Optic Disc Change with Incipient Myopia of Childhood

Purpose: To describe progressive tilting of the optic nerve head (ONH) and development/enlargement of parapapillary atrophy (PPA) observed in children with incipient myopia and to investigate factors associated with such changes. Design: Retrospective, observational study. Participants: This study included 118 eyes of 118 Korean children who were assessed by serial disc photography at intervals of 1 year or more. Methods: All disc photographs were reviewed by 2 experienced ophthalmologists, and eyes were classified into 2 groups with respect to the change in the ONH appearance and development/enlargement of beta-zone PPA: (1) ONH/PPA changed group and (2) ONH/PPA unchanged group. To quantify the ONH/PPA changes, the ratio of the horizontal to vertical disc diameter (HVDR) and the ratio of the maximum PPA width to vertical disc diameter (PVDR) were measured. Factors associated with ONH/PPA changes were evaluated using logistic regression analysis. Refractive errors were measured with cycloplegic refraction. Main Outcome Measures: Morphologic changes of the ONH/PPA as observed in serial disc photographs and its association with myopic shift. Results: Mean subject age and refractive error at the time of initial fundus examination were 7.3 +/- 3.7 years (range, 1-17 years) and -0.9 +/- 1.9 diopters (range, -5.9 to +3.0 diopters), respectively. Mean follow-up period was 38.1 +/- 19.6 months (range, 12-88 months). Fifty-one eyes (43%) were classified as the ONH/PPA change group. In the ONH/PPA change group, HVDR decreased from the initial value of 0.92 +/- 0.08 to the final value of 0.86 +/- 0.11, and the PVDR increased from the initial value of 0.08 +/- 0.07 to the final value of 0.20 +/- 0.11. The ONH/PPA changes were most remarkable in subjects between 7 and 9 years of age (odds ratio [OR] = 6.698; 95% confidence interval [CI], 2.296-19.546) and were associated with greater myopic shift during the follow-up period (OR = 0.483; 95% CI, 0.345-0.676). Conclusions: We demonstrate progressive tilting of the ONH, which was observed with development/enlargement of PPA in children who exhibited myopic shift. These findings suggest that tilted disc, as well as PPA, may be an acquired feature in myopic eyes, arising from scleral stretching. Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2012; 119: 21-26 (C) 2012 by the American Academy of Ophthalmology.