Korean J Ophthalmol > Epub ahead of print
DOI: https://doi.org/10.3341/kjo.2021.0100    [Epub ahead of print]
Published online November 26, 2021.
Assessment of Scleral Contour Changes in High Myopia by Optical Coherence Tomography
Yong Kyun Shin1, Se Woong Kang1, Sang Jin Kim1, Geun Woo Lee1,2, Kyung Jun Choi1
1Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
2Department of Ophthalmology, Catholic University of Daegu School of Medicine, Daegu, Korea
Correspondence:  Se Woong Kang, Tel: +82-2-3410-3562, Fax: +82-2-3410-0074, 
Email: swkang@skku.edu
Received: 25 June 2021   • Revised: 12 November 2021   • Accepted: 17 November 2021
To establish and validate optical coherence tomography (OCT) based diagnostic criteria of high myopia.
This was a cross-sectional study including 100 eyes of high myopia with axial length larger than 26.5 mm and 100 control eyes, which were examined by spectral-domain OCT. Vertical and horizontal OCT of 9 mm scanning across fovea were analyzed. OCT characteristics including mirror artifact, scleral sink due to steep inclination of posterior sclera, scleral visibility, abnormality of outer retinal layer, foveoschisis, and dome-shaped macula were assessed in each group.
The mean axial length was 28.65 ± 2.07 mm (range, 26.51-34.59 mm) in high myopia group and 23.79 ± 0.99 mm (21.26-25.94 mm) in control group. Among the OCT characteristics noted at high frequency in the eyes with high myopia, three criteria achieving high sensitivity and specificity were determined; scleral sink over 500 μm, scleral visibility over 100 μm, and dome-shaped macula. Under conditions of presence of any of three criteria in either horizontal or vertical OCT scanning, the diagnostic sensitivity, specificity, positive predictive value, and negative predictive value for high myopia were found to be 95.0%, 98.0%, 98.0%, and 95.1%, respectively. In a new set of OCT images from 50 eyes with high myopia and 50 eyes of non-high myopia cases, the OCT-based criteria also proved similar level of diagnostic validity.
The OCT-based criteria, which directly addressed posterior scleral contour changes, may lead to an intuitive and accurate diagnosis of high myopia. Also, the criteria may contribute to early detection and monitoring of eyes that cannot be defined as high myopia but can progress. OCT may be useful for monitoring high myopia patients as OCT can detect myopia-associated retinal pathologies as well as scleral contour changes.
Key Words: High myopia, Optical coherence tomography, Scleral sink, Scleral visibility, Dome-shaped macula

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