Among High Myopes with NTG, Younger Patients Showed Faster Progression

Two factors were significantly associated with the rate of functional progression of highly myopic glaucoma. Baseline IOP was related to the rate of MD change, and baseline VF index was related to the rate of MD and VF index change. Photo: Andrew Rouse, OD. Click image to enlarge. Because it is difficult to detect glaucoma and its progression in myopic eyes, especially highly myopic eyes, determining the rate of both visual field (VF) and glaucoma progression is critical in clinical practice. Researchers in South Korea analyzed the rate of glaucoma progression based on the VF and optical coherence tomography (OCT) according to baseline age and investigated the progression pattern in both younger and older patients with normal tension glaucoma (NTG) and myopia. The team determined that the progression rate was faster in the 19 to 29 and 40 to 49 age subgroups and slower in the 30 to 39 and 50 or older age subgroups.“Although the progression rate was slightly slower in older patients, highly myopic NTG progresses at a rate comparable to that of overall NTG, and not only in the young but also in those in their later life,” the researchers wrote in their paper, which was published in American Journal of Ophthalmology.A total of 320 eyes of 320 highly myopic NTG patients (mean age at presentation, 38.7 years) were included in this study with a mean follow-up duration of 13.1 years. Patients were divided into two age groups, “younger (under age 40)” and “older (age 40 or over),” and progression rates for VF index (VFI), mean deviation (MD) and peripapillary retinal nerve fiber layer (RNFL) thickness were evaluated. The mean progression rate was -0.36dB/year in patients under 40 years of age and -0.22dB/year in those over 40. In this cohort study, although VFI, MD and RNFL thickness showed progression with increase of age, the rate of their change presented a bimodal pattern according to age at presentation.“The initial rapid progression among those in the 19 to 29 age group can be interpreted as progression of glaucoma insulted by myopic structural changes around the optic nerve head in young adulthood; and the next rapid change, among those in the 40 to 49 age group, can be interpreted as the progression of open-angle glaucoma (OAG) associated with aging,” the researchers noted. “Considering the debates among clinicians as to whether the myopic element is or is not the issue for treatment planning or prognosis of NTG, these results are noteworthy in their suggestion that highly myopic NTG eyes do progress and should be thoroughly evaluated for their proper management.”The data indicated that close monitoring of highly myopic patients with abnormal VF results, especially those with poor baseline VF index, is called for due to the higher probability of functional progression. This result also highlighted the importance of initial evaluation of intraocular pressure (IOP) and the parameters related to focal VF loss, both in setting the target IOP and further treatment plans. Considering the ongoing progression in highly myopic NTG patients, most of whom typically are younger than OAG patients, proper monitoring and early management of glaucoma are crucial. Click here for the journal source.  Lee J, Shin YI, Huh MG, et al. Rate of progression among different age groups in glaucoma with high myopia: a 10-year follow-up cohort study. Am J Ophthalmol. Apr. 17, 2025.