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Noninfectious Uveitis: A Review of Ophthalmic Management and Clinical Pearls

Luke G Qin, Michael T Pierce, Rachel C Robbins

The uvea is a vascular stratum that includes the iris, ciliary body and choroid. Uveitis is defined as inflammation of a part of the uvea or its entirety, but it is also used to describe inflammatory processes of any part of the eye, such as the vitreous or peripheral retina. The clinical taxonomy of uveitis […]

touchREVIEWS in Ophthalmology. 2024;19(1):1–8:Online ahead of journal publication

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Glaucoma Imaging
2 mins

Evaluation of the Optic Nerve and Retinal Nerve Fiber Layer in Myopic Individuals

Ahmad A Aref, Donald L Budenz
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Published Online: Jun 21st 2012 US Ophthalmic Review, 2012;5(2):91-3 DOI: http://doi.org/10.17925/USOR.2012.05.02.91
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1

Abstract

Overview

Clinical discrimination between myopic tilted optic discs and glaucomatous optic neuropathy is often challenging, especially when considering that myopia is a risk factor for the development of glaucoma. Myopic tilted discs are usually larger than average, with associated relative cupping and thinner neuroretinal rim tissue. Histopathologic study has revealed thinner parapapillary retinal tissue in these eyes. Optical coherence tomography (OCT)-measured average retinal nerve fiber layer (RNFL) thickness has been found to decrease with longer axial length and higher myopic refractive error. Parapapillary RNFL quadrant and clock-hour analyses result in a higher false-positive rate in myopic eyes. Careful slit-lamp examination, quality baseline stereoscopic disc photographs, and frequent serial visual field testing are essential to the follow-up of myopic individuals with suspected glaucoma. A novel diagnostic parameter, OCT-derived ganglion cell analysis, may prove to be useful in the diagnosis and follow-up of these individuals.

Keywords

Retinal nerve fiber layer, myopia, glaucoma, optical coherence tomography, optic nerve

2

Article

According to pooled data from large, population-based eye surveys, the estimated prevalence of myopic refractive error (-1 diopter [D] or less) in individuals >40 years old is 25.4, 26.6, and 16.4 % in the US, Europe, and Australia, respectively. For myopia less than -5 D, the prevalence estimates are 4.5, 4.6, and 2.8 %, respectively.1 The prevalence of myopic refractive error is indeed substantial and is the highest of any ocular disorder in this age group.

Furthermore, optic nerve and visual field abnormalities associated with high myopia are notoriously difficult to differentiate from those associated with glaucomatous optic neuropathy. The challenge of distinguishing otherwise healthy myopic eyes from those afflicted with glaucoma becomes even more complex when considering that myopic refractive error is a risk factor for open-angle glaucoma. Marcus and colleagues2 performed a systematic review and meta-analysis of population-based cross-sectional studies published between 1994 and 2010, in order to determine the association between myopia and glaucoma. Analysis of seven studies that reported risk estimates for both low and high myopia revealed a pooled odds ratio of 1.65 (95 % confidence interval [CI] 1.26–2.17) between low myopia and open-angle glaucoma. The pooled odds ratio for the association between high myopia (-3 D or less) and open-angle glaucoma was found to be 2.46 (95 % CI 1.93–3.15). The authors acknowledge that, due to the presence of myopic visual field defects and relatively larger optic nerve cups in myopic individuals, studies included in this meta-analysis may have overestimated the prevalence of glaucoma and therefore they cite a single longitudinal study3 (deemed to be less prone to misdiagnosis of glaucoma) that yielded the same overall results. High myopic error does indeed appear to be an independent risk factor for open-angle glaucoma; however, clinicians must be aware of myriad clinical features that may confound an accurate diagnosis. This article aims to shed light on these clinical features and also to provide practical tips for the examination and follow-up of myopic individuals with suspected open-angle glaucoma.

To view the full article in PDF or eBook formats, please click on the icons above.

2

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3

Article Information

Disclosure

The authors have no conflicts of interest to declare.

Correspondence

Donald L Budenz, MD, MPH, Department of Ophthalmology, University of North Carolina School of Medicine, 5151 Bioinformatics, CB 7040, Chapel Hill, NC 27599-7040, US. E: dbudenz@med.unc.edu

Received

2011-10-11T00:00:00

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Foreword: touchREVIEWS in Ophthalmology, Volume 17, Issue 2, 2023

Welcome to the latest edition of touchREVIEWS in Ophthalmology, and my first as the journal’s Editor-in-Chief. In this issue, we are delighted to present a series of compelling articles providing insights into some of the cutting-edge developments in this diverse and ever-evolving field. Dhanashree Ratra and Aashna Ratra open the edition with the first in […]

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