On January 20, 2025, the top-tier international ophthalmology journal Ophthalmology published online an original research article by Professor Xiulan Zhang’s team from the Zhongshan Ophthalmic Center, Sun Yat-sen University, titled “Longitudinal Changes of Retinal Nerve Fiber Layer and Ganglion Cell-Inner Plexiform Layer in Highly Myopic Glaucoma: A 3-Year Cohort Study.” Based on three-year longitudinal data from a large cohort, the study reports characteristic changes in the peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell–inner plexiform layer (mGC-IPL) in highly myopic glaucoma, and identifies important biomarkers for its early clinical diagnosis. This marks the team’s sixth original research article published in Ophthalmology.
Original article published in Ophthalmology, with Zhongshan Ophthalmic Center, Sun Yat-sen University, as the first affiliation of the first author and senior corresponding author.
Background
High myopia is a globally prevalent blinding eye disease. In 2000, an estimated 163 million people worldwide (2.7% of the population) had high myopia, and this number is projected to rise to 938 million by 2050. High myopia is a major risk factor for glaucoma, with studies showing that highly myopic individuals have a 2.92- to 7.3-fold higher risk of developing glaucoma compared with the general population. Moreover, high myopia is often associated with structural and functional changes resembling those of glaucoma, making differential diagnosis between the two conditions particularly challenging. Optical coherence tomography (OCT) measurement of peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell–inner plexiform layer (mGC-IPL) thickness is essential for the diagnosis and follow-up of glaucoma. However, the quadrant-specific patterns of pRNFL and mGC-IPL changes in highly myopic glaucoma remain unclear.
Study Results
This study analyzed three-year OCT follow-up data from a large cohort of patients with high myopia and glaucoma established by the team. A total of 243 eyes from 243 subjects were included and divided into three groups: high myopia (HM) without glaucoma, open-angle glaucoma (OAG) without high myopia, and highly myopic glaucoma (HMG). Annual rates of change in pRNFL and mGC-IPL thickness (μm/year) across quadrants were compared among the groups. Results showed that the temporal pRNFL in the HMG group exhibited a significantly faster annual rate of change compared with the OAG group, whereas no significant differences were observed in mGC-IPL change rates across quadrants between the two groups. The study further analyzed the annual percentage change rates (%/year) of pRNFL and mGC-IPL thickness across quadrants in the OAG and HMG groups. It found that, unlike in the OAG group, eyes in the HMG group demonstrated faster percentage change rates of pRNFL in the inferior and temporal quadrants, as well as faster thinning of mGC-IPL in the inferonasal quadrant. This characteristic pattern of change was also observed in OAG and HMG eyes with visual field progression.
Significance
Based on these results, the study suggests that patterns of pRNFL and mGC-IPL change across quadrants differ between OAG and HMG eyes. Rapid thinning of the temporal pRNFL may serve as an important biomarker for the early diagnosis of HMG. In addition, the study reports the physiological thinning rates of pRNFL and mGC-IPL in highly myopic eyes with stable axial length, providing reference values for assessing glaucomatous progression using OCT parameters in this population.
Team Introduction
Professor Xiulan Zhang’s team has long been dedicated to addressing the challenge of differentiating high myopia from glaucoma. To this end, in 2019, Professor Zhang took the lead in establishing the international Glaucoma Suspects with High Myopia (GSHM) study group, comprising 13 experts in high myopia, glaucoma, and epidemiology from seven countries. The group has since conducted a series of clinical studies aimed at providing robust evidence-based support for the early detection, diagnosis, and treatment of patients with high myopia complicated by glaucoma.
This research series has received support from the Clinical Research Center platform at Zhongshan Ophthalmic Center, as well as funding from the National Key R&D Program of China and the Guangdong Provincial High-Level Hospital Construction Project. The team has established a cohort of more than 2,000 patients with high myopia and glaucoma, on which both cohort studies and randomized controlled clinical trials are being conducted. In recent years, the team has published 21 high-impact international papers on high myopia, including one in the top ophthalmology journal Progress in Retinal and Eye Research and three in Ophthalmology.
The present article is part of this series of studies on high myopia and glaucoma. It was led by Zhongshan Ophthalmic Center in collaboration with several leading national and international experts in glaucoma and high myopia, representing another high-quality scientific achievement arising from ZOC’s international collaborations. The corresponding authors of this article are Xiulan Zhang (ZOC, senior corresponding author), Fei Li (ZOC), Robert N. Weinreb (Shiley Eye Institute, UC San Diego, USA), and Xiaodong Sun (Shanghai General Hospital). The first authors are Jingwen Jiang (ZOC), Kangjie Kong (ZOC), and Fengbin Lin (ZOC).
Co-Corresponding Authors:
Xiulan ZHANG, Professor
Zhongshan Ophthalmic Center, Sun Yat-sen University
Fei LI, Associate Professor
Zhongshan Ophthalmic Center, Sun Yat-sen University
Robert N. Weinreb, Professor
Shiley Eye Institute, University of California San Diego, USA
Xiaodong SUN, Professor
Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine
Co-First Authors:
Jingwen JIANG, PhD
Zhongshan Ophthalmic Center, Sun Yat-sen University
Kangjie KONG, PhD
Zhongshan Ophthalmic Center, Sun Yat-sen University
Fengbin LIN, Attending Physician
Zhongshan Ophthalmic Center, Sun Yat-sen University
International Experts Involved:
The study was also co-supervised by leading international experts: Professor Linda M. Zangwill (Shiley Eye Institute, University of California, San Diego, USA); Professor Dennis S.C. Lam (School of Medicine, The Chinese University of Hong Kong, Shenzhen; Chairman, C-MER International Eye Care Group); and Professor Jost B. Jonas (Rothschild Foundation Hospital and French Institute of Myopia, France; Singapore National Eye Centre, Singapore).
Linda M. Zangwill
Dennis S.C. Lam
Jost B. Jonas
Link to Original Article:
https://www.aaojournal.org/article/S0161-6420(25)00068-5/abstract
