title: Peripapillary scleral deformation and retinal nerve fiber damage in high myopia assessed with swept-source optical coherence tomography.
abstract: OBJECTIVE
  To study peripapillary morphologic changes in highly myopic eyes using swept-source optical coherence tomography at a longer wavelength.
  
  
  METHODS
  Prospective cross-sectional study.
  
  
  METHODS
  Peripapillary regions of 196 eyes of 107 patients with high myopia (refractive error, <-8.0 diopters or axial length, >26.0 mm) were analyzed quantitatively and qualitatively with an swept-source optical coherence tomography prototype system that uses a tunable laser light source operated at a 100,000-Hz A-scan repetition rate in the 1-μm wavelength region. The visual field was evaluated by standard automated perimetry. Area of peripapillary atrophy β and presence of scleral protrusion temporal to the optic disc were assessed.
  
  
  RESULTS
  Peripapillary atrophy β area, but not disc area, was significantly larger in eyes with visual field defect (3.16 ± 2.70 mm(2); range, 0.00 to 12.85 mm(2)) than those without visual field defect (2.31 ± 2.83 mm(2); range, 0.00 to 17.70 mm(2)). Temporal scleral protrusion was detected by color stereo disc photography in 22 (19.5%) of 113 eyes with visual field defect and in 4 (4.8%) of 83 eyes without visual field defect. Scleral bending demonstrated a wide range of angles (mean, 31.0 ± 21.1 degrees; range, 2 to 80 degrees). The angle of scleral bending, but not the distances from scleral bend to disc margin or foveal center, correlated significantly with retinal nerve fiber layer thickness above the bend (r = -0.557, P = .007) and visual field defect severity (r = -0.445, P = .038).
  
  
  CONCLUSIONS
  Swept-source optical coherence tomography visualizes peripapillary deep structures in high myopia. Some cases of high myopia may be affected by direct scleral compression or stretching at the peripapillary region.
authors: Department of Ophthalmology and Visual Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan. akagi@kuhp.kyoto-u.ac.jp
authors: Tadamichi
authors: T
authors: Akagi
authors: Masanori
authors: M
authors: Hangai
authors: Yugo
authors: Y
authors: Kimura
authors: Hanako Ohashi
authors: HO
authors: Ikeda
authors: Atsushi
authors: A
authors: Nonaka
authors: Akiko
authors: A
authors: Matsumoto
authors: Masahiro
authors: M
authors: Akiba
authors: Nagahisa
authors: N
authors: Yoshimura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D047728:Myopia, Degenerative / Q000175:diagnosis* / Q000503:physiopathology; D009412:Nerve Fibers / Q000473:pathology*; D009898:Optic Disk / Q000473:pathology*; D011446:Prospective Studies; D012165:Retinal Ganglion Cells / Q000473:pathology*; D012590:Sclera / Q000473:pathology*; D041623:Tomography, Optical Coherence / Q000379:methods*; D014794:Visual Fields; D055815:Young Adult