Ganglion cell-inner plexiform layer examination can help diagnose glaucoma in high myopia

Myopia can be associated with significant structural changes in the eye, including peripapillary atrophy, myopic macular degeneration and the enlargement and rotation of the optic disc (1). These were shown to impair the clinical assessment of cup-to-disc ratios, visual fields, and retinal nerve fiber layers (2), with increased odds of false positive glaucoma diagnoses (3).

While most traditional structural and functional tests are affected by these changes, macular ganglion cell-inner plexiform layer (GCIPL) hemifield test was shown to be relatively unaffected by the tilting of the optic nerve head seen in myopia (2), and Kim et al. have demonstrated its high sensitivity and specificity in diagnosing glaucoma in a context of high myopia (4). GCIPL hemifield test, however, is not yet commercially available for all optical coherence tomography devices.

Contributor: Kevin Gillmann – Moorfields Eye Hospitals, United-Kingdom

References

1. Tan NYQ, Sng CCA, Jonas JB, Wong TY, Jansonius NM, Ang M. Glaucoma in myopia: diagnostic dilemmas. Br J Ophthalmol. 2019 Oct;103(10):1347-1355.
2. Shin H-Y, Park H-YL, Park CK. The effect of myopic optic disc tilt on measurement of spectral-domain optical coherence tomography parameters. Br J Ophthalmol 2015;99:69–74.
3. Yamashita T, Kii Y, Tanaka M, et al. Relationship between Supernormal sectors of retinal nerve fibre layer and axial length in normal eyes. Acta Ophthalmol 2014;92:e481–7.
4. Kim YK, Yoo BW, Jeoung JW, et al. Glaucoma-diagnostic ability of ganglion cell-inner plexiform layer thickness difference across temporal raphe in highly myopic eyes. Investig Ophthalmol Vis Sci 2016;57:5856–63.

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