Study Estimates Optic Neuropathy Risk in Patients with High Myopia

High myopia is one of the leading causes of optic neuropathy because increased axial length stretches the eye, causing strain and structural damage that extends to the retinal ganglion cells. Photo: Andrew Rouse, OD. Click image to enlarge. Using readily available clinical factors, a team of researchers from France, Germany, India and China developed and validated a “probability calculator” equation that estimated the chance of optic neuropathy occurrence in high myopes.The study, published in the British Journal of Ophthalmology, analyzed data from 17,996 participants (35,167 eyes) enrolled in five population-based studies that included children, adults and older adults. Participants underwent comprehensive ophthalmic examinations that included refraction, ocular biometry, optic nerve and macular photography and, in most cohorts, OCT imaging. Adult participants also completed visual field testing.The researchers focused on glaucomatous or glaucoma-like optic neuropathy (GLON) and nonglaucomatous optic neuropathy (NGON). GLON was identified by characteristic optic nerve head changes, while NGON was defined by retinal nerve fiber layer loss and optic nerve pallor without glaucomatous disc changes. The authors also accounted for eyes that exhibited features of both conditions. For more on glaucomatous findings in high myopia, see this feature. The researchers randomly split the study population into development and validation groups to build and test predictive equations. For GLON, they incorporated axial length, age, intraocular pressure (IOP), Indian ethnicity and the potential presence of NGON. The NGON model included axial length, age, Indian ethnicity, myopic macular degeneration stage and the presence of GLON. In the validation cohort, the models “had an area under the receiver operating characteristic curve for GLON prevalence and NGON prevalence of 0.881 and 0.964, respectively,” indicating good discrimination.Axial length and age emerged as particularly influential risk factors. Using the equations, a non-Indian patient with an axial length of 28mm and an IOP of 22mm Hg had an estimated GLON probability of 3.5% at age 30, rising to 60.2% by age 75, with the estimated NGON probability also increasing from 3.4% to 16.4% over the same period. In another example, an eye with a 30mm axial length experienced an estimated rise in GLON risk “from 6.9% to 75.6%,” while its NGON risk increased “from 28.2% to 68.4% from age 30 to 75 years,” as explained in the paper.The authors emphasized that the equations should be viewed as approximate estimates—they "may give only some hints for the future probabilities of GLON and NGON in highly myopic eyes”—explaining that the models were derived from cross-sectional rather than longitudinal data. They also acknowledged that the calculation does not account for future axial elongation, family history or other potential risk factors and still requires external validation before widespread clinical adoption.Click here for the journal source. Jonas JB, Jonas RA, Bikbov MM, et al. Estimation of high myopia-associated optic neuropathies: the two-continent eye study. Br. J. Ophthalmol. June 23, 2026. [Epub ahead of print]. This article was developed by the editorial staff in conjunction with experts in the field. In the process, AI may have been among the editorial tools used to meet the goals of human editors, who approved all content.