High Myopia and Glaucoma-Like Optic Neuropathy. 2020

Jost B Jonas, and Ya Xing Wang, and Li Dong, and Songhomitra Panda-Jonas
Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karis-University, Mannheim, Germany.

OBJECTIVE Previous population-based and hospital-based studies have shown an association between high myopia and higher prevalence of glaucomatous or glaucoma-like optic neuropathy (GON). Here we discuss potential factors associated with such a correlation. METHODS Review. METHODS Findings from population-based and clinical investigations were combined with observations from light-microscopical examinations of human eyes. GON was defined by an abnormal shape of the neuroretinal rim as shown by a vessel kinking close to optic disc border in the inferior, superior, or nasal optic disc region. RESULTS The prevalence of GON increased (P < 0.001) beyond an axial length of 26.5 mm or a myopic refractive error of -8 diopters and reached up to 80% in eyes with an axial length >33 mm. It was associated with a larger optic disc and/or larger parapapillary delta zone. Histological factors potentially associated with the myopia-related increased GON prevalence were an elongation and thinning of the lamina cribrosa resulting in intra-lamina changes and a steepening of the translamina cribrosa pressure gradient; a lengthening and thinning of the peripapillary scleral flange which is the ophthalmoscopical equivalent of parapapillary delta zone and acts as the biomechanical anchor of the lamina cribrosa; and an increased distance of the peripapillary arterial circle of Zinn-Haller to the lamina cribrosa, due to the elongation of the peripapillary scleral flange. In addition to GON, a nonglaucomatous optic nerve damage may occur in the papillo-macular region due to a parapapillary gamma zone-associated lengthening of the retinal nerve fibers. CONCLUSIONS In highly myopic eyes, one should be vigilant not to overlook GON.

UI MeSH Term Description Entries
D007429 Intraocular Pressure The pressure of the fluids in the eye. Ocular Tension,Intraocular Pressures,Ocular Tensions,Pressure, Intraocular,Pressures, Intraocular,Tension, Ocular,Tensions, Ocular
D009900 Optic Nerve The 2nd cranial nerve which conveys visual information from the RETINA to the brain. The nerve carries the axons of the RETINAL GANGLION CELLS which sort at the OPTIC CHIASM and continue via the OPTIC TRACTS to the brain. The largest projection is to the lateral geniculate nuclei; other targets include the SUPERIOR COLLICULI and the SUPRACHIASMATIC NUCLEI. Though known as the second cranial nerve, it is considered part of the CENTRAL NERVOUS SYSTEM. Cranial Nerve II,Second Cranial Nerve,Nervus Opticus,Cranial Nerve, Second,Cranial Nerves, Second,Nerve, Optic,Nerve, Second Cranial,Nerves, Optic,Nerves, Second Cranial,Optic Nerves,Second Cranial Nerves
D009901 Optic Nerve Diseases Conditions which produce injury or dysfunction of the second cranial or optic nerve, which is generally considered a component of the central nervous system. Damage to optic nerve fibers may occur at or near their origin in the retina, at the optic disk, or in the nerve, optic chiasm, optic tract, or lateral geniculate nuclei. Clinical manifestations may include decreased visual acuity and contrast sensitivity, impaired color vision, and an afferent pupillary defect. Cranial Nerve II Diseases,Foster-Kennedy Syndrome,Optic Disc Disorders,Optic Disk Disorders,Optic Neuropathy,Second Cranial Nerve Diseases,Cranial Nerve II Disorder,Neural-Optical Lesion,Disc Disorder, Optic,Disk Disorder, Optic,Disorder, Optic Disc,Foster Kennedy Syndrome,Lesion, Neural-Optical,Neural Optical Lesion,Neural-Optical Lesions,Neuropathy, Optic,Optic Disc Disorder,Optic Disk Disorder,Optic Nerve Disease,Optic Neuropathies,Syndrome, Foster-Kennedy
D005901 Glaucoma An ocular disease, occurring in many forms, having as its primary characteristics an unstable or a sustained increase in the intraocular pressure which the eye cannot withstand without damage to its structure or impairment of its function. The consequences of the increased pressure may be manifested in a variety of symptoms, depending upon type and severity, such as excavation of the optic disk, hardness of the eyeball, corneal anesthesia, reduced visual acuity, seeing of colored halos around lights, disturbed dark adaptation, visual field defects, and headaches. (Dictionary of Visual Science, 4th ed) Glaucomas
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D047728 Myopia, Degenerative Excessive axial myopia associated with complications (especially posterior staphyloma and CHOROIDAL NEOVASCULARIZATION) that can lead to BLINDNESS. Myopia, Pathological,Myopia, Progressive,Degenerative Myopia,Degenerative Myopias,Myopias, Degenerative,Myopias, Pathological,Myopias, Progressive,Pathological Myopia,Pathological Myopias,Progressive Myopia,Progressive Myopias
D041623 Tomography, Optical Coherence An imaging method using LASERS that is used for mapping subsurface structure. When a reflective site in the sample is at the same optical path length (coherence) as the reference mirror, the detector observes interference fringes. OCT Tomography,Optical Coherence Tomography,Coherence Tomography, Optical,Tomography, OCT

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