Optic disc appearance and retinal temporal vessel arcade geometry in high myopia, as based on follow-up data over 38 years

Purpose: To discuss (i) optic disc appearance and (ii) the retinal course of the temporal vessel arcade in a longitudinal series of high myopia patients followed between the ages of 16 and 54. Methods: Thirty-nine individuals from a 1948 Copenhagen birth cohort (n = 9243) who had myopia of -6 to -15 D when aged 14 years were invited for current follow-up exams with 7-10-year intervals. Fundus photos were available from up to five occasions over 38 years, and single eye photo collages were studied with respect to posterior pole changes over time. Results: Fifty-two eyes with high myopia were available. (i) Contrary to the expected predominance of large flat optic discs in long eyes, more than half the eyes in the sample had neurodiscs that were perceived to be small; many were also oval/kinked/tilted and with minimum or absent physiological cups. Among the fellow eyes with unilateral high myopia only one out of the 10 discs appeared as small/tilted. (ii) By age, a more acute angle between upper and lower temporal retinal vessel trunks was found in 12/20 eyes with adult myopia progression (change over time 5-23 degrees) and in 6/24 eyes with stable myopia. In the myopia-progression subgroup, peaking of the angle was correlated with myopia degree, myopia increase and axial elongation. Conclusion: Contrary to clinical expectation, we found neurodiscs that appeared to be small and dense in eyes with high myopia. We further discussed the eventual peaking of the angle between the temporal vessel arcades that is sometimes observed in high myopia. Occasionally, literature on myopia reports the presence of small and tilted discs whereas no mention was found of the issue of temporal vessel arcade peaking.