Patterns of Damage in Young Myopic Glaucomatous-appearing Patients With Different Optic Disc Tilt Direction

Purpose of the Study: The purpose of the study was to compare patterns of damage in young myopic glaucomatous-appearing patients with horizontal disc tilt (HDT) to a control group of patients with vertical disc tilt (VDT). Patients and Methods: We consecutively enrolled 104 eyes of 104 young, myopic, glaucomatous-appearing patients without or with early visual field (VF) defects. The eyes were divided into those with HDT or VDT. The clinical characteristics of the peripapillary retinal nerve fiber layer (pRNFL) and VF damage were compared between groups after matching for age, refractive error, and neural rim area using spectral-domain optical coherence tomography and standard automated perimetry 24-2 VF testing. Multivariate logistic regression analysis was performed to determine the risk factors associated with more advanced VF damage (mean deviation < -6 dB) at initial presentation. Results: The asymmetric loss of pRNFL thickness between hemispheres was significantly greater in the HDT group (P = 0.002). Myopic eyes with HDT were more likely to have peripheral VF loss than those with VDT (P < 0.05). HDT was an independent risk factor for more advanced VF loss at initial presentation (P = 0.011). Conclusions: The disc tilt direction may be related to asymmetrical pRNFL loss and the location and gravity of VF loss at initial presentation in young myopic glaucomatous-appearing patients. These findings are clinically important for initial detection and planning the follow-up strategy in myopic glaucomatous-appearing eyes with different disc tilt directions.