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Glaucoma and High Myopia: Mid-2026 Clinical Insights · Glaucoma, Vision & Longevity: Supplements & Science

• 0:00
  SPEAKER_00: Glaucoma and High Myopia, mid-2026 Clinical Insights Evidence reviewed through July 26, 2026.
• 0:07
  SPEAKER_00: Introduction.
• 0:08
  SPEAKER_00: High myopia and glaucoma often overlap, but they are not the same condition.
• 0:13
  SPEAKER_00: High myopia changes the shape of the eye, optic nerve, retina, and supporting tissues.
• 0:18
  SPEAKER_00: These changes can imitate glaucoma on an eye examination, optical coherence tomography, or visual field test.
• 0:25
  SPEAKER_00: At the same time, high myopia appears to increase the eye's susceptibility to true glaucomatous damage.
• 0:32
  SPEAKER_00: High myopia is commonly defined as a spherical equivalent refractive error of minus six diopters or more negative or an axial length of approximately 26 millimeters or longer, although definitions vary between studies.
• 0:46
  SPEAKER_00: The distinction matters because a highly myopic eye may have an abnormal-looking optic disc and visual field without progressive glaucoma, while another eye may develop glaucoma despite apparently normal eye pressure.
• 0:58
  SPEAKER_00: Evaluating glaucoma in myopic eyes.
• 1:01
  SPEAKER_00: Interpreting the structure-function relationship in high myopia associated glaucoma.
• 1:06
  SPEAKER_00: The most reliable principle through mid-2026 is do not diagnose or exclude glaucoma from one red optical coherence tomography result, one tilted disc, one unusual visual field, or one eye pressure reading.
• 1:20
  SPEAKER_00: Look for reproducible, anatomically coherent change over time.
• 1:24
  SPEAKER_00: Why the glaucoma myopia interface is difficult.
• 1:27
  SPEAKER_00: Axial elongation stretches and remodels the back of the eye.
• 1:30
  SPEAKER_00: The optic disc may become tilted, rotated, enlarged, or obliquely inserted.
• 1:35
  SPEAKER_00: The surrounding tissue may show a large temporal crescent, peripillary atrophy, a gamma zone, posterior staphaloma, or other myopic changes.
• 1:44
  SPEAKER_00: These findings can make the optic cup appear larger than it truly is.
• 1:48
  SPEAKER_00: Shift the normal location of retinal nerve fiber layer bundles.
• 1:52
  SPEAKER_00: Cause false positive color warnings on optical coherence tomography.
• 1:56
  SPEAKER_00: Create visual field defects that resemble nasal steps or arcuate defects.
• 2:01
  SPEAKER_00: Make the same retinal location appear different on serial scans if the scan is not centered consistently.
• 2:07
  SPEAKER_00: Hide early central or paracentral glaucoma damage when only a standard 24-2 visual field is used.
• 2:14
  SPEAKER_00: The 2026 European Glaucoma Society Research Priority Survey found that the most common questions from glaucoma specialists concerned how to distinguish myopic structural change from glaucomatous damage and progression, followed by the reliability of optical coherence tomography and visual field testing.
• 2:33
  SPEAKER_00: This indicates that the problem remains clinically unresolved even among specialists.
• 2:39
  SPEAKER_00: Research priorities for diagnostics, progression monitoring, and treatment of glaucoma in myopic eyes, optical coherence tomography, recognizing myopia-related artifacts.
• 2:51
  SPEAKER_00: Why a normal optical coherence tomography report may be misleading.
• 2:55
  SPEAKER_00: Most commercial optical coherence tomography devices compare a patient's measurements with a normative database.
• 3:02
  SPEAKER_00: These databases may contain relatively few highly myopic eyes.
• 3:06
  SPEAKER_00: As a result, a healthy myopic eye may be incorrectly labeled as having abnormally thin retinal nerve fiber tissue.
• 3:12
  SPEAKER_00: Long axial length also creates ocular magnification.
• 3:16
  SPEAKER_00: A scan circle designed to be a fixed size may actually be placed farther from the optic disc than intended.
• 3:22
  SPEAKER_00: Retinal nerve fiber tissue is naturally thinner farther from the disc, which can produce an artificially low measurement.
• 3:28
  SPEAKER_00: In addition, myopic retinal anatomy can cause the scan to cross, parapapillary atrophy, posterior staphaloma, parapapillary intracoroidal cavitation, retinoschysis, or epiretinal membrane.
• 3:42
  SPEAKER_00: Areas where the automated software cannot correctly identify the retinal boundaries.
• 3:46
  SPEAKER_00: How common are artifacts?
• 3:48
  SPEAKER_00: In one study, optical coherence tomography artifacts were found in approximately 51.9% of scans from highly myopic eyes, compared with 18.6% in eyes without high myopia.
• 4:01
  SPEAKER_00: Parapapillary atrophy was a leading cause of artifact in highly myopic eyes.
• 4:06
  SPEAKER_00: The frequency was even higher when high myopia and glaucoma were both present.
• 4:10
  SPEAKER_00: The prevalence of optical coherence tomography artifacts in high myopia and its influence on glaucoma diagnosis.
• 4:17
  SPEAKER_00: This does not mean optical coherence tomography is useless.
• 4:21
  SPEAKER_00: It means the individual scan must be inspected rather than relying only on the summary page.
• 4:26
  SPEAKER_00: A practical optical coherence tomography quality check.
• 4:31
  SPEAKER_00: Before interpreting a thickness map, the clinician should review the raw cross-sectional images rather than only the color-coded report.
• 4:39
  SPEAKER_00: The automated segmentation lines to confirm that they follow the correct retinal layers.
• 4:44
  SPEAKER_00: The scan centration in relation to the optic disc, Brux membrane opening, and fovea.
• 4:50
  SPEAKER_00: Signal strength and motion artifacts.
• 4:52
  SPEAKER_00: Whether the scan passes through parapapillary atrophy or a posterior staphaloma.
• 4:57
  SPEAKER_00: Whether the same device, scan pattern, and positioning were used at each visit.
• 5:02
  SPEAKER_00: Whether the apparent change is visible on the actual image or exists only in the software's color classification.
• 5:09
  SPEAKER_00: A new red sector is much less convincing when it is caused by segmentation failure, scan displacement, or a pre-existing tilted disc, which optical coherence tomography measurements may help.
• 5:21
  SPEAKER_00: Several approaches may improve confidence.
• 5:24
  SPEAKER_00: Macular ganglion cell interplexiform layer or ganglion cell complex measurements.
• 5:29
  SPEAKER_00: These may show better diagnostic performance than standard peripapillary retinal nerve fiber layer measurements in some highly myopic eyes.
• 5:38
  SPEAKER_00: Brooks membrane opening minimum rim width.
• 5:41
  SPEAKER_00: This measures the minimum rim tissue from the anatomic opening of Brooks membrane rather than relying only on the clinically visible disc margin.
• 5:49
  SPEAKER_00: Anatomically corrected retinal nerve fiber layer scans.
• 5:53
  SPEAKER_00: These attempt to account for axial length and the shifted position of nerve fiber bundles.
• 5:59
  SPEAKER_00: Vertical fovea-centered scans.
• 6:01
  SPEAKER_00: These may improve structure-function matching when the usual peripapillary scan is distorted.
• 6:06
  SPEAKER_00: Swept source or wide field imaging when posterior staphaloma, peripapillary cavitation, or a very large tilted disc makes conventional imaging difficult.
• 6:16
  SPEAKER_00: A 2024 study found that macular ganglion cell inner plexiform layer and peripapillary retinal nerve fiber layer parameters could still have good diagnostic accuracy in high axial myopia, but the results were population-specific and should not replace clinical examination or visual field testing.
• 6:35
  SPEAKER_00: Diagnostic accuracy of optic nerve head and macular optical coherence tomography parameters.
• 6:41
  SPEAKER_00: Comparison of optical coherence tomography structural parameters for diagnosis of glaucoma in high myopia.
• 6:48
  SPEAKER_00: Common optical coherence tomography traps.
• 6:50
  SPEAKER_00: For the full table, please open this article on VisualFieldtest.com.
• 6:54
  SPEAKER_00: Disc tilt, disc rotation, and peripillary anatomy.
• 6:57
  SPEAKER_00: What a tilted disc means.
• 6:59
  SPEAKER_00: A tilted disc is often associated with an oval or vertically elongated disc, oblique insertion of the optic nerve, temporal peripapillary atrophy, or a crescent, rotation of the retinal nerve fiber layer pattern, displacement of the central retinal vessels, a mismatch between the clinically visible disc margin and the true anatomic opening of Bruch's membrane.
• 7:22
  SPEAKER_00: A tilted disc does not prove glaucoma.
• 7:25
  SPEAKER_00: However, it also does not protect the eye from glaucoma.
• 7:28
  SPEAKER_00: The most concerning findings are not simply tilt or cupping, but focal, repeatable, progressive loss that corresponds to a visual field defect.
• 7:36
  SPEAKER_00: Examples include a focal inferior or superior rim notch, a wedge-shaped retinal nerve fiber layer defect, a disc hemorrhage, corresponding loss in the macular ganglion cell interplexiform layer, a repeatable arcuate nasal step or paracentral field defect.
• 7:53
  SPEAKER_00: Why disc measurements can disagree?
• 7:55
  SPEAKER_00: In high myopia, the clinical disc margin, Bruxe membrane opening, and anterior scleral canal opening may not line up.
• 8:02
  SPEAKER_00: A 2025 prospective study found that highly myopic glaucoma eyes had larger Bruxe membrane opening and anterior scleral canal opening areas, greater displacement between these structures, and a smaller neural canal minimum cross-sectional area than non-highly myopic glaucoma eyes.
• 8:21
  SPEAKER_00: These anatomic features were associated with faster temporal visual field and retinal nerve fiber layer change over three years.
• 8:28
  SPEAKER_00: High myopia-induced optic nerve head deformation and glaucoma progression.
• 8:34
  SPEAKER_00: This supports a shift away from judging a myopic disc by cup to disc ratio alone.
• 8:39
  SPEAKER_00: The important question is whether the nerve tissue is being lost in a pattern and at a rate consistent with glaucoma.
• 8:45
  SPEAKER_00: Atypical visual field patterns in high myopia.
• 8:48
  SPEAKER_00: Visual field defects that may occur without glaucoma.
• 8:52
  SPEAKER_00: Highly myopic eyes can produce several unusual visual field patterns: enlarged blind spot, vertical step, partial peripheral rim loss, nonspecific or irregular depression, mixed temporal and nasal loss, gourd-shaped defects, field loss associated with peripapillary atrophy, posterior staphaloma, or peripapillary intracoroidal cavitation.
• 9:14
  SPEAKER_00: A 2025 study found an enlarged blind spot in approximately 37% of eyes with non-pathologic high myopia.
• 9:21
  SPEAKER_00: The enlarged blind spot was associated with a larger gamma zone, larger peripillary hyperreflective ovoid mass-like structures, and other myopic anatomic findings.
• 9:31
  SPEAKER_00: Enlarged blind spot linked to gamma zone and parapillary hyperreflective ovoid mass-like structures.
• 9:37
  SPEAKER_00: A standardized classification system separates high myopia-related defects from glaucoma-like defects.
• 9:43
  SPEAKER_00: Glaucoma-like patterns include nasal step, partial arcuate defect, complete arcuate defect, paracentral defect.
• 9:51
  SPEAKER_00: However, these patterns can also occur in eyes without definite glaucoma.
• 9:55
  SPEAKER_00: In one large high myopia cohort, approximately 10.8% of eyes had glaucoma-like visual field abnormalities despite not being classified as having glaucoma.
• 10:06
  SPEAKER_00: Classification of visual field abnormalities in highly myopic eyes without pathologic change.
• 10:11
  SPEAKER_00: Field patterns more suspicious for glaucoma.
• 10:14
  SPEAKER_00: A field defect becomes more concerning when it is reproducible on at least two reliable tests, located in a nerve fiber bundle pattern, respecting the horizontal meridian, topographically matched to focal superior or inferior rim loss, matched to macular ganglion cell interplexiform layer loss, progressively deepening or expanding in the same location, associated with a disc hemorrhage or corresponding structural change.
• 10:41
  SPEAKER_00: Why central testing matters?
• 10:44
  SPEAKER_00: Glaucoma in highly myopic eyes may affect the central or paracentral field early, particularly when the optic nerve is tilted or the retinal nerve fiber bundles have been displaced.
• 10:54
  SPEAKER_00: A standard 24-2 visual field has relatively sparse sampling in the central 10 degrees.
• 11:00
  SPEAKER_00: Therefore, a 10-2-2 visual field or another denser central strategy should be considered when the patient reports difficulty reading or seeing faces.
• 11:10
  SPEAKER_00: The macular ganglion cell inner plexiform layer is suspicious.
• 11:15
  SPEAKER_00: The optic disc shows a temporal or papillomacular abnormality.
• 11:19
  SPEAKER_00: The 24-2 result is normal, but the structural examination is concerning.
• 11:24
  SPEAKER_00: A paracentral defect is suspected.
• 11:26
  SPEAKER_00: The 2026 structure-function review specifically identified early central and paracentral involvement as an important feature of glaucoma in highly myopic eyes.
• 11:37
  SPEAKER_00: Interpreting the structure-function relationship in high myopia-associated glaucoma, progression risk through July 2026.
• 11:45
  SPEAKER_00: High myopia increases glaucoma risk.
• 11:48
  SPEAKER_00: The exact risk varies by population and definition, but high myopia is consistently associated with greater risk of open-angle glaucoma.
• 11:57
  SPEAKER_00: In the Beijing eye study, high myopia was associated with a 7.3-fold higher 10-year risk of developing open angle glaucoma compared with emetropic or hyperopic eyes.
• 12:08
  SPEAKER_00: In a nationwide Japanese cohort of more than 14 million adults, high myopia was associated with a 2.67-fold higher hazard of developing glaucoma.
• 12:18
  SPEAKER_00: The same Japanese study found a 3.07-fold higher hazard of glaucoma surgery and a 4.03-fold higher hazard of filtering surgery in highly myopic eyes.
• 12:29
  SPEAKER_00: The Japanese study used health record data and did not include detailed axial length, eye pressure, or visual field measurements.
• 12:37
  SPEAKER_00: Therefore, it demonstrates a clinically important association but does not prove that every highly myopic eye progresses faster biologically.
• 12:45
  SPEAKER_00: High myopia as a risk factor for the 10-year incidence of open-angle glaucoma.
• 12:50
  SPEAKER_00: Risk of glaucoma and undergoing glaucoma surgery in myopic and highly myopic eyes.
• 12:56
  SPEAKER_00: Not every progressing visual field is glaucoma.
• 12:59
  SPEAKER_00: An eight-year study of non-pathologic high myopia found that approximately 49.4% of eyes developed some type of visual field defect.
• 13:08
  SPEAKER_00: Enlarged blind spot and nonspecific defects were the most common.
• 13:12
  SPEAKER_00: Longer axial length, thinner central cornea, worse baseline mean deviation, and the presence of a gamma zone were associated with later visual field abnormalities.
• 13:22
  SPEAKER_00: This is an important warning.
• 13:24
  SPEAKER_00: Visual field change in a highly myopic eye is clinically important, but it is not automatically glaucomatous.
• 13:30
  SPEAKER_00: The pattern and its relationship to structural change must be examined.
• 13:35
  SPEAKER_00: Long-term prediction and risk factors for incident visual field defect in non-pathologic high myopia.
• 13:42
  SPEAKER_00: Evidence that some highly myopic glaucoma eyes progress faster.
• 13:46
  SPEAKER_00: In a three-year study, highly myopic glaucoma eyes showed faster temporal visual field progression and faster peripapillary retinal nerve fiber layer thinning than glaucoma eyes without high axial myopia.
• 13:59
  SPEAKER_00: A smaller neural canal minimum cross-sectional area independently predicted global progression.
• 14:05
  SPEAKER_00: These findings are promising, but not yet sufficient to create a universally accepted risk calculator.
• 14:11
  SPEAKER_00: They support closer monitoring when high axial length is combined with definite glaucoma, central damage, structural deformation, or documented change.
• 14:20
  SPEAKER_00: High myopia-induced optic nerve head deformation and glaucoma progression.
• 14:25
  SPEAKER_00: Biomechanical factors and axial length-related susceptibility.
• 14:29
  SPEAKER_00: Stretching of the posterior eye.
• 14:31
  SPEAKER_00: As axial length increases, the sclera, brux membrane, peripapillary scleral flange, and lamina cribrosa may stretch and remodel.
• 14:39
  SPEAKER_00: This can increase the distance between supporting structures, change the angle at which nerve fibers enter the optic nerve.
• 14:47
  SPEAKER_00: Reduce mechanical support around the optic nerve.
• 14:50
  SPEAKER_00: Create uneven stress across the lamina cribrosa.
• 14:53
  SPEAKER_00: Make the optic nerve more vulnerable even when measured eye pressure is not high.
• 14:59
  SPEAKER_00: A 2025 finite element modeling study found greater lamina cribrosa strain and more asymmetric stress during eye movement in highly myopic glaucoma eyes.
• 15:09
  SPEAKER_00: Both stress measures increased with axial length and were associated with faster retinal nerve fiber layer loss.
• 15:16
  SPEAKER_00: This is biologically plausible evidence, but it is not yet a routine clinical test for individual patients.
• 15:23
  SPEAKER_00: Asymmetric stress distribution on the lamina cibrosa in glaucoma patients with high myopia, corneal hysteresis, and tissue vulnerability.
• 15:32
  SPEAKER_00: Corneal hysteresis is a measure related to the eye's biomechanical response to pressure.
• 15:37
  SPEAKER_00: Lower corneal hysteresis has been associated with glaucoma development and progression in several studies.
• 15:44
  SPEAKER_00: In a 2025 United Kingdom Biobank analysis, the association between low corneal hysteresis and incident glaucoma was strongest among highly myopic participants, with a reported hazard ratio of approximately 1.67.
• 15:59
  SPEAKER_00: Corneal hysteresis should be viewed as an additional risk marker, not a standalone diagnostic test.
• 16:04
  SPEAKER_00: Corneal hysteresis as a biomarker in glaucoma development among patients with myopia.
• 16:10
  SPEAKER_00: Corneal hysteresis and progressive retinal nerve fiber layer loss in glaucoma.
• 16:15
  SPEAKER_00: Management adaptations.
• 16:17
  SPEAKER_00: Setting a target eye pressure.
• 16:19
  SPEAKER_00: There is no validated high myopia-specific target pressure.
• 16:22
  SPEAKER_00: Current evidence does not support one universal target eye pressure for all highly myopic patients.
• 16:28
  SPEAKER_00: A target should be individualized according to confirmed stage of glaucoma, baseline eye pressure before treatment, amount and location of optic nerve or visual field damage, rate of documented progression, whether central fixation is threatened, age and expected lifetime exposure to disease, central corneal thickness, corneal hysteresis, or other biomechanical markers, disc hemorrhage, family history, and fellow eye findings, treatment tolerance and surgical risk.
• 16:57
  SPEAKER_00: The 2026 American Academy of Ophthalmology primary open angle glaucoma preferred practice pattern states that lowering pretreatment eye pressure by approximately 25% or more has evidence for slowing progression in primary open angle glaucoma.
• 17:14
  SPEAKER_00: It also recommends selecting a lower target when disease is advanced, progressing rapidly, or accompanied by other risk factors.
• 17:22
  SPEAKER_00: These recommendations are for glaucoma generally, not specifically for high myopia.
• 17:27
  SPEAKER_00: Primary open angle glaucoma, preferred practice pattern, a practical target pressure framework.
• 17:34
  SPEAKER_00: High myopia suspect without confirmed progression.
• 17:37
  SPEAKER_00: Do not lower pressure solely because one optical coherence tomography map is abnormal.
• 17:42
  SPEAKER_00: Confirm the finding and estimate the overall risk.
• 17:45
  SPEAKER_00: Definite early glaucoma, a reduction of approximately 25% from the untreated baseline, is a reasonable general evidence-based starting point, adjusted for disease location and patient risk.
• 17:57
  SPEAKER_00: Central, paracentral, advanced, or rapidly progressing disease.
• 18:02
  SPEAKER_00: A lower target may be appropriate, sometimes requiring multiple medicines, laser treatment, or surgery.
• 18:08
  SPEAKER_00: Progression despite pressure at target, recheck adherence, measurement reliability, pressure fluctuations, and alternative causes of change.
• 18:16
  SPEAKER_00: If progression is confirmed, lower the target further.
• 18:19
  SPEAKER_00: Normal pressure or low pressure glaucoma-like disease.
• 18:23
  SPEAKER_00: Normal measured pressure does not exclude glaucoma.
• 18:26
  SPEAKER_00: Consider pressure fluctuation, measurement error, corneal biomechanics, vascular factors, and the degree of structural susceptibility.
• 18:34
  SPEAKER_00: The key principle is that high myopia may justify a lower tolerance for confirmed progression, but high myopia alone does not automatically justify an extremely low target pressure.
• 18:45
  SPEAKER_00: Imaging and visual field frequency.
• 18:48
  SPEAKER_00: The optimal testing schedule for highly myopic glaucoma suspects is still uncertain.
• 18:52
  SPEAKER_00: This was one of the leading unanswered questions in the 2026 European Glaucoma Society survey.
• 18:59
  SPEAKER_00: General glaucoma guidelines can therefore be adapted according to risk.
• 19:03
  SPEAKER_00: For the full table, please open this article on VisualFieldTest.com.
• 19:08
  SPEAKER_00: The European Glaucoma Society recommends more frequent testing when disease is severe, progression is faster, target pressure has not been achieved, or artifacts are suspected.
• 19:18
  SPEAKER_00: Nice guidance recommends reassessment at 6 to 12 months for patients with controlled pressure but higher clinical risk, and at 2 to 6 months when progression is uncertain or present.
• 19:30
  SPEAKER_00: European Glaucoma Society Guidelines, NICE Glaucoma Diagnosis and Management Recommendations.
• 19:36
  SPEAKER_00: These intervals refer to general glaucoma care.
• 19:39
  SPEAKER_00: In high myopia, the most important adaptations are to use the same optical coherence tomography device whenever possible.
• 19:47
  SPEAKER_00: Repeat questionable scans rather than interpreting isolated color changes.
• 19:51
  SPEAKER_00: Use both macular and optic nerve imaging.
• 19:54
  SPEAKER_00: Add central visual field testing when indicated.
• 19:57
  SPEAKER_00: Review raw images, not just automated summaries.
• 20:01
  SPEAKER_00: Monitor for myopic, macular, or posterior pole disease that can independently change the visual field.
• 20:07
  SPEAKER_00: Stepwise approach to differentiate glaucoma from myopic change.
• 20:11
  SPEAKER_00: Step 1.
• 20:12
  SPEAKER_00: Establish the eye's structural and risk profile.
• 20:15
  SPEAKER_00: Document spherical equivalent refractive error, axial length, age and age at onset of myopia, history of increasing myopia, family history of glaucoma, previous eye pressure measurements, central corneal thickness, corneal hysteresis if available, prior laser refractive surgery, previous optic nerve photographs, and visual fields.
• 20:35
  SPEAKER_00: Axial length is often more informative than refractive error alone, because two eyes with the same prescription may have different posterior eye shapes.
• 20:44
  SPEAKER_00: Step 2.
• 20:45
  SPEAKER_00: Confirm eye pressure properly.
• 20:47
  SPEAKER_00: Use Goldman type applanation when possible and interpret the result in the context of corneal thickness and biomechanics.
• 20:55
  SPEAKER_00: Consider repeated measurements or a pressure profile if the clinical findings suggest glaucoma despite apparently normal pressure.
• 21:03
  SPEAKER_00: Do not diagnose glaucoma from pressure alone, and do not exclude it because the pressure is within the population average.
• 21:09
  SPEAKER_00: Step 3.
• 21:10
  SPEAKER_00: Examine the optic disc stereoscopically.
• 21:13
  SPEAKER_00: Look for true focal rim notching, wedge-shaped retinal nerve fiber loss, disc hemorrhage, localized asymmetry between eyes, correspondence between rim loss and visual field loss.
• 21:24
  SPEAKER_00: Record disc tilt, rotation, size, peripapillary atrophy, and the relationship between the disc margin and brux membrane opening.
• 21:32
  SPEAKER_00: A large or tilted disc should be interpreted as a phenotype, not as a diagnosis.
• 21:37
  SPEAKER_00: Step 4.
• 21:38
  SPEAKER_00: Audit every optical coherence tomography scan.
• 21:41
  SPEAKER_00: Confirm.
• 21:42
  SPEAKER_00: Scan quality, scan centration, segmentation accuracy, absence of motion artifacts, absence of retinal traction, retinoscysis, or peripillary cavitation.
• 21:52
  SPEAKER_00: Whether the scan crosses peripapillary atrophy, whether ocular magnification has been corrected or considered, whether change is present.
• 22:00
  SPEAKER_00: On the raw image and not just the color map.
• 22:02
  SPEAKER_00: Give extra weight to repeated, focal, anatomically plausible changes rather than diffuse abnormalities in the standard normative classification.
• 22:12
  SPEAKER_00: Step 5.
• 22:13
  SPEAKER_00: Characterize the visual field pattern.
• 22:15
  SPEAKER_00: Classify the defect as more typical of myopic anatomy, such as enlarged blind spot, vertical step, peripheral rim loss, or irregular loss.
• 22:23
  SPEAKER_00: More typical of glaucoma, such as repeatable nasal step, arcuate, or paracentral loss, a combined pattern.
• 22:30
  SPEAKER_00: Repeat the field if it is unreliable or unexpected.
• 22:34
  SPEAKER_00: Use a 10 to 2 test or another central strategy when the defect is close to fixation or the macular scan is suspicious.
• 22:41
  SPEAKER_00: Step 6.
• 22:42
  SPEAKER_00: Test structure function agreement.
• 22:44
  SPEAKER_00: Ask whether inferior structural loss matches a superior visual field defect.
• 22:49
  SPEAKER_00: Superior structural loss matches an inferior field defect.
• 22:52
  SPEAKER_00: Macular ganglion cell loss matches central or paracentral field loss.
• 22:57
  SPEAKER_00: The defect is present in the same location on repeated tests.
• 23:01
  SPEAKER_00: The rate of structural change is plausible for the observed functional change.
• 23:05
  SPEAKER_00: Strong topographic agreement increases the likelihood of glaucoma.
• 23:09
  SPEAKER_00: Poor agreement does not rule it out, but it should trigger a search for myopic macular disease, peripapillary lesions, scan artifact, or another optic nerve disorder.
• 23:20
  SPEAKER_00: Step 7.
• 23:21
  SPEAKER_00: Look for progression using both event and trend analysis.
• 23:24
  SPEAKER_00: A single test may be abnormal because of measurement noise.
• 23:28
  SPEAKER_00: More convincing progression includes repeated change at the same locations, a consistent downward slope in retinal, nerve fiber, or ganglion cell measurements, deepening or expansion of the same visual field defect, matching change across photographs, optical coherence tomography, and visual field testing.
• 23:47
  SPEAKER_00: Because myopic changes can also evolve, stability is reassuring but should be demonstrated over an appropriate period rather than assumed from one normal follow-up.
• 23:57
  SPEAKER_00: Step 8.
• 23:58
  SPEAKER_00: Decide whether observation or treatment is safer.
• 24:01
  SPEAKER_00: Long-term eye pressure lowering treatment is most strongly supported when there is confirmed glaucomatous progression, reproducible structure-function agreement, high-risk disease-threatening central vision, consistently elevated or markedly fluctuating eye pressure.
• 24:18
  SPEAKER_00: Definite glaucoma in the fellow eye.
• 24:20
  SPEAKER_00: Additional susceptibility markers such as thin central cornea, low corneal hysteresis, disc hemorrhage, or severe optic nerve deformation.
• 24:29
  SPEAKER_00: When findings are stable, discordant, and dominated by myopic anatomy, careful observation may avoid unnecessary treatment.
• 24:37
  SPEAKER_00: The 2026 practical framework similarly emphasizes progression-centered diagnosis and caution against treating every myopic glaucoma-like appearance as definite glaucoma.
• 24:47
  SPEAKER_00: Myopic and glaucomatous optic neuropathy in highly myopic eyes.
• 24:51
  SPEAKER_00: Managing myopic glaucoma beyond structural fragility and diagnostic challenges.
• 24:57
  SPEAKER_00: Conclusion.
• 24:58
  SPEAKER_00: By July 2026, the clinical approach to glaucoma in high myopia has become more longitudinal, multimodal, and progression focused.
• 25:07
  SPEAKER_00: The most important practical lessons are high myopia increases glaucoma risk, but also creates many glaucoma mimics.
• 25:15
  SPEAKER_00: Disc tilt, large peripipillary atrophy, and abnormal optical coherence tomography color maps are not diagnostic by themselves.
• 25:23
  SPEAKER_00: Raw optical coherence tomography images and segmentation lines must be reviewed.
• 25:28
  SPEAKER_00: Macular ganglion cell measurements, Bruch's membrane opening-based measurements, and axial length aware imaging can improve interpretation.
• 25:36
  SPEAKER_00: Visual fields may show enlarged blind spots, mixed or irregular defects, and early central damage.
• 25:43
  SPEAKER_00: A 10-2 visual field is important when central or paracentral glaucoma is suspected.
• 25:48
  SPEAKER_00: Longer axial length and altered lamina cribrosa biomechanics may increase susceptibility to damage.
• 25:55
  SPEAKER_00: Target pressure should be individualized and lowered further when progression is confirmed.
• 26:00
  SPEAKER_00: High risk or newly diagnosed eyes generally require closer testing than once-yearly imaging.
• 26:06
  SPEAKER_00: The strongest evidence for glaucoma remains reproducible, topographically coherent progression across structure and function.
• 26:13
  SPEAKER_00: For patients, the most useful question is not simply, was my scan abnormal?
• 26:17
  SPEAKER_00: It is, do my optic nerve, retinal measurements, visual field, eye pressure, and changes over time tell the same story?
• 26:25
  SPEAKER_00: All links to sources are available in the text version of this article.
• 26:30
  SPEAKER_00: You can find the full article at visualfieldtest.com.
• 26:34
  SPEAKER_00: Thanks for listening.
• 26:35
  SPEAKER_00: To check your visual field, click the link at the bottom of this article or visit visualfieldtest.com.