Clinical Pearls:
- Demographics
- Consider patient’s age, family history and amount of myopia
- Axial length measurements may offer correlation to degree of laminar vulnerability
- Review additional factors including max IOP, central corneal thickness and corneal hysteresis to help differentiate those at higher risk for glaucoma or progression
- Clinical data
- Dilated fundus exam used to stereoscopically asses the optic nerve tissue
- Documentation of peripapillary atrophy, disc hemorrhages and amount of disc tilting
- Fundus photography assess structural changes when OCT is unreliable
- RNFL scans difficult to obtain and interpret (be mindful of red disease)
- Ganglion cells measurements may be more useful than RNFL (be mindful of myopic macular pathology)
- Myopia can cause visual defects that mimic glaucoma but typically do not progress
- Clinical decision making
- Repeat testing to determine baselines/progression
- Understand higher degree of glaucoma risk in myopic patients
- Use above strategies to aid in detection of true glaucomatous progression