Elsevier

Ophthalmology

Volume 121, Issue 5, May 2014, Pages 1013-1019
Ophthalmology

Original article
Optic Disc Torsion Presenting as Unilateral Glaucomatous-Appearing Visual Field Defect in Young Myopic Korean Eyes

https://doi.org/10.1016/j.ophtha.2013.11.014Get rights and content

Purpose

To investigate the ocular features of companion eyes in an attempt to find eye-related factors that are associated with unilateral glaucomatous-appearing visual field (VF) defects in young myopic subjects.

Design

Retrospective, cross-sectional study.

Participants

Thirty-nine patients (age range, 20–50 years) with unilateral glaucomatous-appearing VF defect and myopia.

Methods

A comparison was performed between VF-affected eyes and contralateral normal eyes. Optic disc torsion and tilt ratio were measured from disc photographs. Logistic regression analysis and linear regression analysis were performed to investigate various ocular parameters, including torsion degree and tilt ratio, that may be associated with the presence and severity of VF defect.

Main Outcome Measures

Torsion degree, tilt ratio, and the severity of VF defect.

Results

Optic disc torsion degree (16.63±9.78°) of VF-affected eyes was statistically greater than that of the normal contralateral eyes (8.69±7.28°; P<0.001). Optic disc torsion was more prevalent in VF-affected eyes (66.6%) than in normal contralateral eyes (15.3%; P<0.001). In the multivariate analysis, the degree of optic disc torsion was associated significantly with the presence of VF defect (P = 0.005). The torsion degree (P = 0.006) and retinal nerve fiber layer thickness (P = 0.004) were associated significantly with the severity of VF defect.

Conclusions

The prevalence and degree of optic disc torsion in the VF-affected eyes were significantly greater than those of contralateral normal eyes in unilateral, young, myopic patients with glaucomatous-appearing VF defect. Optic disc torsion should be considered in the presence of unilateral glaucomatous-appearing VF defect in young myopic eyes.

Section snippets

Patients

The medical records of patients who visited the outpatient glaucoma clinic of the Asan Medical Center in Seoul, Korea, from March 2012 through February 2013 were reviewed retrospectively. This study was approved by the Asan Medical Center Institutional Review Board and adhered to the Declaration of Helsinki. All study subjects underwent ophthalmologic examinations that included manual refraction, Goldmann applanation tonometry, VF testing (Humphrey Field Analyzer; Carl Zeiss Meditec, Dublin,

Results

Thirty-nine patients who met the inclusion criteria were analyzed (mean age, 36.0±6.52 years; 20 women; all Koreans). Among these cases, 19 eyes (48.7%) had unilateral glaucomatous-appearing VF defects in the right eye and 20 (51.2%) had unilateral glaucomatous-appearing VF defects in the left eye. The VF-affected eyes had significantly lower VF MDs and higher pattern standard deviations (−7.25±3.79 dB and 10.10±4.14 dB, respectively) than the contralateral normal eyes (−1.85±1.79 dB and

Discussion

Axial myopia has been identified as a risk factor for OAG in many population-based studies.11, 12, 13, 14 Myopic eyes with an increased AL may have a greater deformability of the lamina cribrosa and higher scleral tension across the lamina than emmetropic eyes or eyes with a shorter AL.23, 24, 25, 26 This may contribute to a higher susceptibility to OAG in these myopic eyes, even when the IOP is the same as that of the emmetropic eye. However, we often encounter cases in our clinic where

References (32)

  • D. Poinoosawmy et al.

    Frequency of asymmetric visual field defects in normal-tension and high-tension glaucoma

    Ophthalmology

    (1998)
  • D.S. Greenfield et al.

    Visual field and intraocular pressure asymmetry in the Low-Pressure Glaucoma Treatment Study

    Ophthalmology

    (2007)
  • M.T. Nicolela et al.

    Color Doppler imaging in patients with asymmetric glaucoma and unilateral visual field loss

    Am J Ophthalmol

    (1996)
  • M.J. Cartwright et al.

    Correlation of asymmetric damage with asymmetric intraocular pressure in normal-tension glaucoma (low-tension glaucoma)

    Arch Ophthalmol

    (1988)
  • I.O. Haefliger et al.

    Relationship between asymmetry of visual field defects and intraocular pressure difference in an untreated normal (low) tension glaucoma population

    Acta Ophthalmol (Copenh)

    (1990)
  • L.L. Lin et al.

    Epidemiologic study of ocular refraction among schoolchildren in Taiwan in 1995

    Optom Vis Sci

    (1999)
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    Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

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