Clinical Ophthalmology (Mar 2021)
The Role of Multimodal Approach in the Assessment of Glaucomatous Damage in High Myopes
Abstract
Pedro Manuel Baptista,1,2 Rita Vieira,1 André Ferreira,1,3 Ana Figueiredo,1 Isabel Sampaio,1 Rita Reis,1 Maria João Menéres1,2 1Ophthalmology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal; 2Instituto de CIências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal; 3Department of Biomedicine – Unit of Anatomy, Faculty of Medicine, Universidade do Porto, Porto, PortugalCorrespondence: Pedro Manuel BaptistaCentro Hospitalar Universitário do Porto, Largo Prof. Abel Salazar, Porto, 4099-001, PortugalTel +35 1917868372Email [email protected]: To compare the optic disc structure and peripapillary retinal function between high myopes with and without glaucoma and to address the differential role of papillary optical coherence tomography angiography (OCT-A) and circumpapillary microperimetry (cpMP) on the diagnosis and prognosis of this patients.Patients and Methods: It is a cross-sectional study including 30 high myopic patients (60 eyes), divided into 15 with (GG) and 15 without glaucoma (NGG). Demographic and clinical data were collected from patient records. Papillary structure (peripapillary retinal nerve fiber layer thickness, ppRNFLTs) and vascularization (small vessel densities, SVD´s) were assessed with SD-OCT (RTVue XR Avanti, with AngioVue system, Optovue®). cpMP was carried out with the MP-3 microperimeter (Nidek®).Results: The GG were older, had lower best-corrected visual acuities and higher intraocular pressures and axial lengths (p< 0.001). The GG showed lower values in all ppRNFLTs (p< 0.05), lower values in all SVDs (p< 0.001), except the SVD-inside disc (p=0.638) and lower retinal sensitivities within all cpMPs (p< 0.001). The adjusted analysis computing the best two parameters per exam revealed that the anatomical model including the ppRNFLT-inferior and ppRNFLT-temporal and the vascular model including SVD-inferior and SVD-superior had the best discrimination power between groups, with cross-validated AUROCs of 0.9599 and 0.9921, respectively.Conclusion: Despite the apparent superiority of the papillary vascular study, a multimodal approach including the papillary anatomic and circumpapillary microperimetric assessments can be the new way on the diagnosis and prognosis of glaucoma in high myopia.Keywords: glaucoma, high myopia, peripapillary retinal nerve fiber layer thickness, optic disc dysgenesis, papillary optical coherence tomography angiography, circumpapillary microperimetry
