Classification of Visual Field Abnormalities in Highly Myopic Eyes without Pathologic Change.

PURPOSE: To develop a classification system of visual field (VF) abnormalities in highly myopic eyes with and without glaucoma. DESIGN: Secondary analysis of VF data from a longitudinal cohort study. PARTICIPANTS: One thousand eight hundred ninety-three VF tests from 1302 eyes (825 individuals). METHODS: All participants underwent VF testing (Humphrey 24-2 Swedish interactive threshold algorithm standard program; Carl Zeiss Meditec) and detailed ophthalmic examination. A comprehensive set of VF defect patterns was defined via observation of the 1893 VF reports, literature review, and consensus meetings. The classification system comprised 4 major types of VF patterns, including normal type, glaucoma-like defects (paracentral defect, nasal step, partial arcuate defect, arcuate defect), high myopia-related defects (enlarged blind spot, vertical step, partial peripheral rim, nonspecific defect), and combined defects (nasal step with enlarged blind spot). A subset (n = 1000) of the VFs was used to evaluate the interobserver and intraobserver agreement and weighted κ values of the classification system by 2 trained readers. The prevalence of various VF patterns and their associated factors were determined. MAIN OUTCOME MEASURES: The classification of VF in highly myopic eyes and its associated risk factors. RESULTS: We found that normal type, glaucoma-like defects, high myopia-related defects, and combined defects accounted for 74.1%, 10.8%, 15.0%, and 0.1% of all unique VF tests, respectively. The interobserver and intraobserver agreements were > 89%, and the corresponding κ values were 0.86 or more between readers. Both glaucoma-like and high myopia-related VF defects were associated with older age (odds ratios [ORs], 1.07 [95% confidence interval (CI), 1.04-1.10; P < 0.001] and 1.06 [95% CI, 1.04-1.10; P < 0.001]) and longer axial length (ORs, 1.65 [95% CI, 1.32-2.07; P < 0.001] and 1.37 [95% CI, 1.11-1.68; P = 0.003]). Longer axial length showed a stronger effect on the prevalence of glaucoma-like VF defects than on the prevalence of high myopia-related VF defects (P = 0.036). CONCLUSIONS: We propose a new and reproducible classification system of VF abnormalities for nonpathologic high myopia. Applying a comprehensive classification system will facilitate communication and comparison of findings among studies.

Longitudinal Choriocapillaris Vascular Density Changes in Different Types of Primary Open-Angle Glaucoma.

Purpose: To evaluate longitudinal changes in choriocapillaris perfusion in patients with glaucoma with four phenotypes of optic disc damage and to explore associated factors with decreased choriocapillaris vessel density (CVD). Methods: This prospective longitudinal study included 96 eyes of 96 patients with primary open-angle glaucoma (POAG). Patients with POAG was differentiated into the optic disc phenotypes of focal ischemic type (FI), myopic type (MY), senile sclerotic type (SS), and generalized enlargement type (GE). Patients were followed up every three months. Simple linear regression was used to investigate the factors associated with a reduction in CVD. Results: The median follow-up time was 2.5 years (range, 2.0-3.0 years). Choriocapillaris perfusion tended to decrease over time, with CVD decreasing significantly faster in the FI type than in the other three types (P < 0.001). The percentage decrease in the FI type was 7.85%, 10.89%, and 8.88% faster than MY, SS and GE, respectively, after correcting for age, gender, axial length, intraocular pressure, mean deviation, retinal nerve fiber layer (RNFL), and image quality score. In multivariate regression, decreased CVD was independently associated with the rate of RNFL thinning. Conclusions: FI type had the fastest rate of CVD decline in the four phenotypes of optic disc damage, and decreased CVD was positively correlated with the rate of RNFL thinning. Translational Relevance: The role of the choriocapillaris in the pathogenesis and therapeutic potential of glaucoma require further attention to facilitate better management of glaucoma patients.

Assessment of Artifacts in Swept-Source Optical Coherence Tomography Angiography for Glaucomatous and Normal Eyes.

Purpose: To evaluate the frequency of and identify the factors that influence the artifacts of swept-source optical coherence tomography angiography (SS-OCTA) in glaucomatous and normal eyes. Methods: Artifacts of OCTA images of open-angle glaucoma (OAG) and normal subjects were analyzed using SS-OCTA. Univariate and multivariate logistic regression analyses were performed to evaluate the association of age, sex, best-corrected visual acuity, axial length (AL), intraocular pressure, presence and severity of OAG, and image quality score (IQS) with the presence of artifacts. Results: Images from 4426 subjects were included in the study. At least one type of artifact was present in 24.54% of the images. The most common artifacts were occurrence of motion (705 eyes, 15.93%), followed by defocus (628 eyes, 14.19%), decentration (134 eyes, 3.03%), masking (62 eyes,1.40%), and segmentation errors (23 eyes, 0.52%). Multivariate logistic analyses showed that the presence of OAG (odds ratio [OR] = 2.71; 95% confidence interval [CI], 2.09-3.51; P < 0.001), female sex (OR = 1.34; 95% CI, 1.12-1.61; P = 0.001), longer AL (OR = 1.09; 95% CI, 1.02-1.17; P = 0.017), and IQS < 40 (OR = 3.75; 95% CI, 3.15-4.48; P < 0.001) were significantly associated with higher odds for the presence of any artifact. The IQS had poor performance for detecting artifacts, with an area under the curve of 0.723, sensitivity of 73.04%, and specificity of 62.53%. Conclusions: OAG eyes had more SS-OCTA image artifacts than normal eyes. IQS is an imperfect tool for identifying artifacts. Translational Relevance: Special attention should be paid to the effect of artifacts when using SS-OCTA in the clinical setting to assess vascular parameters in patients with glaucoma.