Myopic Glaucoma More Than Just High Pressure,details Review

Although Primary Open-Angle Glaucoma (POAG) is widely recognized, existing population-based studies often fail to address how unique structural distortions and statistically normal Intraocular Pressure (IOP) create a diagnostic gap that leaves many younger patients underdiagnosed. To bridge this gap, lead author Caroline K. Diniz from the Suel Abujamra Institute and the Glaucoma Institute in São Paulo, Brazil, along with her colleagues, conducted this review to establish a practical framework for the early recognition and optimized management of this condition.

Therefore, the review was designed as a comprehensive narrative review that synthesized thirty years of peer-reviewed clinical and basic science literature from major databases to establish an evidence-based framework for identifying the distinct pathophysiology of myopic glaucoma. The researchers analyzed structural and functional markers while evaluating emerging imaging sensitivities and target pressure thresholds as primary endpoints to address the current limitations in monitoring high-risk populations.

Key Clinical Findings of the Review Include:

• Structural Fragility: Research indicates that axial elongation and thinning of the lamina cribrosa cause glaucomatous progression even when IOP levels fall between 12 and 16 mm Hg.

• Functional Deficits: Research shows that standard 24-2 perimetry often fails to detect early paracentral visual field defects common in myopic eyes, whereas 10-2 testing significantly improves detection rates.

• Diagnostic Indicators: Research found the "crescent moon sign" to be a critical indicator for identifying optic disc cupping in tilted myopic discs that are often misidentified during routine examination.

• Imaging Precision: Research confirms that Wide-field Optical Coherence Tomography Angiography (WF-OCTA) provides superior sensitivity in identifying structural damage by addressing the anatomical distortions inherent in elongated eyes compared to conventional imaging.

• Surgical Management: Research emphasizes that for high-risk younger patients, maintaining a narrow postoperative pressure window between 7 and 11 mm Hg is vital to prevent complications like hypotony maculopathy.

The results suggest that the projected increase in global myopia to 50% of the population by 2050 requires a clinical shift toward individualized monitoring and lower target pressures to prevent irreversible functional disability in these high-risk eyes.

Thus, the review concludes practitioners should consider implementing individualized monitoring and lower pressure targets early in the disease course to address the enhanced structural vulnerability of the myopic optic nerve.

While the review establishes a vital framework, its narrative design and focus on Asian cohorts highlight the necessity for future longitudinal studies to explore the long-term prognosis and natural history of the disease across diverse ethnic groups.

Reference

Diniz CK, Meira MA, Gondim LAVAS, et al. Managing Myopic Glaucoma—Beyond Structural Fragility and Diagnostic Challenges: Review Article. J Curr Glaucoma Pract 2026;20(1):20–25.