Correlation analysis of optic disc structure and fundus morphological markers in highly myopic eyes_Chinese Journal of Ocular Fundus Diseases

Authors：

Chen Xi , Guo Xiaoxiao , Li Shanshan , You Ran , Wang Wei , Zhao Lu ,  Wang Yanling

Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China;

Corresponding author：

Wang Yanling, Email: wangyanling999@vip.sina.com

Keywords：

Myopia, degenerative; Optic disk; Morphological marker

DOI：

10.3760/cma.j.cn511434-20210226-00102

Video：

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Objective To observe the changes of optic disc structure in patients with high myopia and the correlation with the morphological markers of the fundus. Methods A retrospective study. From July 2018 to January 2020, 90 patients (155 eyes) diagnosed as high myopia in Department of Ophthalmology of Beijing Friendship Hospital affiliated to Capital Medical University were included in the study. Among them, there were 31 males (52 eyes) and 59 females (103 eyes), with age of 57.1±14.2 years old and axial length (AL) of 28.5±2.6 mm. According to the classification of myopic macular degeneration, patients were divided into 4 groups based on forms and degree of lesions, including non-pathological myopia group, mild traction lesions group, severe traction lesions group and neovascular lesions group, 35, 58, 41, 21 eyes, respectively. The digitized fundus photographs and an Image J system were used to measure the horizontal, vertical, maximal, and minimal diameter of the optic disc, the horizontal and vertical diameter of the parapapillary δ zone and γ zone, ovality index, distance between the most superior point of the temporal superior arterial arcade and most inferior point of the temporal inferior arterial arcade (VDA), angle between the temporal arterial arcade and optic disc (angle kappa), distance between the optic disc center and the fovea (DFD), angle between the horizontal disc axis and the disc–fovea line (DFA). The correlation between the diameter of the optic disc and other parameters was analyzed. Univariate and multivariate analysis were used to compare differences between groups. Results The horizontal diameter of the optic disc was positively correlated with the horizontal diameter of the δ zone (r=0.300, P＜0.001), Kappa angle (r=0.260, P=0.003), and elliptic index (r=0.650, P＜0.001); it was negatively correlated with DFD (r=－0.190, P=0.030). Optic disc vertical diameter and optic disc horizontal diameter (r=0.280), δ-zone horizontal diameter (r=0.330) and vertical diameter (r=0.460), γ-zone horizontal diameter (r=0.430) and vertical diameter (r=0.390), DFD (r=0.390) was positively correlated (P<0.001); it was negatively correlated with DFA (r=－0.210, P=0.001) and Kappa angle (r=－0.210, P=0.004). Compared with the non-pathological myopia group, there were statistically significant differences in the horizontal and vertical diameters of the optic disc in the severe traction disease group (P＜0.05). Among them, the horizontal diameter difference did not depend on the eye axis and age difference; the vertical diameter difference was caused by the eye axis difference. Compared with the non-pathological myopia group, the difference in the horizontal diameter of the optic disc in the neovascular disease group was statistically significant (P＜0.05), and did not depend on the difference in the axis and age; the difference in the vertical diameter of the optic disc was not statistically significant (P＞0.05). Conclusion The morphology of optic disc was related to several fundus morphological markers, which was differentiated according to the age, AL and the degree of disease in patients with high myopia.

Citation： Chen Xi, Guo Xiaoxiao, Li Shanshan, You Ran, Wang Wei, Zhao Lu, Wang Yanling. Correlation analysis of optic disc structure and fundus morphological markers in highly myopic eyes. Chinese Journal of Ocular Fundus Diseases, 2022, 38(3): 205-210. doi: 10.3760/cma.j.cn511434-20210226-00102 Copy

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2.	Du R, Xie S, Igarashi-Yokoi T, et al. Continued increase of axial length and its risk factors in adults with high myopia[J]. JAMA Ophthalmol, 2021, 139(10): 1096-1103. DOI: 10.1001/jamaophthalmol.2021.3303.
3.	Takahashi H, Tanaka N, Shinohara K, et al. Importance of paravascular vitreal adhesions for development of myopic macular retinoschisis detected by ultra-widefield OCT[J]. Ophthalmology, 2021, 128(2): 256-265. DOI: 10.1016/j.ophtha.2020.06.063.
4.	Hsia Y, Wang SW, Huang CJ, et al. Clinical characteristics of highly myopic patients with asymmetric myopic atrophic maculopathy-analysis using multimodal imaging[J]. Invest Ophthalmol Vis Sci, 2021, 62(3): 21. DOI: 10.1167/iovs.62.3.21.
5.	Zheng F, Wong CW, Sabanayagam C, et al. Prevalence, risk factors and impact of posterior staphyloma diagnosed from wide-field optical coherence tomography in Singapore adults with high myopia[J/OL]. Acta Ophthalmol, 2021, 99(2): e144-e153[2020-06-29]. https://pubmed.ncbi.nlm.nih.gov/32602252/. DOI: 10.1111/aos.14527.
6.	Chen Q, He J, Yin Y, et al. Impact of the morphologic characteristics of optic disc on choroidal thickness in young myopic patients[J]. Invest Ophthalmol Vis Sci, 2019, 60(8): 2958-2967. DOI: 10.1167/iovs.18-26393.
7.	Sawada Y, Araie M, Shibata H, et al. Optic disc margin anatomic features in myopic eyes with glaucoma with spectral-domain OCT[J]. Ophthalmology, 2018, 125(12): 1886-1897. DOI: 10.1016/j.ophtha.2018.07.004.
8.	Ohno-Matsui K, Kawasaki R, Jonas JB, et al. International photographic classification and grading system for myopic maculopathy[J]. Am J Ophthalmol, 2015, 159(5): 877-883. DOI: 10.1016/j.ajo.2015.01.022.
9.	Ruiz-Medrano J, Montero JA, Flores-Moreno I, et al. Myopic maculopathy: current status and proposal for a new classification and grading system (ATN)[J]. Prog Retin Eye Res, 2019, 69: 80-115. DOI: 10.1016/j.preteyeres.2018.10.005.
10.	Jonas JB, Weber P, Nagaoka N, et al. Temporal vascular arcade width and angle in high axial myopia[J]. Retina, 2018, 38(9): 1839-1847. DOI: 10.1097/IAE.0000000000001786.
11.	Jonas JB, Fang Y, Weber P, et al. Parapapillary gamma and delta zones in high myopia[J]. Retina, 2018, 38(5): 931-938. DOI: 10.1097/IAE.0000000000001650.
12.	Bennett AG, Rudnicka AR, Edgar DF. Improvements on Littmann's method of determining the size of retinal features by fundus photography[J]. Graefe's Arch Clin Exp Ophthalmol, 1994, 232(6): 361-367. DOI: 10.1007/BF00175988.
13.	Du R, Fang Y, Jonas JB, et al. Clinical features of patchy chorioretinal atrophy in pathologic myopia[J]. Retina, 2020, 40(5): 951-959. DOI: 10.1097/IAE.0000000000002575.
14.	Guo XX, Chen X, Li SS, et al. Measurements of the parapapillary atrophy area and other fundus morphological features in high myopia with or without posterior staphyloma and myopic traction maculopathy[J]. Int J Ophthalmol, 2020, 13(8): 1272-1280. DOI: 10.18240/ijo.2020.08.14.
15.	Lee KS, Lee JR, Kook MS. Optic disc torsion presenting as unilateral glaucomatous-appearing visual field defect in young myopic Korean eyes[J]. Ophthalmology, 2014, 121(5): 1013-1019. DOI: 10.1016/j.ophtha.2013.11.014.
16.	Samarawickrama C, Mitchell P, Tong L, et al. Myopia-related optic disc and retinal changes in adolescent children from Singapore[J]. Ophthalmology, 2011, 118(10): 2050-2057. DOI: 10.1016/j.ophtha.2011.02.040.
17.	Guo X, Chen X, Li M, et al. Association between morphological characteristics of the optic disc and other anatomical features of the fundus in highly myopic eyes[J]. Eur J Ophthalmol, 2021, 31(5): 2329-2338. DOI: 10.1177/1120672120945901.
18.	Park HY, Kim SE, Park CK. Optic disc change during childhood myopic shift: comparison between eyes with an enlarged cup-to-disc ratio and childhood glaucoma compared to normal myopic eyes[J/OL]. PLoS One, 2015, 10(7): e0131781[2015-07-06]. https://pubmed.ncbi.nlm.nih.gov/26147983/. DOI: 10.1371/journal.pone.0131781.
19.	Li Z, Guo X, Xiao O, et al. Optic disc features in highly myopic eyes: the ZOC-BHVI high myopia cohort study[J]. Optom Vis Sci, 2018, 95(4): 318-322. DOI: 10.1097/OPX.0000000000001200.
20.	Tay E, Seah SK, Chan SP, et al. Optic disk ovality as an index of tilt and its relationship to myopia and perimetry[J]. Am J Ophthalmol, 2005, 139(2): 247-252. DOI: 10.1016/j.ajo.2004.08.076.
21.	Lee KM, Choung HK, Kim M, et al. Positional change of optic nerve head vasculature during axial elongation as evidence of lamina cribrosa shifting[J]. Ophthalmology, 2018, 125(8): 1224-1233. DOI: 10.1016/j.ophtha.2018.02.002.

1. Ohno-Matsui K, Lai TY, Lai CC, et al. Updates of pathologic myopia[J]. Prog Retin Eye Res, 2016, 52: 156-187. DOI: 10.1016/j.preteyeres.2015.12.001.
2. Du R, Xie S, Igarashi-Yokoi T, et al. Continued increase of axial length and its risk factors in adults with high myopia[J]. JAMA Ophthalmol, 2021, 139(10): 1096-1103. DOI: 10.1001/jamaophthalmol.2021.3303.
3. Takahashi H, Tanaka N, Shinohara K, et al. Importance of paravascular vitreal adhesions for development of myopic macular retinoschisis detected by ultra-widefield OCT[J]. Ophthalmology, 2021, 128(2): 256-265. DOI: 10.1016/j.ophtha.2020.06.063.
4. Hsia Y, Wang SW, Huang CJ, et al. Clinical characteristics of highly myopic patients with asymmetric myopic atrophic maculopathy-analysis using multimodal imaging[J]. Invest Ophthalmol Vis Sci, 2021, 62(3): 21. DOI: 10.1167/iovs.62.3.21.
5. Zheng F, Wong CW, Sabanayagam C, et al. Prevalence, risk factors and impact of posterior staphyloma diagnosed from wide-field optical coherence tomography in Singapore adults with high myopia[J/OL]. Acta Ophthalmol, 2021, 99(2): e144-e153[2020-06-29]. https://pubmed.ncbi.nlm.nih.gov/32602252/. DOI: 10.1111/aos.14527.
6. Chen Q, He J, Yin Y, et al. Impact of the morphologic characteristics of optic disc on choroidal thickness in young myopic patients[J]. Invest Ophthalmol Vis Sci, 2019, 60(8): 2958-2967. DOI: 10.1167/iovs.18-26393.
7. Sawada Y, Araie M, Shibata H, et al. Optic disc margin anatomic features in myopic eyes with glaucoma with spectral-domain OCT[J]. Ophthalmology, 2018, 125(12): 1886-1897. DOI: 10.1016/j.ophtha.2018.07.004.
8. Ohno-Matsui K, Kawasaki R, Jonas JB, et al. International photographic classification and grading system for myopic maculopathy[J]. Am J Ophthalmol, 2015, 159(5): 877-883. DOI: 10.1016/j.ajo.2015.01.022.
9. Ruiz-Medrano J, Montero JA, Flores-Moreno I, et al. Myopic maculopathy: current status and proposal for a new classification and grading system (ATN)[J]. Prog Retin Eye Res, 2019, 69: 80-115. DOI: 10.1016/j.preteyeres.2018.10.005.
10. Jonas JB, Weber P, Nagaoka N, et al. Temporal vascular arcade width and angle in high axial myopia[J]. Retina, 2018, 38(9): 1839-1847. DOI: 10.1097/IAE.0000000000001786.
11. Jonas JB, Fang Y, Weber P, et al. Parapapillary gamma and delta zones in high myopia[J]. Retina, 2018, 38(5): 931-938. DOI: 10.1097/IAE.0000000000001650.
12. Bennett AG, Rudnicka AR, Edgar DF. Improvements on Littmann's method of determining the size of retinal features by fundus photography[J]. Graefe's Arch Clin Exp Ophthalmol, 1994, 232(6): 361-367. DOI: 10.1007/BF00175988.
13. Du R, Fang Y, Jonas JB, et al. Clinical features of patchy chorioretinal atrophy in pathologic myopia[J]. Retina, 2020, 40(5): 951-959. DOI: 10.1097/IAE.0000000000002575.
14. Guo XX, Chen X, Li SS, et al. Measurements of the parapapillary atrophy area and other fundus morphological features in high myopia with or without posterior staphyloma and myopic traction maculopathy[J]. Int J Ophthalmol, 2020, 13(8): 1272-1280. DOI: 10.18240/ijo.2020.08.14.
15. Lee KS, Lee JR, Kook MS. Optic disc torsion presenting as unilateral glaucomatous-appearing visual field defect in young myopic Korean eyes[J]. Ophthalmology, 2014, 121(5): 1013-1019. DOI: 10.1016/j.ophtha.2013.11.014.
16. Samarawickrama C, Mitchell P, Tong L, et al. Myopia-related optic disc and retinal changes in adolescent children from Singapore[J]. Ophthalmology, 2011, 118(10): 2050-2057. DOI: 10.1016/j.ophtha.2011.02.040.
17. Guo X, Chen X, Li M, et al. Association between morphological characteristics of the optic disc and other anatomical features of the fundus in highly myopic eyes[J]. Eur J Ophthalmol, 2021, 31(5): 2329-2338. DOI: 10.1177/1120672120945901.
18. Park HY, Kim SE, Park CK. Optic disc change during childhood myopic shift: comparison between eyes with an enlarged cup-to-disc ratio and childhood glaucoma compared to normal myopic eyes[J/OL]. PLoS One, 2015, 10(7): e0131781[2015-07-06]. https://pubmed.ncbi.nlm.nih.gov/26147983/. DOI: 10.1371/journal.pone.0131781.
19. Li Z, Guo X, Xiao O, et al. Optic disc features in highly myopic eyes: the ZOC-BHVI high myopia cohort study[J]. Optom Vis Sci, 2018, 95(4): 318-322. DOI: 10.1097/OPX.0000000000001200.
20. Tay E, Seah SK, Chan SP, et al. Optic disk ovality as an index of tilt and its relationship to myopia and perimetry[J]. Am J Ophthalmol, 2005, 139(2): 247-252. DOI: 10.1016/j.ajo.2004.08.076.
21. Lee KM, Choung HK, Kim M, et al. Positional change of optic nerve head vasculature during axial elongation as evidence of lamina cribrosa shifting[J]. Ophthalmology, 2018, 125(8): 1224-1233. DOI: 10.1016/j.ophtha.2018.02.002.

Chinese Journal of Ocular Fundus Diseases

Correlation analysis of optic disc structure and fundus morphological markers in highly myopic eyes

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