Glaucoma-induced optic disc morphometric changes and glaucoma diagnostic ability of Heidelberg Retina Tomograph II in highly myopic eyes.
OBJECTIVE
This study was performed to first investigate the morphological differences in the optic nerve head between highly myopic non-glaucomatous controls and highly myopic glaucomatous eyes in comparison with the differences between emmetropic non-glaucomatous controls and emmetropic glaucomatous eyes using confocal scanning laser ophthalmoscopy. Further, the ability of the apparatus in glaucoma diagnosis in highly myopic eyes was compared with that in emmetropic eyes.


METHODS
Healthy subjects and age-matched patients with early-stage open-angle glaucoma were divided into two groups: emmetropic eyes (-1.0 to +1.0 diopters) and highly myopic eyes (-12.0 to -5.0 diopters).The participants were comprised of 65 emmetropic normal eyes, 59 emmetropic glaucomatous eyes, 62 highly myopic normal eyes, and 68 highly myopic glaucomatous eyes and eyes with pathologic myopia were carefully excluded. Confocal scanning laser tomographic parameters were compared among all subjects after adjustment for age and disc area. The ROC curves and sensitivity and specificity for glaucoma detection using several clinical methods were then compared between the emmetropic and highly myopic eyes.


RESULTS
Rim area, cup/disc area ratio, mean cup depth, and cup shape measure of glaucoma eyes are significantly different from those of normal eyes in both highly myopic eyes and emmetropic eyes. Methodological overestimation of retinal nerve fiber layer cross sectional area due to optic disc tilting was suggested in the highly myopic eyes. The diagnostic performance of glaucoma using several discriminant methods significantly deteriorated in the highly myopic eyes.


CONCLUSIONS
In the highly myopic glaucomatous eyes, confocal scanning laser tomographic parameters were significantly different from that of non-glaucomatous highly myopic eyes but diagnostic performance of glaucoma was deteriorated than that in emmetropic eyes. These findings demonstrate the utility and limitations of the apparatus in diagnosing glaucoma in highly myopic patients.
Department of Ophthalmology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan.
Chihiro
C
Mayama
Department of Ophthalmology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan.
Tae
T
Tsutsumi
Department of Ophthalmology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan.
Hitomi
H
Saito
Department of Ophthalmology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan.
Ryo
R
Asaoka
Department of Ophthalmology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan.
Atsuo
A
Tomidokoro
Department of Ophthalmology, Tajimi Municipal Hospital, Tajimi, Japan.
Aiko
A
Iwase
Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan.
Shinichiro
S
Otani
Miyata Eye Hospital, Miyakonojo, Miyazaki, Japan.
Kazunori
K
Miyata
Department of Ophthalmology, the University of Tokyo Graduate School of Medicine, Tokyo, Japan ; Kanto Central Hospital of The Mutual Aid Association of Public School Teachers, Tokyo, Japan.
Makoto
M
Araie
D000704:Analysis of Variance; D058453:Emmetropia / Q000502:physiology; D005901:Glaucoma / Q000150:complications* / Q000175:diagnosis* / Q000473:pathology*; D006801:Humans; D018613:Microscopy, Confocal / Q000379:methods; D009216:Myopia / Q000150:complications*; D009898:Optic Disk / Q000473:pathology*; D012372:ROC Curve; D012160:Retina / Q000648:ultrastructure*; D012680:Sensitivity and Specificity; D014054:Tomography / Q000379:methods*