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Optic Disc Change during Childhood Myopic Shift: Comparison between Eyes with an Enlarged Cup-To-Disc Ratio and Childhood Glaucoma Compared to Normal Myopic Eyes.

Park HY, Kim SE, Park CK - PLoS ONE (2015)

Bottom Line: The initial intraocular pressure (IOP) at diagnosis was significantly different among the groups (P<0.001).However, the changes in the HDD/VDD and PPW/VDD ratios were significantly greater in the disc suspect group and significantly smaller in the glaucoma group.Eyes of childhood glaucoma showed less change in the disc morphology during myopic shift compared to eyes with normal disc or enlarged cup-to-disc ratio.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.

ABSTRACT

Background: Progressive disc tilting and the development or enlargement of peripapillary atrophy (PPA) are observed during a myopic shift in children. This could be related to the changes around the optic nerve head during eyeball elongation. If the biomechanical properties at or around the optic nerve head are changed after exposure to elevated intraocular pressure (IOP) in glaucoma eyes, different response of the disc tilting and PPA changes could take place during eyeball elongation by myopic shift. On the basis of this background, the aim of this study was to compare the morphological changes in the optic disc induced by a myopic shift during childhood between normal control eyes, eyes from disc suspects with an enlarged cup-to-disc ratio (CDR), and eyes with childhood glaucoma.

Methods: Total of 82 eyes from 82 subjects younger than 14 years of age were included in the study. Serial disc photographs were classified into one of two groups: eyes with an optic nerve head (ONH) or peripapillary atrophy (PPA) change or without an ONH/PPA change. Using ImageJ software, the outlines of the optic disc and PPA were plotted, and the vertical disc diameter (VDD), horizontal disc diameter (HDD), and maximum PPA width (PPW) were measured. The changes in the ratios of these parameters and the relationships between the degree of myopic shift or the ONH/PPA change were analyzed.

Results: Twenty-five eyes with normal optic disc appearance, 36 eyes with enlarged cup-to-disc ratio, and 21 eyes of glaucoma patients were analyzed. The initial intraocular pressure (IOP) at diagnosis was significantly different among the groups (P<0.001). The degree of myopic shift during follow-up period was not significantly different among the groups (P=0.612). However, the changes in the HDD/VDD and PPW/VDD ratios were significantly greater in the disc suspect group and significantly smaller in the glaucoma group. Among the 42 eyes with an ONH/PPA change, 16 (38.1%) were from the normal control group, 24 (57.1%) were from the disc suspect group, and 2 (4.8%) were from the glaucoma group (P < 0.001).

Conclusions and relevance: The optic disc change during childhood myopic shift was different in eyes with various conditions. Eyes of childhood glaucoma showed less change in the disc morphology during myopic shift compared to eyes with normal disc or enlarged cup-to-disc ratio.

No MeSH data available.


Related in: MedlinePlus

Six cases of childhood eyes with a myopic shift.Eyes with a normal optic disc (A and B) and eyes with an enlarged cup-to-disc ratio (CDR) (C and D) that have progressive disc tilting and development/enlargement of peripapillary atrophy (PPA). The previous disc margin is the PPA margin in follow-up photographs (white arrowheads). Note that the cilioretinal vessels (black arrowheads) at the disc margin move into the PPA region as the disc tilt progresses. Serial disc photographs show that with a similar myopic shift, approximately 1.00 to 1.25 diopters by refraction, the eye with an enlarged CDR (C, C’, and C”) had more prominent disc tilting and development/enlargement of PPA compared to the eye with a normal optic disc (A, A’, and A”). In eyes with a larger myopic shift, approximately 3.75 to 4.00 diopters by refraction, progressive disc tilting and development/enlargement of PPA was greater in the eyes with an enlarged CDR (D and D’) compared to the eyes with a normal disc (B and B’). Eyes with primary congenital glaucoma (E and F) had nearly no disc tilting or development of peripapillary atrophy during the myopic shift of approximately 1.75 to 3.50 diopters by refraction.
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pone.0131781.g002: Six cases of childhood eyes with a myopic shift.Eyes with a normal optic disc (A and B) and eyes with an enlarged cup-to-disc ratio (CDR) (C and D) that have progressive disc tilting and development/enlargement of peripapillary atrophy (PPA). The previous disc margin is the PPA margin in follow-up photographs (white arrowheads). Note that the cilioretinal vessels (black arrowheads) at the disc margin move into the PPA region as the disc tilt progresses. Serial disc photographs show that with a similar myopic shift, approximately 1.00 to 1.25 diopters by refraction, the eye with an enlarged CDR (C, C’, and C”) had more prominent disc tilting and development/enlargement of PPA compared to the eye with a normal optic disc (A, A’, and A”). In eyes with a larger myopic shift, approximately 3.75 to 4.00 diopters by refraction, progressive disc tilting and development/enlargement of PPA was greater in the eyes with an enlarged CDR (D and D’) compared to the eyes with a normal disc (B and B’). Eyes with primary congenital glaucoma (E and F) had nearly no disc tilting or development of peripapillary atrophy during the myopic shift of approximately 1.75 to 3.50 diopters by refraction.

Mentions: Progressive changes in disc tilting and the development/enlargement of PPA in myopic eyes have been suggest that the disc shape change is due to scleral stretching associated with the axial elongation of the eyeball.[9] The eyes from the normal control and disc suspect groups had a similar mean age but were significantly different regarding changes in the ONH/PPA. The eyes with childhood glaucoma were the youngest in age but had a significantly smaller ONH/PPA change compared to the other groups. The present study demonstrates that it is possible that the properties of the sclera may determine the amount of disc shape change that is associated with the development of myopia. As shown the in representative cases, compared to normal control eyes (Fig 2A and 2B), the eyes with an enlarged CDR (Fig 2C and 2D) had more pronounced disc shape changes and displayed the development or enlargement of PPA even with a similar myopic shift in refractions. In contrast, the eyes with glaucoma (Fig 2E and 2F) had only minimal changes in the disc shape after the myopic shift in refraction. To our knowledge, this is the first study that examined and compared the ONH changes between various subgroups, glaucomatous eyes in particular.


Optic Disc Change during Childhood Myopic Shift: Comparison between Eyes with an Enlarged Cup-To-Disc Ratio and Childhood Glaucoma Compared to Normal Myopic Eyes.

Park HY, Kim SE, Park CK - PLoS ONE (2015)

Six cases of childhood eyes with a myopic shift.Eyes with a normal optic disc (A and B) and eyes with an enlarged cup-to-disc ratio (CDR) (C and D) that have progressive disc tilting and development/enlargement of peripapillary atrophy (PPA). The previous disc margin is the PPA margin in follow-up photographs (white arrowheads). Note that the cilioretinal vessels (black arrowheads) at the disc margin move into the PPA region as the disc tilt progresses. Serial disc photographs show that with a similar myopic shift, approximately 1.00 to 1.25 diopters by refraction, the eye with an enlarged CDR (C, C’, and C”) had more prominent disc tilting and development/enlargement of PPA compared to the eye with a normal optic disc (A, A’, and A”). In eyes with a larger myopic shift, approximately 3.75 to 4.00 diopters by refraction, progressive disc tilting and development/enlargement of PPA was greater in the eyes with an enlarged CDR (D and D’) compared to the eyes with a normal disc (B and B’). Eyes with primary congenital glaucoma (E and F) had nearly no disc tilting or development of peripapillary atrophy during the myopic shift of approximately 1.75 to 3.50 diopters by refraction.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4493000&req=5

pone.0131781.g002: Six cases of childhood eyes with a myopic shift.Eyes with a normal optic disc (A and B) and eyes with an enlarged cup-to-disc ratio (CDR) (C and D) that have progressive disc tilting and development/enlargement of peripapillary atrophy (PPA). The previous disc margin is the PPA margin in follow-up photographs (white arrowheads). Note that the cilioretinal vessels (black arrowheads) at the disc margin move into the PPA region as the disc tilt progresses. Serial disc photographs show that with a similar myopic shift, approximately 1.00 to 1.25 diopters by refraction, the eye with an enlarged CDR (C, C’, and C”) had more prominent disc tilting and development/enlargement of PPA compared to the eye with a normal optic disc (A, A’, and A”). In eyes with a larger myopic shift, approximately 3.75 to 4.00 diopters by refraction, progressive disc tilting and development/enlargement of PPA was greater in the eyes with an enlarged CDR (D and D’) compared to the eyes with a normal disc (B and B’). Eyes with primary congenital glaucoma (E and F) had nearly no disc tilting or development of peripapillary atrophy during the myopic shift of approximately 1.75 to 3.50 diopters by refraction.
Mentions: Progressive changes in disc tilting and the development/enlargement of PPA in myopic eyes have been suggest that the disc shape change is due to scleral stretching associated with the axial elongation of the eyeball.[9] The eyes from the normal control and disc suspect groups had a similar mean age but were significantly different regarding changes in the ONH/PPA. The eyes with childhood glaucoma were the youngest in age but had a significantly smaller ONH/PPA change compared to the other groups. The present study demonstrates that it is possible that the properties of the sclera may determine the amount of disc shape change that is associated with the development of myopia. As shown the in representative cases, compared to normal control eyes (Fig 2A and 2B), the eyes with an enlarged CDR (Fig 2C and 2D) had more pronounced disc shape changes and displayed the development or enlargement of PPA even with a similar myopic shift in refractions. In contrast, the eyes with glaucoma (Fig 2E and 2F) had only minimal changes in the disc shape after the myopic shift in refraction. To our knowledge, this is the first study that examined and compared the ONH changes between various subgroups, glaucomatous eyes in particular.

Bottom Line: The initial intraocular pressure (IOP) at diagnosis was significantly different among the groups (P<0.001).However, the changes in the HDD/VDD and PPW/VDD ratios were significantly greater in the disc suspect group and significantly smaller in the glaucoma group.Eyes of childhood glaucoma showed less change in the disc morphology during myopic shift compared to eyes with normal disc or enlarged cup-to-disc ratio.

View Article: PubMed Central - PubMed

Affiliation: Department of Ophthalmology and Visual Science, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Korea.

ABSTRACT

Background: Progressive disc tilting and the development or enlargement of peripapillary atrophy (PPA) are observed during a myopic shift in children. This could be related to the changes around the optic nerve head during eyeball elongation. If the biomechanical properties at or around the optic nerve head are changed after exposure to elevated intraocular pressure (IOP) in glaucoma eyes, different response of the disc tilting and PPA changes could take place during eyeball elongation by myopic shift. On the basis of this background, the aim of this study was to compare the morphological changes in the optic disc induced by a myopic shift during childhood between normal control eyes, eyes from disc suspects with an enlarged cup-to-disc ratio (CDR), and eyes with childhood glaucoma.

Methods: Total of 82 eyes from 82 subjects younger than 14 years of age were included in the study. Serial disc photographs were classified into one of two groups: eyes with an optic nerve head (ONH) or peripapillary atrophy (PPA) change or without an ONH/PPA change. Using ImageJ software, the outlines of the optic disc and PPA were plotted, and the vertical disc diameter (VDD), horizontal disc diameter (HDD), and maximum PPA width (PPW) were measured. The changes in the ratios of these parameters and the relationships between the degree of myopic shift or the ONH/PPA change were analyzed.

Results: Twenty-five eyes with normal optic disc appearance, 36 eyes with enlarged cup-to-disc ratio, and 21 eyes of glaucoma patients were analyzed. The initial intraocular pressure (IOP) at diagnosis was significantly different among the groups (P<0.001). The degree of myopic shift during follow-up period was not significantly different among the groups (P=0.612). However, the changes in the HDD/VDD and PPW/VDD ratios were significantly greater in the disc suspect group and significantly smaller in the glaucoma group. Among the 42 eyes with an ONH/PPA change, 16 (38.1%) were from the normal control group, 24 (57.1%) were from the disc suspect group, and 2 (4.8%) were from the glaucoma group (P < 0.001).

Conclusions and relevance: The optic disc change during childhood myopic shift was different in eyes with various conditions. Eyes of childhood glaucoma showed less change in the disc morphology during myopic shift compared to eyes with normal disc or enlarged cup-to-disc ratio.

No MeSH data available.


Related in: MedlinePlus