Screening of high myopia patients for association with primary open angle glaucoma.

Article Information

Title: Screening of high myopia patients for association with primary open angle glaucoma.

Journal: The Professional Medical Journal (TPMJ)

HEC Recognition History

Category	From	To
Y	2024-10-01	2025-12-31
Y	2023-07-01	2024-09-30
Y	2022-07-01	2023-06-30
Y	2021-07-01	2022-06-30

Publisher: Independent Medical College, Faisalabad- Pakistan

Country: Pakistan

Year: 2022

Volume: 29

Issue: 4

Language: English

DOI: 10.29309/TPMJ/2022.29.04.6593

Keywords: Primary open angle glaucoma (POAG)Cupped-Disc Ratio (CDR)Diopter Spherical (DS)Intra Ocular Pressure (IOP)Optical Coherence Topography (OCT)

Abstract

Objectives: To review the prevalence of primary open angle glaucoma in patients with high myopia. Study Design: Observational Study. Setting: Department of Ophthalmology, KDA Teaching Hospital Kohat. Period: January 2019 to December 2019. Material &amp; Methods: During this period 93 high myopic patients were selected. Informed consents were taken from them after explaining the purpose, procedure and tests required for diagnosis. Out of 93 patients 74 were male and 19 were female. Age range of the patients was from 20 to 57 years with mean age 43 years. Proper proforma was designed for documentation of intraocular pressure, perimetry, fundoscopy (Cup-disc ratio) and Optical coherence topography. Refraction of all patients was done with auto-refractometer and then subjectively. All 93 patients were high myopic with refractive error of -6 diopter spherical and above. Intraocular pressure was checked with air puff tonometer. Anterior segment examination was checked with slit lamp. Gonioscopy was done in 9 patients whose angles were suspected to be narrow or open. Pupils were dilated with tropicamide eye drops. Fundosopy with direct and indirect slit lamp biomicrosopy was done for Cupped-Disc ratio. 2 patients who had high intraocular pressure with no glaucomatous cupping disc were advised Optical coherence topography. Perimetry to all patients was advised with automated visual field analyzer. Results: Out of 93 high myopic patients 13(13.97%) had glaucomatous features. Out of 13 patients intraocular pressure more than 21mmHg and glaucomatous field defects were present in 100% while glaucomatous cupping discs were present in 11(84.61%) patients. Conclusion: High myopia is high risk association with primary open angle glaucoma.

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Research Objective

To review the prevalence of primary open angle glaucoma in patients with high myopia.

Methodology

Observational study conducted in the Department of Ophthalmology, KDA Teaching Hospital Kohat from January 2019 to December 2019. 93 high myopic patients (refractive error of -6 diopter spherical and above) were selected. Data collected included intraocular pressure (IOP), perimetry, fundoscopy (Cup-disc ratio), and Optical Coherence Topography (OCT). Refraction was done with an auto-refractometer and subjectively. IOP was checked with an air puff tonometer. Anterior segment examination was done with a slit lamp. Gonioscopy was performed on 9 patients with suspected narrow or open angles. Pupils were dilated with tropicamide. Fundoscopy was done for Cup-Disc ratio. OCT was advised for 2 patients with high IOP and no glaucomatous cupping. Perimetry was advised to all patients using an automated visual field analyzer.

Methodology Flowchart

                        graph TD;
    A["Select 93 High Myopic Patients"] --> B["Obtain Informed Consent"];
    B --> C["Collect Data"];
    C --> D["Measure Refraction"];
    C --> E["Check Intraocular Pressure"];
    C --> F["Perform Anterior Segment Examination"];
    C --> G["Perform Gonioscopy if needed"];
    C --> H["Dilated Fundoscopy CDR"];
    C --> I["Advise OCT if needed"];
    C --> J["Advise Perimetry"];
    J --> K["Analyze Results"];
    K --> L["Identify Glaucomatous Features"];
    L --> M["Report Findings"];

Discussion

The study supports existing research and meta-analyses indicating a strong association between high myopia and Primary Open Angle Glaucoma (POAG). High myopia is identified as a significant risk factor for POAG, and myopic patients may experience other serious ocular comorbidities. Therefore, regular screening for POAG in all myopic patients is crucial for timely diagnosis and treatment.

Key Findings

Out of 93 high myopic patients, 13 (13.97%) had glaucomatous features. Among these 13 patients, 100% had intraocular pressure > 21 mmHg and glaucomatous field defects, while 84.61% had glaucomatous cupped-disc.

Conclusion

High myopia is a high-risk association with primary open angle glaucoma. All myopic patients should be screened for POAG at frequent intervals to allow for timely management of concurrent comorbidities.

Fact Check

1. Prevalence of Glaucoma in High Myopia: The study found that 13.97% of high myopic patients had glaucomatous features.
2. Intraocular Pressure in Glaucomatous High Myopes: 100% of the 13 patients with glaucomatous features had an intraocular pressure greater than 21 mmHg.
3. Study Period: The study was conducted from January 2019 to December 2019.

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