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      Characteristics of the Peripapillary Structure and Vasculature in Patients With Myopic Anisometropia

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          Abstract

          Purpose

          To evaluate the interocular differences of the peripapillary structural and vascular parameters and that of association with axial length (AL) in participants with myopic anisometropia using swept-source optical coherence tomography.

          Methods

          This prospective cross-sectional study included 90 eyes of 45 participants. Each participant's eyes were divided into the more and less myopic eye respectively according to spherical equivalent. The β- and γ-parapapillary atrophy (PPA) areas, Bruch's membrane opening distance, border length, and border tissue angle were measured manually. Peripapillary choroidal vascularity index and choroidal thickness (CT) values in superior, nasal, inferior, and temporal were calculated using a custom-built algorithm based on MATLAB.

          Results

          The interocular difference in AL and spherical equivalent was 0.62 ± 0.26 mm and −1.50 (−2.13, −1.25) diopters (D), respectively. The interocular difference in spherical equivalent was highly correlated with that of the AL. The β- and γ-PPA areas were significantly greater in more myopic eyes. The mean and inferior peripapillary choroidal vascularity index and all regions of peripapillary CT were significantly lower in the more myopic eyes. The interocular difference in AL was significantly positively correlated with the interocular differences in γ-PPA area and border length and negatively correlated with the interocular differences in temporal choroidal vascularity index and mean, inferior, and temporal peripapillary CT. There was an independent correlation between the interocular differences in AL and the interocular differences in γ-PPA area, inferior, and temporal peripapillary CT.

          Conclusions

          Significant differences between both groups were detected in most peripapillary parameters, especially in peripapillary CT. The γ-PPA area, border length, and peripapillary CT were significantly correlated with the elongation of AL.

          Translational Relevance

          The current study characterized and analyzed the peripapillary parameters in myopic anisometropia, which helped to monitor myopic progression.

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          Most cited references59

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          Myopia

          Ian G Morgan, Kyoko Ohno-Matsui, Seang-Mei Saw (2012)
          The Lancet, 379(9827), 1739-1748
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            The epidemics of myopia: Aetiology and prevention.

            Ian G. Morgan, Amanda N. French, Regan S. Ashby … (2018)
            There is an epidemic of myopia in East and Southeast Asia, with the prevalence of myopia in young adults around 80-90%, and an accompanying high prevalence of high myopia in young adults (10-20%). This may foreshadow an increase in low vision and blindness due to pathological myopia. These two epidemics are linked, since the increasingly early onset of myopia, combined with high progression rates, naturally generates an epidemic of high myopia, with high prevalences of "acquired" high myopia appearing around the age of 11-13. The major risk factors identified are intensive education, and limited time outdoors. The localization of the epidemic appears to be due to the high educational pressures and limited time outdoors in the region, rather than to genetically elevated sensitivity to these factors. Causality has been demonstrated in the case of time outdoors through randomized clinical trials in which increased time outdoors in schools has prevented the onset of myopia. In the case of educational pressures, evidence of causality comes from the high prevalence of myopia and high myopia in Jewish boys attending Orthodox schools in Israel compared to their sisters attending religious schools, and boys and girls attending secular schools. Combining increased time outdoors in schools, to slow the onset of myopia, with clinical methods for slowing myopic progression, should lead to the control of this epidemic, which would otherwise pose a major health challenge. Reforms to the organization of school systems to reduce intense early competition for accelerated learning pathways may also be important.
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              The multifunctional choroid.

              Debora Nickla, Josh Wallman (2010)
              The choroid of the eye is primarily a vascular structure supplying the outer retina. It has several unusual features: It contains large membrane-lined lacunae, which, at least in birds, function as part of the lymphatic drainage of the eye and which can change their volume dramatically, thereby changing the thickness of the choroid as much as four-fold over a few days (much less in primates). It contains non-vascular smooth muscle cells, especially behind the fovea, the contraction of which may thin the choroid, thereby opposing the thickening caused by expansion of the lacunae. It has intrinsic choroidal neurons, also mostly behind the central retina, which may control these muscles and may modulate choroidal blood flow as well. These neurons receive sympathetic, parasympathetic and nitrergic innervation. The choroid has several functions: Its vasculature is the major supply for the outer retina; impairment of the flow of oxygen from choroid to retina may cause Age-Related Macular Degeneration. The choroidal blood flow, which is as great as in any other organ, may also cool and warm the retina. In addition to its vascular functions, the choroid contains secretory cells, probably involved in modulation of vascularization and in growth of the sclera. Finally, the dramatic changes in choroidal thickness move the retina forward and back, bringing the photoreceptors into the plane of focus, a function demonstrated by the thinning of the choroid that occurs when the focal plane is moved back by the wearing of negative lenses, and, conversely, by the thickening that occurs when positive lenses are worn. In addition to focusing the eye, more slowly than accommodation and more quickly than emmetropization, we argue that the choroidal thickness changes also are correlated with changes in the growth of the sclera, and hence of the eye. Because transient increases in choroidal thickness are followed by a prolonged decrease in synthesis of extracellular matrix molecules and a slowing of ocular elongation, and attempts to decouple the choroidal and scleral changes have largely failed, it seems that the thickening of the choroid may be mechanistically linked to the scleral synthesis of macromolecules, and thus may play an important role in the homeostatic control of eye growth, and, consequently, in the etiology of myopia and hyperopia. Copyright 2009 Elsevier Ltd. All rights reserved.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Transl Vis Sci Technol
                Journal ID (iso-abbrev): Transl Vis Sci Technol
                Journal ID (publisher-id): TVST
                Title: Translational Vision Science & Technology
                Publisher: The Association for Research in Vision and Ophthalmology
                ISSN (Electronic): 2164-2591
                Publication date (Electronic): 18 October 2023
                Publication date Collection: October 2023
                Volume: 12
                Issue: 10
                Electronic Location Identifier: 16
                Affiliations
                [1 ]National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, China
                [2 ]Department of Ophthalmology, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang, China
                Author notes
                [# ] Correspondence: Meixiao Shen, Eye Hospital, Wenzhou Medical University, Wenzhou, 618# Fengqi East Road, Hangzhou, Zhejiang 310000, China. e-mail: smx77@ 123456sohu.com
                Lijun Shen, Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China and Department of Ophthalmology, Zhejiang Provincial People's Hospital, Hangzhou, 618# Fengqi East Road, Hangzhou, Zhejiang 310000, China. e-mail: slj@ 123456mail.eye.ac.cn
                [*]

                YQ and DC share the first authorship.

                [**]

                MS and LS contributed equally to this research.

                Article
                Publisher ID: TVST-22-5207
                DOI: 10.1167/tvst.12.10.16
                PMC ID: 10593134
                PubMed ID: 37850949
                SO-VID: cefb2c2a-11e4-4f0d-acb5-fe25b87fb37b
                Copyright © Copyright 2023 The Authors
                License:

                This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

                History
                Date accepted : 23 August 2023
                Date received : 19 October 2022
                Page count
                Pages: 10
                Categories
                Subject: Retina
                Subject: Retina

                Keywords: myopia,anisometropia,interocular difference,optic nerve head,swept-source optical coherence tomography,choroidal vascularity index,choroidal thickness
                Data availability:
                Keywords: myopia, anisometropia, interocular difference, optic nerve head, swept-source optical coherence tomography, choroidal vascularity index, choroidal thickness

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