Optic Disc Tilt and Glaucoma Progression in Myopic Glaucoma: A Longitudinal Match-Pair Case-Control Study.

Purpose: To investigate the long-term follow-up results for tilted disc eyes and case-matched nontilted disc eyes in myopic glaucoma patients.
Methods: We included 28 tilted disc eyes of 28 myopic primary open-angle glaucoma (POAG) patients and 28 case-matched nontilted disc eyes of 28 myopic POAG patients with minimum 5 years of follow-up. One matching set included one tilted disc eye and one case-matched nontilted disc eye. The eyes had similar characteristics including age, axial length, baseline intraocular pressure, and initial visual field mean deviation. The progression of glaucoma was evaluated in functional and structural tests. Kaplan-Meier survival analysis and Cox proportional hazards model were used to evaluate glaucoma progression and identify the factors predictive of glaucoma progression.
Results: The mean age and follow-up duration were 50.1 ± 11.7 years and 90.8 ± 38.1 months, respectively. Of the 56 total eyes, glaucoma progression was detected in 22 (39.3%). Of these, 16 of the 28 nontilted disc eyes (57.1%) and 6 of the 28 tilted disc eyes (21.4%) demonstrated glaucoma progression. Patients with nontilted disc had a greater cumulative probability of progression than those with disc tilt (P = 0.01 by log-rank test). A Cox proportional hazards model indicated that lower disc tilt ratio and the presence of disc hemorrhage were significantly associated with disease progression (P = 0.02 and 0.04, respectively). Conclusions: In myopic POAG patients, more stable courses were found in eyes with disc tilt than in those without disc tilt. Clinical evaluation of optic disc morphology might help to predict future progression in myopic glaucomatous eyes.