Korean J Ophthalmol.  2019 Dec;33(6):520-527. 10.3341/kjo.2019.0069.

Progressive Optic Disc Tilt in Young Myopic Glaucomatous Eyes

• Yoon JY
• Sung KR
• Yun SC
• Shin JW

• KMID: 2465132
• DOI: http://doi.org/10.3341/kjo.2019.0069

Abstract

PURPOSE
To explore the progressive change and associated factors of optic disc tilt in young myopic glaucomatous eyes by analyzing long-term follow-up data.
METHODS
Optic disc images were obtained from spectral-domain optical coherence tomography enhanced depth imaging from at least five different visits. At each visit, the disc tilt angle (DTA), defined as the angle between the Bruch's membrane opening plane and the optic canal plane, was estimated at the central frame that passes through the optic disc. Glaucoma progression was assessed on the basis of changes noted on serial optic disc and retinal nerve fiber layer photographs or changes in the visual field (VF). A linear mixed effect model was used to assess the influence of parameters (age, sex, baseline and follow-up intraocular pressure, retinal nerve fiber layer thickness, VF mean deviation, axial length, central corneal thickness), and presence of glaucomatous progression upon DTA change.
RESULTS
A total of 26 eyes of 26 young myopic primary open-angle glaucoma patients (axial length >24.0 mm; mean age, 25.1 ± 4.0 years; mean follow-up, 3.3 ± 0.9 years) were included. DTA was 7.0 ± 3.4 degrees at baseline and 8.3 ± 3.8 degrees at last visit, which represents a significant difference (p < 0.001). Worse VF mean deviation (p < 0.001) and longer axial length (p = 0.006) were significantly associated with DTA increase.
CONCLUSIONS
Young myopic glaucomatous eyes showed progressive optic disc tilting. Progressive optic disc tilting in young myopic glaucomatous eyes may be related to either continuous axial myopic shift or glaucomatous structural change.

Keyword

Glaucoma; Myopia; Optic disk; Visual fields

MeSH Terms

Bruch Membrane
Follow-Up Studies
Glaucoma
Glaucoma, Open-Angle
Humans
Intraocular Pressure
Myopia
Nerve Fibers
Optic Disk
Retinaldehyde
Tomography, Optical Coherence
Visual Fields
Retinaldehyde

Figure

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  Fig. 1 Measurement of lamina cribrosa depth and disc tilt angle. Bruch's membrane opening (BMO, points A and B) was defined by the proximal tips of the Bruch's membrane. A line connecting the BMO on each side (line AB), was regarded as the BMO plane. The disc tilt angle was defined as the angle between the BMO plane and the optic canal plane (line AC) that passes through the optic disc (θ).

• 

  Fig. 2 Disc tilt angle change over time in all eyes. Redline indicates eyes which show glaucomatous progression while blue line indicates stable eyes.

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  Fig. 3 Representative case example is shown. Upper images were obtained at baseline examination, and lower images were obtained 39 months later from baseline. (A,B) A 28-year-old woman had progressive tilting in her optic disc (baseline, 9.3 degrees; 39 months later, 10.4 degrees) and deepening of the lamina cribrosa (baseline, 359.9 microns; 39 months later, 366.9 microns). (C) Her visual field and retinal nerve fiber layer photographs showed rapid progression.

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  Fig. 4 Representative case example is shown. Upper images were obtained at baseline examination and lower images were obtained 52 months later from baseline. (A,B) A 30-year-old man showed progressive tilting in his optic disc (baseline, 8.6 degrees; 52 months later, 11.7 degrees and deepening of lamina cribrosa baseline, 351.5 micron; 52 months later, 380.7 micron), but (C) there was no evidence of glaucomatous progression either in the structural or functional test.

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