Case #60 – Does my Myopic Patient Have Glaucoma?

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About the Authors: Dr. Andrew Rouse is a graduate of SUNY Optometry Class of 2022. Dr. Rouse will be doing a residency in Ocular Disease at Bascom Palmer Eye Institute in Miami, Florida starting July 1st, 2022.   Dr. Lauren Sabol is a graduate of SUNY Optometry Class of 2022.   Dr. Tejanand Ramdass is

Case #60 – Does my Myopic Patient Have Glaucoma? – Page 22 of 222022-07-05T21:26:37+00:00

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References:Holden BA, Fricke TR, Wilson DA, et al. Global prevalence of myopia and high myopia and temporal trends from 2000 through 2050. Ophthalmology. 2016;123(5):1036-42.Wang J, Li Y, Musch DC, et al. Progression of myopia in school-aged children after COVID-19 home confinement. JAMA Ophthalmol. 2021;139(3):293-300.GBD 2019 Blindness and Vision Impairment Collaborators. Causes of blindness and vision

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Clinical Pearls:DemographicsConsider patient’s age, family history and amount of myopiaAxial length measurements may offer correlation to degree of laminar vulnerabilityReview additional factors including max IOP, central corneal thickness and corneal hysteresis to help differentiate those at higher risk for glaucoma or progression Clinical dataDilated fundus exam used to stereoscopically asses the optic nerve tissueDocumentation of peripapillary

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Additional Tests: Axial Length Myopia and particularly high myopia can cause many changes to the retina and increased risk for glaucoma and retinal detachments. The refraction gives some insight to the degree of myopia, however, the axial length measurement is more beneficial. The higher the axial length, the greater the stretching and thinning of the

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Additional Test: Diurnal IOPs This patient had all IOP measurements taken in the afternoon. IOP is known to fluctuate throughout the day with the lowest in the morning and highest at night time when sleeping. The increase in IOP at night is particularly important for ocular perfusion pressure (OPP). Ocular perfusion pressure describes the blood

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To treat or not to treat? This patient was NOT started on IOP-lowering medications and instead monitored more frequently. The patient was scheduled to return in 1 month to repeat the visual field to confirm progression and to check the IOP. If progression on the visual field was confirmed, IOP-lowering medication would be initiated. The

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Updated Case Information:   Glaucoma Profile: 57-year-old male (-) Family History of Glaucoma Thin pachs 485/472 Gonio open to CB 360 OD and OS IOP Trend: OD 20 mmHg (2020) → 23 mmHg (3 months later) → 17 mmHg (6 months later) OS 18 mmHg (2020) → 23 mmHg (3 months later) → 17 mmHg

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Corneal Hysteresis Corneal hysteresis (CH) is a measurement of the cornea’s ability to dampen the effects of pressure. Studies have linked the viscoelastic properties of the cornea to the lamina cribrosa.16 Due to this link, CH can possibly provide insight of the effect IOP has on the lamina cribrosa. Some of these studies have shown

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OCT and Visual Field Limitation: Vitreous Floaters Vitreous floaters and posterior vitreous detachments are more common in myopic patients. Posterior vitreous detachments complicate OCT and visual field measurements because when the floaters move it obstructs the imaging. One way to avoid this limitation is to have the patient look up to move the floater out

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Visual Field Limitation: Myopia Visual Field Defects   As previously stated, myopia can cause stretching and thinning of the retina and tilting or torsion of the optic nerve head. These retinal changes may result in visual field defects that are not glaucomatous in nature, but at times, mimic glaucoma. In the Zhongshan Ophthalmic Center-Brien Holden

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