Morphology and Microcirculation Changes of Optic Nerve Head Between Simple High Myopia and Pathologic Myopia

doi:10.21203/rs.3.rs-1038132/v1

PDF

Research Article

Morphology and Microcirculation Changes of Optic Nerve Head Between Simple High Myopia and Pathologic Myopia

https://doi.org/10.21203/rs.3.rs-1038132/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted 15 Nov, 2021

You are reading this latest preprint version

This study explored morphology and microcirculation changes of optic nerve head (ONH) in simple high myopia(SHM) and pathologic myopia(PM), in order to evaluate and identify ONH changes in the development of PM. We divided 193 right eyes of 193 patients into SHM and PM according to the retinopathy. We found that ONH is one of the earliest pathological changes in myopia, and its morphology changes were also the most obvious. PM is closely linked to the reduction of choroidal perfusion and structural changes of ONH. Microcirculation showed a significant priority changes in myopia. Further research should address whether these fndings are associated with future disease development in highly myopic eyes.

Health Policy

Ophthalmology

Morphology

microcirculation

optic nerve

pathologic myopia

Pathologic myopia(PM) is an important cause of low vision and blindness, and population incidence is 0.9%~3.1% in Asian countries[1]. Different from simple high myopia(SHM), PM can lead to irreparable visual impairment, and is irreversible. Typical fundus lesions of PM include fundus tigre, lacquer crack, retinal choroidal atrophy, choroid neovascular, macular atrophy, posterior scleral staphyloma, retinosis. Although PM is irreversible, it is urgently needed to strengthen the early identification. Previous study found that the optic nerve head(ONH) is one of the earliest pathological changes in myopia, and its morphology changes were also the most obvious[2]. Evaluation and identification of early ONH changes in HM, which will be conducive to the early diagnosis and treatment of PM. Prior to fundus lesions occurred, patients were reasonably treated to reduce vision-threatening complications.

Subjects and study design

The study adhered to the principles of the Declaration of Helsinki and was approved by the Ethics Committee of Changsha Aier Eye Hospital, Central South University, Changsha, China. The medical records of 193 consecutive patients with myopia from May 2020 to January 2021 at the refractive department were reviewed retrospectively. Comprehensive examinations including slit-lamp biomicroscopy, mydriatic indirect ophthalmoscopy, intraocular pressure(IOP), axial length(AL)(IOL Master 700; Carl Zeiss Meditec, Germany), ultra-widefield fundus imaging (Optos; Daytona P200T, Nikon,Japan), swept source optical coherence tomograph(SS-OCT)(DRIOCT Triton, Topcon, Japan), visual acuity and refractive error were conducted for all participants.

The inclusion criteria was: (1) the diopter > -6.00DS and the AL > 26mm; (2) IOP ≤ 21mmHg; (3) SS-OCT acquisition signal ≥ 60. Patients were excluded from the study if they had hypertension, diabetes, systemic connective tissue disorder, any other ophthalmic disease (such as cataract, glaucoma, macular hole, retinal hole, retinal hemorrhage etc.), history of ophthalmic trauma and surgery.

According to Meta-PM[3], myopia without fundus lesions and/or just fundus tigre considered as SHM. PM defined as patients with diffuse retinal choroidal atrophy, patchy retinal choroidal atrophy, macular atrophy, or any combined additional lesions: paint crack, choroidal neovascularization, fuchs plaque, scleral staphyloma.

Parameters from Optos and SS-OCT

We used the Optos to perform digital photography, and the images was exporte into the Image-pro Plus (version 6.0) to measure the morphology of ONH. Size, disc-fovea distance(DFD), angle α, tilt, rotation, peripapillary atrophy(PPA) area, and PPA radian were measured from these photographs by the aforementioned retinal ophthalmologists(Fig. 1). The area of PPA (an inner crescent of chorioretinal atrophy with the visible sclera and choroidal vessels) and ONH were expressed as the total number of pixels using the Image-Pro Plus. The definitions of the tilt and rotation were explained before[4]. Briefly, Tilt was quantified by the tilt index, which defined as the ratio between the largest diameter(LD) and the smallest diameter(SD) of ONH. ONH may considered as tilt, when the tilt index>1.3. Rotation was defined as the angle between the long axis and the vertical meridian of ONH. The vertical meridian was defined as a vertical line that passes through the center of ONH and at 90°from the horizontal line which connects the fovea and the center of ONH. When the rotation angle is greater than 15°, ONH may considered as rotation. The angle α between retinal temporal arterial vascular arcades was measured from the center of ONH with 250 pixels radius[5].

We use SS-OCT (centered on the ONH, with a scanning range of 6×6mm) where system automatically measures the peripapillary retinal nerve fiber layer(PRNFL) thickness, peripapillary choriodal thickness(PCT), peripapillary scleral thickness(PST), and peripapillary vessel density(PVD) (Fig. 2). We divided the ONH into 12 directions (1-superonasal, SN; 2-nasosuperior, NS; 3-nasal, N; 4-nasoinferior, NI; 5-inferonasal, IN; 6-inferior, I; 7-inferotemporal, IT; 8-temporoinferior, TI; 9-temporal, T; 10-temporosuperior, TS; 11-superotemporal, ST; 12-superior, S), Before SS-OCT image acquisition, we input the examinee's information (including diopter, corneal curvature and AL) to adjust the magnification factor. The average value was used in the final analysis.

Statistical analysis

SPSS22.0 software was used for the statistical analysis. Wherever the data had the normal distribution, it was presented as mean±standard deviation (X±SD), and the LSD test was applied for difference analysis between two groups. Wherever the data could not meet the normal distribution, it was represented as median (upper quartile, lower quartile), and the non-parametric test (Mann-Whitney (U)) was used for difference analysis. The count data was expressed as a percentage(%) and was analysed with the χ² test. The P-value of <0.05, the difference was considerd to be statistically significant.

A total of 193 right eyes who met the inclusion and exclusion criteria were analyzed. Among them, 138 eyes were SHM, and 55 eyes were PM. As shown in Table 1, we could not detect any significant differences in SD, area, rotation and avg-PST between the two groups. Compared with the PM group(30.80±8.88 years), the patients in the SHM group(26.16±5.51 years) were significantly younger(P=0.010). There was a significant difference in the proportion of genders between the PM group (26: 29) and the SHM group (42༚96)(P=0.027). In addition, the PM group showed longer AL, longer DFD, longer LD, bigger SE, bigger tilt index, bigger tilt ratio, bigger PPA and radian, smaller angle α, smaller full-peripapillary sclera appearance, thinner PRNFL, thinner PCT, than the NPS group (All P<0.05).

Table 1

Demographic data, morphological parameters of SHM and PM.
	SHM(n=138)	PM(n=55)	t/Z/χ²	P
Age(yrs)	26.16±5.51	30.80±8.88	-3.585	0.010^*
Gender(male: female)	42: 96	26: 29	4.886	0.027^*
AL(mm)	26.62±1.04	28.54±1.48	-8.808	0.000^**
SE(D)	-8.35±1.26	-12.89±2.84	-11.409	0.000^**
DFD(Pixel)	430.53±25.09	450.41±33.38	-3.962	0.000^**
angle α(°)	122.85±22.34	113.77±17.39	2.728	0.007^**
LD(Pixel)	155.59(145.02,165.46)	162.19(147.14,182.73)	-2.525	0.012^*
SD(Pixel)	125.02±17.27	131.21±28.79	-1.489	0.141
area(Pixel)	15077(13291.5,17487.5)	16173(13582,20187)	-1.450	0.147
tilt index	1.27±0.13	1.32±0.18	-2.229	0.027^*
tilt ratio(%)	33.33%	49.09%	4.152	0.042^*
rotation angle (°)	24.64(12.28,47.99)	27.60(15.65,52.47)	-0.838	0.402
rotation ratio (%)	70.29%	76.36%	0.720	0.396
PPA area(Pixel)	6900(3977.25,11757.25)	14373(5876,30341)	-4.303	0.000^**
PPA/ONH	0.52±0.04	1.24±0.17	-4.070	0.000^**
PPA radian(°)	145.45(112.22,179.03)	166.98(121.88,257.71)	-2.834	0.005^*
Avg-PRNFL (µm)	104.96±10.70	101.14±8.88	2.347	0.020^*
Avg-PCT (µm)	108.75±30.70	93.82±29.96	3.072	0.002^*
Avg- PST(µm)	340.44±25.58	335.26±34.11	0.786	0.435
full-peripapillary sclera appearance(%)	64(46.4%)	35(63.6%)	4.689	0.030^*
AL=axial length; SE=spherical equivalent; DFD=disc-fovea distance; LD=largest diameter; SD=smallest diameter; PPA =peripapillary atrophy; ONH=optic nerve head; PRNFL=peripapillary retinal nerve fiber layer; PCT=peripapillary choriodal thickness; PST=peripapillary scleral thickness. ^P<0.05; ^*P<0.001

PRNFL parameters were compared between groups (Table 2, Fig. 3). Compared to the SHM, Avg-PRNFL (104.96±10.70um vs 101.14±8.88um, P=0.02), SN(97.56±20.09um vs 91.27±19.03um, P=0.048), I(122.91±18.58um vs109.95±20.20um, P<0.001), TI(88.58±18.52um vs 95.86±19.64um, P=0.016), ST(131.01±20.60um vs 122.23±23.80um, P=0.011) and S(114.21±17.90um vs 102.53±16.68um, P<0.001) were significantly thinner in the PM group. Nevertheless, there were no significant differences in the NS, N, NI, NI, IT, T, TS.

Table 2

PRNFL parameters of SHM and PM.
	SHM(n=138)	PM(n=55)	t	P
Avg-PRNFL (µm)	104.96±10.70	101.14±8.88	2.347	0.020^*
SN	97.56±20.09	91.27±19.03	1.991	0.048^*
NS	65.93±16.42	62.66±13.54	1.312	0.191
N	62.73±15.05	61.59±12.67	0.497	0.620
NI	59.53±15.89	60.42±14.42	-0.361	0.718
IN	94.92±22.74	87.29±22.30	2.115	0.036
I	122.91±18.58	109.95±20.20	4.263	0.000^**
IT	151.04±21.57	143.67±28.36	1.739	0.086
TI	88.58±18.52	95.86±19.64	-2.421	0.016^*
T	97.93±17.75	103.51±20.48	-1.884	0.061
TS	107.25±19.96	110±25.83	-0.793	0.429
ST	131.01±20.60	122.23±23.80	2.552	0.011^*
S	114.21±17.90	102.53±16.68	4.172	0.000^**
PRNFL=peripapillary retinal nerve fiber layer. ^P<0.05; ^*P<0.001

PCT parameters were compared between groups (Table 3, Fig. 4). Compared to the SHM, Avg-PCT(108.75±30.70um vs 93.82±29.96um, P=0.002), SN(130.76±38.81um vs 110.27±38.43um, P=0.001), NS(126.66±40.96um vs 106.61±35.56um, P=0.001), N(131.08±39.93um vs 110.64±28.39um, P<0.001), NI(126.52±42.66um vs 102.87±30.40um, P<0.001), IN(92.07±29.67um vs 110.01±40.27um, P=0.001), I(99.41±39.91um vs 86.02±28.86um, P=0.011) and ST(116.43±40.71um vs 99.36±39.41um, P=0.009) were significantly thinner in the PM group. Nevertheless, there were no significant differences in the IT, IT, T, TS, S.

Table 3

PCT parameters of SHM and PM.
	SHM(n=138)	PM(n=55)	t	P
Avg- PCT (µm)	108.75±30.70	93.82±29.96	3.072	0.002^*
SN	130.76±38.81	110.27±38.43	3.320	0.001^**
NS	126.66±40.96	106.61±35.56	3.384	0.001^**
N	131.08±39.93	110.64±28.39	3.993	0.000^**
NI	126.52±42.66	102.87±30.40	4.318	0.000^**
IN	110.01±40.27	92.07±29.67	3.404	0.001^**
I	99.41±39.91	86.02±28.86	2.593	0.011^*
IT	87.86±38.99	80.05±30.44	1.330	0.185
TI	77.24±36.45	73.13±35.89	0.710	0.478
T	79.42±63.87	67.42±40.40	1.293	0.198
TS	89.22±36.13	78.60±38.46	1.810	0.072
ST	116.43±40.71	99.36±39.41	2.652	0.009^*
S	130.42±39.37	118.78±40.34	1.841	0.067
PCT=peripapillary choriodal thickness. ^P<0.05; ^*P<0.001

The PVD parameters were compared between the groups (Table 4, Fig. 5).We found significant differences in SN, NS, NI, IN, IT, TI, and TS between two groups. The Avg-PVD(50.58±2.99% vs 47.59±2.78%) (P<0.001) in the SHM group were significantly higher compared to the PM group.

Table 4

PVD parameters of SHM and PM.
	SHM(n=138)	PM(n=55)	t	P
Avg-PVD(%)	50.58±2.99	47.59±2.78	6.398	0.000^**
SN	49.07±4.11	46.14±4.98	4.196	0.000^**
NS	44.97±5.16	40.66±6.10	4.971	0.000^**
NI	44.11±5.88	41.01±6.17	3.267	0.001^**
IN	49.01±5.14	44.62±6.25	5.029	0.000^**
IT	57.16±4.49	53.09±4.56	5.653	0.000^**
TI	54.93±5.41	50.83±7.60	4.202	0.000^**
TS	56.27±5.21	51.52±7.07	5.146	0.000^**
ST	54.38±4.43	52.82±5.29	2.090	0.038^*
PVD=peripapillary vessel density. P<0.05; *P<0.001

Comparison of morphology and microcirculation between SHM and PM(Fig. 6). A1 shows an ONH with reddish, oval, temporal type PPA, belong to SHM; A2 shows an ONH with yellowish, oval, toroidal type PPA, belong to PM; B and D show that the microvascular density of PM is reduced, accompanied by a patch defect area. C shows significant changes in PRFNL distribution in PM compared with SHM. E shows no changes in PST in PM compared with SHM, but the full-peripapillary sclera appearance is enhanced, and PCT is thinner.

The main purpose of this study is to compare the difference of ONH between SHM and PM, so as to find the measurable indicators of morphological and microcirculatory parameters related to ONH. At present, the clinical definition of PM is not clear. Therefore, it is necessary to discover the unique features of PM from the existing examination equipment.

1 The relative position of ONH

Previous study have shown that axial myopia mainly depends the posterior eyeball enlargement, and the closer the posterior pole the more obvious[6]. To assess the extent of expansion of the posterior eyeball, We measured the DFD and angle α. DFD is a description of the relative position of ONH and fovea, and we found that DFD in the PM group was longger than the SHM group. In a prospective study[7], it was found that DFD increased from (4.98±0.3) mm to (6.11±0.5) mm in adolescents with an increasing AL. As a characteristic indicator of the posterior polar morphological changes of HM, angle α is an important reference for the nasal displacement of ONH. We found that the angle α of SHM (122.85±22.34) bigger than PM(113.77±17.39). Compared with the SHM, the distance between ONH and fovea of PM was further widened, and the upper and below retinal vessels were pulled to cause the reduction of vascular clamp. In a prospective observation study, Lee[8] found that with axial elongation of myopia, the central vascular trunk of retina were dragged nasally, believing that nasally passive traction of the lamina cribiosa was the main reason. Changes in DFD and angle α can be explained by the expansion of the posterior eyeball in myopia, and the closer the posterior pole the more obvious. Therefore, it is once again proved that the posterior eyeball enlargement and the peripapillary tissue pulling displacement are progressive aggravation in PM.

2 The shape and size of ONH

Normal ONH is round or oval with an average diameter of 1.5mm. ONH is the access of the optic nerve and retinal vessels in eye, consisting of nerves, vessels and bindweb. The changes of ONH are often manifested as tilt and PPA in HM. Results show that there is no significant difference between the area and SD of ONH in SHM group and PM group, while LD and tilt index of ONH are significantly different, and the ratio of tilt increased in PM. On the one hand, the ONH becomes more non-round and more flat in HM. On the other hand, the serious tilt and distorted deformation have an adverse impact on the optic nerve and resulting in vision decline[9]. This indicates that the identifiable or quantitative parameters should be obtained from the tilt and deformation of ONH.

3 The size and type of peripapillary atrophy(PPA)

PPA is attributed to photoreceptor reduction, RPE and choroid capillary loss, bruch membrane displacement or defects. As a characteristic change of myopia, the expansion of PPA indicates the progression of myopia. During 20 years prospective studies on fundus in children with HM, Yokoi[10] found that 87% of adults with PM had diffuse choroid retinal atrophy in childhood, suggesting that adult patients with PM already showed a fundus appearance different from the fundus appearance in children with simple myopia. Meanwhile, the sign of peripapillary diffuse chorioretinal atrophy in childhood may be an indicator or biomarker for more advanced myopic chorioretinal atrophy in later life. Our results show that the PPA area and radian of the PM group were significantly greater than the SHM. However, the actual area size cannot be calculated due to image analysis using image J software. So we introduce the ratio of PPA area / ONH area (PPA/ONH) to estimate the size of the PPA. The PPA/ONH of the PM group was 1.24 ± 0.17, significantly greater than 0.52 ± 0.04 in the SHM group. It indicates that when the PPA area is bigger than the ONH area, we need to carefully examine and find evidence of PM.

4 The thickness of the peripapillary tissue

ONH is seamless connected to the RNFL, choroid, and sclera, and which play a key role in morphology changes. PRNFL mainly shows changes in thickness and distribution in HM. Our results show that the average thickness of PRNFL in PM group is lower than that of SHM group, especially inferior and superior; However, the temporoinferior PRNFL of PM group is slightly higher than that of SHM group. Analogously, while studying the changes in displacement and morphology of ONH, Tan[11] found that the angle between the superior and inferior temporal RNFL bundles decreased by 3.3°for every 1mm increasing of AL. A reasonable explanation is that the retina pulls along with the ONH to the nasal side in axial myopia, and the inferior and superior RNFL move closer toward the temporal side. Clinically, there is often a shift of the peak RNFL position to the temporal side, which leads to relative thickening in temporal.

The choroid, as a vascular tissue, lies between scleral and retina. Compared with normal people, both in anatomy and OCT, choroid is shown to be significantly atrophy and thinning in HM[12]. Moreover, our study further demonstrated that the choroid of PM(93.82±29.96μm) was thinner compared with SHM(108.75±30.70μm). Subregional measurements show that nasal and superior PCT were thicker than the inferior and temporal PCT, where the temporal side was the thinnest. This heterogeneity of altered choroid may be an intrinsic reason why myopia-associated fundus lesions often occurring on the temporal side of ONH[13]. Choroid not only support outer retinal nutrition, but also release multiple vascular factors to regulate scleral growth. Studies have found that a compensatory increase in retinal vessel oxygen saturation was observed in moderate myopia, which may be related to insufficient choroid blood supply to the outer retina and increased oxygen consumption. But this compensatory effect disappears immediately when HM occurs, making the retina more prone to pathological changes. Meanwhile, Liu[14] found that the choroid is involved in the transmission of biological signals from retina to sclera, and is involved in the regulation of scleral remodeling and staphyloma. Therefore, more attention should be paid to choroid to assess the progression of PM.

As the outermost layer of the eyeball, the sclera plays an important role in stabilizing intraocular pressure, protecting intraocular structure and maintaining normal morphology. The morphology and structure of the sclera is constantly changing, and its biochemical and biomechanical properties change with AL, including phenotype of the scleral fibroblasts and composition of the extracellular matrix[15]. Whether the posterior scleral bound is detected by SS-OCT is closely related to the choroidal thickness and the bruch membrane atrophy, so the full sclera appearance reflects the pathologic status of eyeball. Ohno-Matsui used the SS-OCT to find that 57% of the eyes can show the whole scleral structure, and the Tenon's capsule and orbital fat tissue can also be shown in some eyes[16]. In this study, the rate of full-peripapillary sclera appearance in whole subjects reached 51.3%, and the rate in PM(63.6%) was significantly higher than that in SHM(46.4%). This also means that prescleral tissue atrophy was much higher in the PM than SHM. However, no comparable parameters were obtained by scleral thickness, and may suggest that PST isn't a reliable indicator of PM.

In conclusion, we speculate that choroidal changes may precede the RNFL and sclera, by affecting the blood supply of the two tissues, stimulate myopia toward HM, and ultimately result in PM. These initial insights may provide clues and basis for further investigation of histology in HM.

5 The microcirculation of the ONH

In this study, the PVD was lower in the PM group compared with the SHM. Similarly, a study showed that HM with less peripapillary retinal blood flow index and vessel density(VD) compared to the emmetropia, suggesting decreased peripapillary microcirculation perfusion[17]. We also found that the PVD in PM was lower in each direction than in SHM, and the VD in the temporal direction was higher than that in the nasal direction in both group. This result may suggest that blood flow may be preferentially perfused in the bow-shaped nerve fiber region to meet the energy metabolic needs of RNFL. Just as no significant VD reduction was found in the macula of HM. Such a relative retention of retinal blood flow perfusion in the vital area can ensure the normal visual function. At the same time, we found that the PCT in the nasal direction was thicker than that in the temporal direction, quite opposite to the results of retinal blood perfusion. The reason may be due to the anatomical characteristics of the ONH, and the complex blood circulation, witch mainly provided by the retinal circulation and choroidal circulation. Meanwhile, the Zinn-Haller provided the main blood supply to the lamina cribiosa of ONH, and Ishida[18] found that the distance between the Zinn-Haller and the boundary of ONH increased significantly with AL. On the one hand, the Zinn-Haller may play a key role in maintaining blood perfusion stabilization in the ONH; On the other hand, the progressive tilt and rotation of ONH are often accompanied by abnormal and slow choroidal circulation and terminal artery occlusion in HM, It is easy to occur circulation disorder in ONH. However, the mechanism of reduced retinal and choroidal perfusion is unclear. It is often believed that hyperexpansion causes the retina and choroidal thinning in HM, and these thinning tissues may reduce oxygen demand and thus blood perfusion[19].

We acknowledge a number of limitations associated with our study. This is a retrospective study and hence longitudinal data were not available, thus, it may not reflect the true representative of the population. Furthermore, as the requirements of SS-OCT scan quality, most patients with PM were excluded from the study, and selection bias inevitably occurs. Last, the magnification effect of images may affect the results of OCT measurements (e. g., vessel density and area), but the current formula for amplification correction is not uniform, and remeasurement is separated from the OCT measure system, which may bring new deviations. However, the range of 4.5×4.5mm scans used in this study is small enough that the effect of the amplification effect is not significant.

Consequently, the PM is closely linked to the reduction of choroidal perfusion and structural changes of ONH. Compared with SHM, PM is older, higher diopter, AL and DFD are longer, the angle α is smaller, tilt index is bigger, PPA area and radian are larger, PCT is generally thinner, and PVD is lower. It is not possible to regain normal vision once PM related complications occur. Hence, there is an unmet need for preventive measures to avoid the development of myopia-associated complications in HM eyes that needs to be urgently taken care of. Future work should focus on the etiology of PM.

Funding

Grant/financial support: Supported by National Natural Science Foundation of China (Grant No.81970801), Health Commission of Hunan Province (Grant No.202107020468, 202107021955,20190734).

Availability of data and materials

The datasets used and analyzed for the present study are available from the corresponding author.

Authors’ contributions

WT & XD designed the research study; WT & JO wrote the paper; WT, YL, & JO analyzed and interpreted the data; XD, YL & JOcontributed to critical revision of the article; XD, XW & YL obtained and provided administrative, technical or logistic support. All authors approved the manuscript.

Ethics approval and consent to participate

All research methods are in accordance with the tenets of the Declaration of Helsinki and approved by the Ethics Committee of Changsha Aier Eye Hospital(LL-SOP-008(F)-002-02).

Consent for publication

All study subjects gave informed consent.

Competing interests

The authors declare no conflict of interest.

Wong Y L, Saw S M. Epidemiology of Pathologic Myopia in Asia and Worldwide[J]. Asia Pac J Ophthalmol （Phila）, 2016,5（6）：394-402.DOI：10.1097/APO.0000000000000234.
Samarawickrama C, Mitchell P, Tong L, et al. Myopia-related optic disc and retinal changes in adolescent children from singapore[J]. Ophthalmology, 2011,118（10）：2050-2057.DOI：10.1016/j.ophtha.2011.02.040.
Ohno-Matsui K. Pathologic Myopia[J]. Asia Pac J Ophthalmol （Phila）, 2016,5（6）：415-423.DOI：10.1097/APO.0000000000000230.
Sung M S, Kang Y S, Heo H, et al. Characteristics of Optic Disc Rotation in Myopic Eyes[J]. Ophthalmology, 2016,123（2）：400-407.DOI：10.1016/j.ophtha.2015.10.018.
Nie F, Ouyang J,Tang W et al. Posterior staphyloma is associated with the microvasculature and microstructure of myopic eyes.[J] .Graefes Arch Clin Exp Ophthalmol, 2021, undefined: undefined.10.1007/s00417-020-05057-0
Vurgese S, Panda-Jonas S, Jonas J B. Scleral thickness in human eyes[J]. PLoS One, 2012,7（1）：e29692.DOI：10.1371/journal.pone.0029692.
Guo Y, Liu L J, Tang P, et al. Optic disc-fovea distance and myopia progression in school children： the Beijing Children Eye Study[J]. Acta Ophthalmol, 2018,96（5）：e606-e613.DOI：10.1111/aos.13728.
Lee K M, Choung H K, Kim M, et al. Positional change of optic nerve head vasculature during axial elongation as evidence of lamina cribrosa shifting： Boramae myopia cohort study report 2[J]. Ophthalmology, 2018,125（8）：1224-1233.DOI：10.1016/j.ophtha.2018.02.002.
Pichi F, Romano S, Villani E, et al. Spectral-domain optical coherence tomography findings in pediatric tilted disc syndrome[J]. Graefes Arch Clin Exp Ophthalmol, 2014,252（10）：1661-1667.DOI：10.1007/s00417-014-2701-8.
Yokoi T, Jonas J B, Shimada N, et al. Peripapillary Diffuse Chorioretinal Atrophy in Children as a Sign of Eventual Pathologic Myopia in Adults[J]. Ophthalmology, 2016,123（8）：1783-1787.DOI：10.1016/j.ophtha.2016.04.029.
Tan N, Sng C, Ang M. Myopic optic disc changes and its role in glaucoma[J]. Curr Opin Ophthalmol, 2019,30(2)：89-96.DOI：10.1097/ICU.0000000000000548.
Song A, Hou X, Zhuo J, et al. Peripapillary choroidal thickness in eyes with high myopia[J]. J Int Med Res, 2020,48（4）：1220716825.DOI：10.1177/0300060520917273.
Deng J, Li X, Jin J, et al. Distribution Pattern of Choroidal Thickness at the Posterior Pole in Chinese Children With Myopia[J]. Invest Ophthalmol Vis Sci, 2018,59（3）：1577-1586.DOI：10.1167/iovs.17-22748.
Liu X, He X, Yin Y, et al. Retinal oxygen saturation in 1461 healthy children aged 7-19 and its associated factors[J]. Acta Ophthalmol, 2019,97（3）：287-295.DOI：10.1111/aos.14043.
McBrien N A, Gentle A. Role of the sclera in the development and pathological complications of myopia[J]. Prog Retin Eye Res, 2003,22（3）：307-338.DOI：10.1016/s1350-9462（02）00063-0.
Ohno-Matsui K, Akiba M, Modegi T, et al. Association between shape of sclera and myopic retinochoroidal lesions in patients with pathologic myopia[J]. Invest Ophthalmol Vis Sci, 2012,53（10）：6046-6061.DOI：10.1167/iovs.12-10161.
Wang X, Kong X, Jiang C, et al. Is the peripapillary retinal perfusion related to myopia in healthy eyes? A prospective comparative study[J]. BMJ Open, 2016,6（3）：e10791.DOI：10.1136/bmjopen-2015-010791.
Ishida T, Jonas J B, Ishii M, et al. Peripapillary arterial ring of zinn-haller in highly myopic eyes as detected by optical coherence tomography angiography[J]. Retina, 2017,37(2)：299-304.DOI：10.1097/IAE.0000000000001165.
Ohno-Matsui K, Jonas J B. Posterior staphyloma in pathologic myopia[J]. Prog Retin Eye Res, 2019,70：99-109.DOI：10.1016/j.preteyeres.2018.12.001.

No competing interests reported.

PDF

Version 1

posted 15 Nov, 2021

You are reading this latest preprint version

Morphology and Microcirculation Changes of Optic Nerve Head Between Simple High Myopia and Pathologic Myopia

Status:

Version 1

Abstract

Figures

Introduction

Methods

Subjects and study design

Parameters from Optos and SS-OCT

Statistical analysis

Results

Discussion

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1