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Purpose: To report the occurrence probability of disc haemorrhage (DH) and risk factors for it in otherwise healthy Japanese normal‐tension glaucoma (NTG) patients who had lower normal intraocular pressure (IOP) and were followed without treatment for 5 years. Methods: A prospective observational study. Normal‐tension glaucoma (NTG) patients with IOP consistently ≤15 mmHg without treatment were enrolled. The presence or absence of DH was checked semi‐annually on the fundus photographs by three independent observers, while patients were followed without treatment. Cox proportional hazards model taking inter‐eye correlation into consideration was adopted to identify risk factors for DH occurrence. The main outcomes were DH occurrence probability during 5‐year period and its risk factors. Results: One hundred seventeen eyes of 90 patients with mean age of 54.1 years, mean deviation value of −3.6 decibels and mean IOP during follow‐up of 12.4 mmHg were included. Disc haemorrhage (DH) was observed at least once in 34 eyes and more than twice in 15 eyes during the follow‐up. The DH occurrence probability at 5 years was 31% (95% confidence interval: 21–40%), and lower myopic refraction (HR = 1.18; p = 0.018), higher IOP during follow‐up (HR = 1.35; p = 0.047) and presence of DH at baseline (HR = 4.19; p = 0.002) were its risk factors. Conclusion: Disc haemorrhage (DH) occurrence probability of Japanese healthy NTG patients with mean IOP of 12.4 mmHg and no systemic and/or topical treatment was 31% at 5 years. Lower myopic refraction, higher IOP and its existence at baseline were its risk factors. [ABSTRACT FROM AUTHOR]

Purpose: The influence of myopia on glaucoma progression remains unknown, possibly because of the multifactorial nature of glaucoma and difficulty in assessing a solo contribution of myopia. The purpose of this study is to investigate the association of myopia with visual field (VF) progression in glaucoma using a paired-eye design to minimize the influence of confounding systemic factors that are diverse among individuals. Methods: This retrospective study evaluated 144 eyes of 72 subjects with open-angle glaucoma, with similar intra-ocular pressure between paired eyes, spherical equivalent (SE) ≤ -2 diopter (D), and axial length ≥ 24 mm. Paired eyes with faster and slower VF progression were grouped separately, according to the global VF progression rate assessed by automated pointwise linear regression analysis. The SE, axial length, tilt ratio and torsion angle of optic discs, Bruch’s membrane (BM) opening area, and gamma zone parapapillary atrophy (PPA) width were compared between the two groups. Factors associated with faster VF progression were determined by logistic regression analysis. Results: The mean follow-up duration was 8.9 ± 4.4 years. The mean value of SE and axial length were -6.31 ± 1.88 D and 26.05 ± 1.12 mm, respectively. The mean global visual field progression rate was -0.32 ± 0.38 dB/y. Tilt ratio, BM opening area, and gamma zone PPA width were significantly greater in the eyes with faster VF progression than those with slower progression. In multivariate analysis, these factors were significantly associated with faster VF progression (all P < 0.05), while SE and axial length were not associated with it. Conclusion: In myopic glaucoma subjects, tilt of the optic disc and temporal shifting and enlargement of the BM opening were associated with faster rate of VF progression between paired eyes. This suggests that myopia influences VF progression in glaucomatous eyes via optic disc deformations rather than via refractive error itself. [ABSTRACT FROM AUTHOR]

Purpose: To examine the association of myopia with the visual field (VF) defects in open-angle glaucoma (OAG) using paired eyes to eliminate the effect of unknown confounding factors that are diverse among individuals. Methods: One hundred eighteen eyes of 59 subjects with myopia (spherical equivalent [SE] ≥ -2 diopter [D] and axial length ≥ 24.0 mm) whose intra-ocular pressure between paired eyes was similar and the mean deviation (MD) of the Humphrey VF test differed by more than 6 dB were included. Refractive errors (SE, axial length) and parameters associated with the papillary and parapapillary myopic deformation (tilt ratio, torsion angle, and β-zone parapapillary atrophy [PPA] area without Bruch’s membrane) were measured in each eye. The paired eyes were divided into worse and better eyes according to the MD of the VF, and parameters were compared between them. Further, multiple linear regression analysis was performed to examine the correlation of the difference in various parameters with the MD difference between paired eyes. Results: The SE of all eyes was -6.39 ± 2.15 D (mean ± standard deviation) and axial length was 26.42 ± 1.07 mm. MD of the worse and better VF eyes were -13.56 ± 6.65 dB and -4.87 ± 5.32 dB, respectively. Eyes with worse VFs had significantly greater SE, axial length, tilt ratio, and PPA area without Bruch’s membrane than those with better VFs (all P < 0.05). In multiple linear regression analysis, the difference of the MD between paired eyes was significantly correlated with the difference in the tilt ratio and PPA area without Bruch’s membrane. Conclusion: The myopic papillary and parapapillary deformations, but not refractive error itself, were related to the worse VF in paired eyes with OAG. This suggests that myopia influences the severity of the glaucomatous VF defects via structural deformation. [ABSTRACT FROM AUTHOR]

Purpose To investigate characteristics of lamina cribrosa (LC) defects in myopic eyes with open-angle glaucoma (OAG) using spectral-domain (SD) optical coherence tomography (OCT). Design Cross-sectional study. Participants One hundred thirty-three eyes with OAG and 83 eyes without OAG, with axial length of 24 mm or more. Methods Serial enhanced depth imaging SD OCT B-scans of the optic disc were acquired and reviewed for LC defects (diameter, ≥100 μm) and large pores (diameter, 60–100 μm). The numbers and locations of LC defects and large pores in each eye were assessed. In eyes with OAG, factors related to the number of LC defects were evaluated, as well as the association between the locations of LC defects and visual field (VF) defects (e.g., paracentral scotoma [PCS] and superior or inferior hemifield defects). Main Outcome Measures Numbers and locations of LC defects and large pores. Results In myopic eyes with and without OAG, the average numbers of LC defects were 3.8 and 0.8 and numbers of large pores were 1.9 and 1.6, respectively. In both groups, LC defects and large pores were located predominantly at the temporal periphery. Among eyes with OAG, the number of LC defects was relatively high in the eyes with greater optic disc tilt angle and worse mean deviation of the VF (both P < 0.001). The number of temporal LC defects and tilt angle were associated with presence of PCS, whereas the number of inferior and superior LC defects and torsion direction were associated with presence of superior and inferior VF defects. Conclusions Myopic eyes with OAG exhibited LC defects and large pores at similar locations as those without OAG, but in greater numbers, suggesting that these focal alternations of the LC in myopic eyes may evolve into larger defects when glaucoma develops in the eye. The number of LC defects, which was related to the optic disc tilt angle, was associated significantly with glaucomatous VF defects in both severity and location. This suggests that myopia may influence glaucomatous VF defects through optic disc tilt by way of an increased number of LC defects at the temporal periphery. [ABSTRACT FROM AUTHOR]

To elucidate the clinical and epidemiologic characteristics of optic neuritis in Japan. Multicenter cross-sectional, observational cohort study. A total of 531 cases of unilateral or bilateral noninfectious optic neuritis identified in 33 institutions nationwide in Japan. Serum samples from patients with optic neuritis were tested for anti–aquaporin-4 antibodies (AQP4-Abs) and anti–myelin oligodendrocyte glycoprotein antibodies (MOG-Abs) using a cell-based assay and were correlated with the clinical findings. Antibody positivity, clinical and radiologic characteristics, and visual outcome. Among 531 cases of optic neuritis, 12% were AQP4-Ab positive, 10% were MOG-Ab positive, 77% were negative for both antibodies (double-negative), and 1 case was positive for both antibodies. Pretreatment visual acuity (VA) worsened to more than a median 1.0 logarithm of the minimum angle of resolution (logMAR) in all groups. After steroid pulse therapy (combined with plasmapheresis in 32% of patients in AQP4-Ab–positive group), median VA improved to 0.4 logMAR in the AQP4-Ab–positive group, 0 logMAR in the MOG-Ab–positive group, and 0.1 logMAR in the double-negative group. The AQP4-Ab–positive group showed a high proportion of females, exhibited diverse visual field abnormalities, and demonstrated concurrent spinal cord lesions on magnetic resonance imaging (MRI) in 22% of the patients. In the MOG-Ab–positive group, although posttreatment visual outcome was good, the rates of optic disc swelling and pain with eye movement were significantly higher than those in the AQP4-Ab–positive and double-negative groups. However, most cases showed isolated optic neuritis lesions on MRI. In the double-negative group, 4% of the patients had multiple sclerosis. Multivariate logistic regression analysis of all participants identified age and presence of antibodies (MOG-Ab and AQP4-Ab) as significant factors affecting visual outcome. The present large-scale cohort study revealed the clinicoepidemiologic features of noninfectious optic neuritis in Japan. Anti–aquaporin-4 antibody–positive optic neuritis has poor visual outcome. In contrast, MOG-Ab positive cases manifested severe clinical findings of optic neuritis before treatment, but few showed concurrent lesions in sites other than the optic nerve and generally showed good treatment response with favorable visual outcome. These findings indicate that autoantibody measurement is useful for prompt diagnosis and proper management of optic neuritis that tends to become refractory. [ABSTRACT FROM AUTHOR]

Purpose To investigate optic disc margin anatomic features in myopic eyes with open-angle glaucoma (OAG) using spectral-domain (SD) OCT. Design Cross-sectional study. Participants Two hundred four eyes of 102 participants with OAG and 106 eyes of 53 participants without glaucoma with axial length of 24 mm or more. Methods Radial SD OCT B-scans centered on the optic discs were acquired in each eye, and the SD OCT data were colocalized with the optic disc stereophotographs. Optic disc margin anatomic features were evaluated as (1) SD OCT structure coinciding with the disc margin identified in the stereophotograph, (2) border tissue configuration, and (3) presence of Bruch's membrane overhang, and their frequency was computed in each clock-hour position. Further, paired eyes of myopic participants with OAG were divided into eyes with better or worse visual field defect (VFD), according to the mean deviation of the Humphrey visual field test, and associated factors were compared. Main Outcome Measures Spectral-domain OCT structures coinciding with the visible optic disc margin in stereophotographs. Results In myopic eyes with OAG, mean axial length was 25.96±1.07 mm and mean deviation was –8.87±7.78 dB. In approximately 90% of the participants, anterior scleral opening (ASO) coincided with the temporal disc margin and Bruch's membrane opening (BMO) with the nasal disc margin. Border tissue configuration was externally oblique in the temporal region and internally oblique in the nasal region of the optic disc. Bruch's membrane overhang was observed in a relatively small percentage of eyes. The same pattern of disc margin anatomic features was observed in the myopic eyes without glaucoma. The myopic optic disc was shaped by the temporal shifting of the BMO from the ASO, and the extent of shifting was expressed as the width of γ zone parapapillary atrophy (PPA). The greater γ zone PPA width was associated significantly with the worse VFD between paired eyes. Conclusions The myopic eyes with OAG exhibited characteristic optic disc margin anatomic features that was considered to be derived from myopic deformation of the eye. The greater γ zone PPA width may increase susceptibility to the glaucomatous stress. [ABSTRACT FROM AUTHOR]