Association of progressive optic disc tilt with development of retinal nerve fibre layer defect in children with large cup-to-disc ratio

Background/aims Whereas myopic optic disc deformation has been posited as a risk factor for glaucomatous damage, longitudinal studies evaluating their association have been sparse. We investigated whether the optic nerve head (ONH)'s morphological alteration during myopia progression play any role in development of retinal nerve fibre layer defect (RNFLD) in children with a large vertical cup-to-disc ratio (vCDR). Methods Sixty-five normotensive eyes of 65 children aged under 8 years with (1) vCDR >= 0.5 but no additional signs of glaucoma and (2) who could be tracked at young adulthood (18-28 years) were included. Children's spherical equivalent (SE), intraocular pressure, vCDR and optic disc tilt ratio were recorded. Rare events logistic regression analysis was employed to identify factors associated with RNFLD-development risk. Results The study group's mean age was 5.4 +/- 1.3 years, its average vCDR was 0.62 +/- 0.07, and the average SE was -0.3 +/- 1.4 dioptres ((D), range -3.15 to 2.75D) at the baseline. After an average follow-up of 16.1 +/- 3.0 years, the mean vCDR was 0.64 +/- 0.09, and the mean SE, -3.2 +/- 2.2D (range -7.25 to 0.00 D). Among the 65 eyes, 12 (18.5%) developed RNFLD. A greater SE change (OR=1.737, p=0.016) and a greater increase in tilt ratio (OR=2.364, p=0.002) were both significantly associated with higher RNFLD-development risk. Conclusion In this cohort of Korean children with large vCDR, progressive optic disc tilt in the course of myopia progression was associated with higher RNFLD-development risk. This finding suggests that morphological alterations in the ONH during axial elongation might represent an underlying susceptibility to glaucomatous damage in large-vCDR children.

Automated summary

This study aimed to investigate the relationship between optic disc morphological changes during myopia progression and the development of retinal nerve fiber layer defect (RNFLD). The results showed that progressive optic disc tilt during myopia progression was associated with a higher risk of RNFLD development in children with large vertical cup-to-disc ratio (vCDR).