Imaging in Myopic Glaucoma

Myopia is an important risk factor for glaucoma. The prevalence of myopia is increasing dramatically, and thus too, myopic glaucoma will be more often encountered. Recent advances in Spectral-Domain Optical Coherence Tomography (SD-OCT) technology enable fast, objective, and quantitative structural imaging of the optic nerve head (ONH), retinal nerve fiber layer (RNFL), and macula for facilitated and enhanced glaucoma diagnostics. However, myopic eyes have unique structural features, which might cause artifacts in OCT imaging or induce false positivity or negativity in interpreting OCT results. For correct diagnosis of glaucoma, it is essential to understand myopic eyes’ structural features that might affect imaging and interpretation of OCT. The key OCT parameters in glaucoma diagnosis include peripapillary RNFL thickness, macular ganglion cell-inner plexiform layer (GCIPL) thickness, and neuroretinal rim thickness measurements. Here, I review the anatomical features of these structures in myopia, how they affect imaging and the diagnostic performance of OCT, how these structures and tests might be misinterpreted, and how to overcome pitfalls and to make correct diagnoses of myopic eyes with or without glaucoma.