Tilted Optic Disc and Small Cup-to-disc Ratio Risk Factors for PHOMS

Since peripapillary hyperreflective ovoid mass-like structures (PHOMS) are common findings in adolescents, it is vital to find out whether they can cause secondary impairment of the optic nerve fibers. Exactly how PHOMS develop remains unclear, and whether they are pathological is still debated. Swept-source optical coherence tomography angiography (OCT-A), which can provide excellent visualization of retinal capillary structures, is an excellent tool for observing the structure of PHOMS and assessing their effects on surrounding tissue.In Translational Vision Science & Technology, researchers recently presented the structural OCT and OCT-A characteristics of PHOMS by swept-source OCT-A, which provided convincing evidence for revealing the composition of PHOMS and their influence on the papillary structure and microvasculature. Their study noted that the presence of PHOMS in healthy individuals was closely related to the structural features of the optic nerve head (ONH). PHOMS were usually accompanied by congested and dilated nerve fibers and radial peripapillary capillaries. PHOMS eyes had higher degree of myopic refractive error, longer AL and larger ONH tilt angles. Increased ONH tilt significantly elevated the risk of PHOMS. These images from the study show en face structural OCT, horizontal and vertical OCT-A B-scan images of PHOMS in different sizes. Photo: Xiao D, et al. Transl Vis Sci Technol. 2025;14(8):34. Click image to enlarge. “Besides tilted optic disc, we identified a new risk factor for PHOMS in adolescents: a smaller cup-to-disc ratio (CDR),” the study authors wrote in their paper. “Therefore, we should pay more attention to adolescents with tilted optic discs and small CDR clinically.” A total of 218 eyes of 117 healthy adolescents were included. Swept-source OCT-A images centered on the ONH were captured on eyes included. Structural characteristics of the ONH were compared between adolescents with or without PHOMS. The mean ages were 11.1 years in the PHOMS group and 11.0 years in the no PHOMS group. Between the two groups, there was no statistical difference in terms of age, sex distribution, or BCVA. Significantly lower spherical equivalent and longer axial length (AL) were seen in the PHOMS group as compared to the no PHOMS group. For ONH parameters, the PHOMS group exhibited significantly smaller mean CDR, vertical CDR, cup area and cup volume.PHOMS were found in 33.5% of the adolescent eyes. OCT-A showed blood flow signals within all PHOMS. Large ONH tilt angle and small CDR were independent risk factors for PHOMS, and they were closely related to the size of PHOMS. Thickened peripapillary retinal nerve fiber layer (RNFL) and elevated radial peripapillary capillary vessel density were observed in adolescents with PHOMS, especially in those with large PHOMS.The researchers propose that the size of PHOMS is an important factor affecting RNFL, and we should pay attention to the development of PHOMS.“We speculate that the thickening RNFL may be a temporary result of impaired axoplasmic transport with accumulation of organelles, or a compensatory increase of mitochondrial biogenesis or a combination of them,” they wrote. “In addition, retinal dragging toward the temporal in tilted optic disc may also play a role in this change.”Therefore, long-term monitoring of RNFL and visual field alteration in individuals with PHOMS is necessary in the future to make certain whether these changes are pathological.Click here for the journal source. Xiao D, Hua D, Tsering L, et al. The observation of peripapillary hyperreflective ovoid mass-like structures in adolescents by swept-source optical coherence tomography angiography. Transl Vis Sci Technol. 2025;14(8):34.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.