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