 46°-90°), nasal-low(NL,91°-135°), inferonasal(IN,136°-180°), inferotemporal(IT, 181°-225°), temporal-low(TL, 226°-270°), temporal-up(TU, 271°-325°) sectors, according to the ONH axis. The Octopus perimeter, with a precise static technique for middle and peripheral areas, highly automated, can statistical evaluate defects changes. Time and energy can be gained by the use of the Octopus, since it supplies data obtained from use of the Baylor program. Some clinicals prefer to follow up campimetric evolution of glaucomatous patients with the Octopus because it offers more sensibility and precision in quantifying losses¹⁷. Based on these superiority, we gained the RNFL and GCC thickness data and VF parameter from mentioned machines, and tried to analyze the correlation between those sectoral structure-function parts.

Our data showed different correlation between sectoral RNFL thickness and VF parameter in two out of eight sectors(NU/NL) in three groups. RNFL thickness had weak correlation coefficients in NU/ NL sectors in moderate myopia POAG and high myopia POAG, while RNFL thickness had no correlation coefficients in NU/NL sectors in super-high myopia POAG. It had to be noted that in all three myopia groups, we did not include any patient with choroidal atrophy foci excluding the temporal atrophy arc at the time of recruitment. In myopic eyes, axial elongation of the globe is accompanied by anatomical changes of the optic disc and the peripapillary tissue which can observed in fundus photography. In previous studies, the peripapillary RNFL has been reported to be thicker in the temporal quadrant and thinner in the inferior quadrant in myopic eyes due to a temporal shift of the lower and upper peaks in the RNFL spatial distribution^18–20. For each sector, the classic pattern of peripapillary RNFL thinning in patients with POAG appears to be preferential superior and inferior RNFL loss, with the temporal sector affected last ²¹. In myopia POAG, we found sectoral RNFL thickness in NU/NL got no correlation with VF sensitivity in super-high myopia POAG, this results possibly caused by the RNFL spatial distribution with the optic disc tilt and torsion.

Our data showed consistently moderate correlation between sectoral RNFL thickness and VF parameter in two out of eight sectors(ST/IT) in three groups despite the axial elongation. This result is similar with the study of Baniasadi et al, which showed progressive RNFL thinning is greater in the inferior-temporal and superior-temporal sectors in glaucomatous optic neuropathy eyes compared to normal eyes¹⁵. This result indicated us ST/IT RNFL thickness remain top reliable sectoral index to monitor glaucoma progression. In ST/IT sectors, with axial elongating, sectoral RNFL thickness and VF sensitivity remain consistently moderate correlation and the regression equation showed good goodness of fit between sectoral RNFL thickness and VF sensitivity.

Our data showed moderate correlation between sectoral RNFL thickness and VF sensitivity in two out of eight sector(SN/IN) in moderate and high myopia POAG groups but weak correlation in super-high myopia POAG when the axial elongated to 27mm and above. This result indicated us SN/IN RNFL thickness is secondary reliable sectoral index to monitor glaucoma progression. This result might also cause by optic disc tilt and torsion leading to RNFL spatial distribution¹⁹.

Our data showed moderate correlation between sectoral RNFL thickness and VF parameter in two out of eight sectors(TL/TU) in moderate POAG groups but weak correlation in high myopia and super-high myopia POAG when the axial elongated to 26mm and above. In the temporal sector, temporal atrophy arc is a typical anatomical structure observed in high myopia(AL greater than or equal to 26mm), and with the axial elongated, greater and deeper the temporal atrophy arc became. So in TL/TU sectors, two parts explained the correlation difference, including temporal atrophy arc and optic disc tilt and torsion¹⁹. This result indicated us TL/TU RNFL thickness is terdiary reliable sectoral index to monitor glaucoma progression.

In our study, we also found the correlation coefficients for global RNFL and GCC thicknesses and corresponding VF sensitivity showed moderate correlation in moderate, high and super-high myopia POAG( R = 0.506 to 0.698, p < 0.001). The reduction of RNFL thickness in glaucoma and its value for detecting and monitoring glaucoma progression is widely known²². GCC has been increasingly demonstrated as valuable in detecting and monitoring glaucoma in a manner comparable to RNFL thickness with excellent long-term stability and reproductivity²³. Our findings keep consistent with existing findings in first place, also they proved the reliability of our data in this research in certain degree(Fig. 5).

In glaucoma, the thinning of RNFL usually begins in the inferior and superior sectors followed by the nasal and temporal sectors(four-quadrants way)¹⁵. However, in high myopia patients the RNFL is thinner in non-temporal sectors, but thicker in the temporal sector, which may be led by the retina being dragged toward the temporal horizon and myopic optic tilt during the process of axial elongation^19,21. Combined with previous studies, the thinning of ST/IT RNFL thickness in high myopia maybe more indicative of the risk of glaucoma, while TU/TL RNFL thickness thinning maybe more caused by myopic reason. But more basic research needs to be carried out.

Our study has limitations. We found sectoral RNFL thickness and VF sensitivity correlation differ in high myopia POAG, but more work on anatomy of the papilla need to be done to explain the possible reason. Second, the cross-sectional design does not allow us to elucidate changes in the structure-function relationship over time, which would enhance our understanding of glaucoma progression. Third, in later period of POAG, all RNFL had already defect to severe degree which had a poor indication of VF defect, our study may not helpful for later period of POAG with high myopia or not. Last, the data used in our study were obtained from specific software version of two machine, data from other kind of machine may also need for subsequent studies to avoid bais result.

Competing interests

The authors declare no competing interests.

Funding

Shanghai Sailing Program(21YF1405400)

Author Contribution

J.L.R. conceptualized the study, was involved in the development of the methodology and drafted the original manuscript, S.H.Q. was involved in the development of the methodology and revision of the manuscript, C.Q. was involved in the conceptualization of the study and editing of the manuscript. All authors reviewed the manuscript.

Data Availability

The data that support the findings of this study are available from the corresponding author upon reasonable request.

Holden, B. A. et al. Global Prevalence of Myopia and High Myopia and Temporal Trends from 2000 through 2050. Ophthalmology123, 1036-1042 (2016). https://doi.org/10.1016/j.ophtha.2016.01.006
García, G. et al. Circumpapillary OCT-focused hybrid learning for glaucoma grading using tailored prototypical neural networks. Artif. Intell. Med.118, 102132 (2021). https://doi.org/10.1016/j.artmed.2021.102132
Pan, C. W. et al. Differential associations of myopia with major age-related eye diseases: the Singapore Indian Eye Study. Ophthalmology120, 284-291 (2013). https://doi.org/10.1016/j.ophtha.2012.07.065
Tham, Y. C. et al. Global prevalence of glaucoma and projections of glaucoma burden through 2040: a systematic review and meta-analysis. Ophthalmology121, 2081-2090 (2014). https://doi.org/10.1016/j.ophtha.2014.05.013
Curtin, B. J. & Karlin, D. B. Axial length measurements and fundus changes of the myopic eye. I. The posterior fundus. Trans. Am. Ophthalmol. Soc.68, 312-334 (1970).
Hwang, Y. H., Yoo, C. & Kim, Y. Y. Characteristics of peripapillary retinal nerve fiber layer thickness in eyes with myopic optic disc tilt and rotation. J. Glaucoma21, 394-400 (2012). https://doi.org/10.1097/IJG.0b013e3182182567
Sung, M. S., Kang, Y. S., Heo, H. & Park, S. W. Characteristics of Optic Disc Rotation in Myopic Eyes. Ophthalmology123, 400-407 (2016). https://doi.org/10.1016/j.ophtha.2015.10.018
Garway-Heath, D. F., Poinoosawmy, D., Fitzke, F. W. & Hitchings, R. A. Mapping the visual field to the optic disc in normal tension glaucoma eyes. Ophthalmology107, 1809-1815 (2000). https://doi.org/10.1016/s0161-6420(00)00284-0
El Beltagi, T. A. et al. Retinal nerve fiber layer thickness measured with optical coherence tomography is related to visual function in glaucomatous eyes. Ophthalmology110, 2185-2191 (2003). https://doi.org/10.1016/S0161-6420(03)00860-1
Zhang, X. et al. Optic neuropathy in high myopia: Glaucoma or high myopia or both? Prog. Retin. Eye Res.99, 101246 (2024). https://doi.org/10.1016/j.preteyeres.2024.101246
Roberti, G. et al. Detection of central visual field defects in early glaucomatous eyes: Comparison of Humphrey and Octopus perimetry. PLoS One12, e0186793 (2017). https://doi.org/10.1371/journal.pone.0186793
Iverson, S. M., Feuer, W. J., Shi, W. & Greenfield, D. S. Frequency of abnormal retinal nerve fibre layer and ganglion cell layer SDOCT scans in healthy eyes and glaucoma suspects in a prospective longitudinal study. Br. J. Ophthalmol.98, 920-925 (2014). https://doi.org/10.1136/bjophthalmol-2013-303877
Mok, K. H., Lee, V. W. & So, K. F. Retinal nerve fiber loss pattern in high-tension glaucoma by optical coherence tomography. J. Glaucoma12, 255-259 (2003). https://doi.org/10.1097/00061198-200306000-00013
Yu, M. et al. Risk of Visual Field Progression in Glaucoma Patients with Progressive Retinal Nerve Fiber Layer Thinning: A 5-Year Prospective Study. Ophthalmology123, 1201-1210 (2016). https://doi.org/10.1016/j.ophtha.2016.02.017
Baniasadi, N. et al. Patterns of Retinal Nerve Fiber Layer Loss in Different Subtypes of Open Angle Glaucoma Using Spectral Domain Optical Coherence Tomography. J. Glaucoma25, 865-872 (2016). https://doi.org/10.1097/ijg.0000000000000534
Li, S., Wang, X., Li, S., Wu, G. & Wang, N. Evaluation of optic nerve head and retinal nerve fiber layer in early and advance glaucoma using frequency-domain optical coherence tomography. Graefes Arch. Clin. Exp. Ophthalmol.248, 429-434 (2010). https://doi.org/10.1007/s00417-009-1241-0
Pradines, F., Delbosc, B. & Royer, J. [Automated and semiautomated perimetry. Comparative trial of 3 devices (Baylor programmer, Friedmann Mark II campimeter, Octopus 2000 R.)]. J. Fr. Ophtalmol.8, 173-185 (1985).
Song, Y. et al. High Myopia Normative Database of Peripapillary Retinal Nerve Fiber Layer Thickness to Detect Myopic Glaucoma in a Chinese Population. Ophthalmology130, 1279-1289 (2023). https://doi.org/10.1016/j.ophtha.2023.07.022
Lin, F. et al. Classification of Visual Field Abnormalities in Highly Myopic Eyes without Pathologic Change. Ophthalmology129, 803-812 (2022). https://doi.org/10.1016/j.ophtha.2022.03.001
Burgoyne, C. F. & Morrison, J. C. The anatomy and pathophysiology of the optic nerve head in glaucoma. J. Glaucoma10, S16-18 (2001). https://doi.org/10.1097/00061198-200110001-00007
Biswas, S., Lin, C. & Leung, C. K. Evaluation of a Myopic Normative Database for Analysis of Retinal Nerve Fiber Layer Thickness. JAMA ophthalmology134, 1032-1039 (2016). https://doi.org/10.1001/jamaophthalmol.2016.2343
Akashi, A. et al. The ability of macular parameters and circumpapillary retinal nerve fiber layer by three SD-OCT instruments to diagnose highly myopic glaucoma. Invest. Ophthalmol. Vis. Sci.54, 6025-6032 (2013). https://doi.org/10.1167/iovs.13-12630
Shin, J. W., Sung, K. R., Lee, G. C., Durbin, M. K. & Cheng, D. Ganglion Cell-Inner Plexiform Layer Change Detected by Optical Coherence Tomography Indicates Progression in Advanced Glaucoma. Ophthalmology124, 1466-1474 (2017). https://doi.org/10.1016/j.ophtha.2017.04.023

No competing interests reported.

The relationship of retinal nerve fiber layer thickness and visual field parameter in eight sectors of primary open-angle glaucoma with high myopia based on spectral-domain OCT

Status:

Version 1

Abstract

Figures

Introduction

Materials and Methods

Statistical analysis

Results

Discussion

Declarations