Mild, Moderate Myopia Linked with Fast Glaucoma Progression

The association between high myopia and glaucoma prevalence is marked, with factors contributing to this like tilting and deformation of the optic disc as well as axial length-related stretching and weakening of the lamina cribrosa, in turn, which may increase susceptibility of the optic disc to damage from an elevated IOP. These images show RNFL thickness maps (left panel) and RNFL thickness deviation maps (right panel) of two myopic eyes with AL of (top) 27.26mm (spherical error: -6.75D) and (bottom) 26.61mm (spherical error: -2.00D). The RNFL distribution angles were 103.38 (top) and 137.58 (bottom) showing the increased temporalization of the RNFL bundles. Photo: Andrew Rouse, OD. Click image to enlarge. A progressive optic neuropathy, glaucoma is one of the leading causes of irreversible blindness worldwide. Along with complications that can arise from high myopia—in particular, pathologic myopia—patients with both of these ocular conditions are at a disadvantage in terms of sight preservation. In pursuit of helping these patients retain as much sight as possible, researchers wanted to investigate the impact myopia has on regional visual field (VF) loss and progression in glaucoma.A large sample of 112,633 24-2 VFs was analyzed by a team of experts from several top ophthalmology institutions (Harvard, Mass Eye and Ear, Wills Eye, Bascom Palmer and others), with longitudinal analyses done on patients with at least five reliable visual fields over four years. Three VF progression outcomes were calculated:1. Mean deviation (MD) progression, defined as MD slope < 02. Total deviation (TD) pointwise progression, defined as at least three TD locations with TD slope ≤ -1 dB/year3. MD fast progression, defined as MD slope ≤ -1 dB/yearAfter analysis, it was found that more negative spherical equivalent values were associated with worse TD values in the paracentral VF region, up to -0.14 dB/year. A more negative spherical equivalent was linked with MD, TD pointwise and MD fast progression; these results were comparable even when patients with high myopia, MD, VF index and MD fast progression. For more on the relationship between myopia and glaucoma, see this feature. One of the main two findings of this study is that more negative refractive error was not only linked to presence of progression—as measured by MD progression and TD pointwise progression—but also with fast progression, as measured with MD fast progression; this has not previously been reported. The other salient piece of information is that even when mild and moderate myopia only was included, more negative refractive error was still associated with normal and fast progression. Similarly, the relationship of mild and moderate myopia being linked with glaucoma progression has not been elucidated, although progression with high myopia has.High myopia causes fundus changes seen even after adolescence, while low to moderate myopia may or may not stabilize before reaching this point. Because of structural changes that take place with high myopia, glaucoma can be difficult to diagnose and can result in later diagnosis, reinforcing that diagnostic tools and cutoffs are needed to identify and treat these patients in a timely manner.The authors of the study highlight some key takeaways for clinicians: “Our findings regarding the association of mild and moderate myopia with normal and fast progression likely due to glaucoma highlight the importance of controlling myopia in young patients, whose degree of myopia may worsen with age, and potentially heightening clinical surveillance of patients with glaucoma and only mild degrees of myopia.”Click here for the journal source. Lokhande A, Song L, Pang Y, et al. The impact of myopia on regional visual field loss and progression in glaucoma. Transl Vis Sci Technol. 2025;14(9):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.