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Bo Ram Seol, Ki Ho Park, Jin Wook Jeoung; Optic disc tilt and glaucoma progression in myopic glaucoma: A longitudinal match pair case-control study. Invest. Ophthalmol. Vis. Sci. 2018;59(9):2105.
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To investigate the long-term follow up results of tilted disc eyes and case matched non-tilted disc eyes in myopic glaucoma patients.
We included 28 eyes with tilted disc and case matched 28 eyes with non-tilted disc from myopic open angle glaucoma (OAG) patients. The disc tilt was evaluated using disc tilt ratio which was estimated based on disc photographs. One matching set consists of one tilted disc eye and case matched one non-tilted disc eye. They have similar characteristics including age, axial length, baseline intraocular pressure, average retinal nerve fiber layer (RNFL) thickness, and initial visual field mean deviation. Rate of glaucoma progression was compared between tilted disc eyes and non-tilted disc eyes. Kaplan–Meier survival analysis and Cox’s proportional hazard model were used to identify factors that predicted glaucoma progression.
Mean age and follow-up duration were 50.1 ± 11.7 years and 90.8 ± 38.1 months. Of 56 eyes, glaucoma progression was detected in 22 (39.3%) eyes. Of these, 16 of 28 non-tilted disc eyes (57.1%), and 6 of 28 tilted disc eyes (21.4%) demonstrated glaucoma progression, respectively. The rate of average RNFL thinning was significantly faster in non-tilted disc eyes (-1.40 ± 1.45 μm/year) than in tilted disc eyes (-0.46 ± 1.16 μm/year; P=0.015). A multivariate Cox’s proportional hazard model indicated that lower disc tilt ratio and thinner average RNFL thickness were significantly associated with disease progression (P = 0.004 and 0.028, respectively). Patients with non-tilted disc had a greater cumulative probability of progression than those with disc tilt (P = 0.006 by log-rank test) (Figure 1).Figure 1. Tilted disc eyes demonstrated a greater cumulative probability of non-progression (Kaplan-Meier analysis). The cumulative probability of non-progression was 80.2% in tilted disc eyes (solid color) and 44.5% in non-tilted disc eyes (dotted color) at 60 months (P = 0.006).
In myopic OAG patients, more stable courses were observed in eyes with disc tilt than those without disc tilt. Clinical evaluation of optic disc morphology may help to predict the future progression in myopic glaucomatous eyes.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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