TABLE 3A.
Functional change related to disc tilt.
| References | Sample size | Mean age (mean ± SD) (years) | Follow-up | Image | Definitions of disc tilt and disc torsion | Main findings |
| Cross-sectional | ||||||
| Tay et al. (25) | 137 Myopic eyes | 21.2 ± 1.1 | – | Fundus photograph | Disc tilt: ratio of disc diameter = shortest/longest. | Greater optic disc tilt was associated with higher myopia and reduced sensitivity of VF test (trial lenses) (r = 4.25, P < 0.01). |
| Hong et al. (16) | 236 NTG eyes with myopia | 53.14 ± 13.78 | – | Fundus photograph, OCT-A | Disc tilt: ratio of disc diameter = longest/shortest. Disc torsion: deviation of the longest axis of the optic disc from the perpendicular meridian. |
Disc torsion degree and disc tilt ratio were negatively correlated with BCVA. Disc tilt ratio was also correlated with peripapillary area deep vessel density fluctuation. Worse mean retinal sensitivity of the central 12 points of SITA 24-2 VF test showed significant correlation with greater disc tilt ratio. |
| Sawada et al. (87) | 118 Eyes with OAG | 54.5 ± 13.6 | – | Fundus photograph | Disc tilt: ratio of disc diameter = longest/shortest. Disc torsion: deviation of the longest axis of the optic disc from the perpendicular meridian. |
Eyes with worse VFs had significantly greater tilt ratio. The difference in the tilt ratio between paired eyes correlated with the difference of the MD. |
| Shoeibi et al. (88) | 58 Highly myopic eyes | Tilted disc: 28.95 ± 7.2, Non-tilted disc: 27.87 ± 6.08 |
– | Fundus photograph | Disc tilt: ratio of disc diameter = shortest/longest Disc torsion: deviation of the longest axis of the optic disc from the perpendicular meridian. |
No differences in the VF indices in highly myopic patients with or without tilted discs. |
| Choi et al. (90) | 136 Glaucoma patients with isolated superior or inferior hemifield loss, 99 normal controls | Glaucoma: 54.3 ± 13.8 Normal control 52.9 ± 5.5 |
– | Fundus photograph, OCT | Disc tilt: ratio of disc diameter = longest/shortest Tilt angle: Temporal disc tilt: the tilt degree between a horizontal line and a line that was manually drawn to connect the two points where the height profile and the disc margin met. Vertical disc tilt: the angle between the vertical line and the line connecting the two points where the height profile and the disc margin met. Disc torsion: deviation of the longest axis of the optic disc from the perpendicular meridian. |
Vertical disc tilt was an independent factor related to the initial location of a VF defect (superior vs. inferior) after controlling for age, MD, axial length, disc ovality index, torsion degree, disc size, and temporal disc tilt. |
| Choi et al. (91) | 136 Patients with early-stage POAG | Single-hemispheric: 54.0 ± 13.9, Bi-hemispheric: 54.2 ± 14.1 |
– | Fundus photograph, OCT, | Disc tilt: ratio of disc diameter = longest/shortest Tilt angle: line connecting RPE border/BMO. An additional line connected 2 points that are located at an arbitrarily chosen distance of 80 pixels from the RPE/BMO on each side. The angle of tilt was the angle between these two lines. |
The asymmetry in RNFL thickness decreased with increase disc ovality, without association with spherical equivalent, axial length, or the angle between the temporal retinal veins. Disc ovality was an independent risk factor for bi-hemispheric RNFL defects (after controlling for VF MD, age, axial length, and disc area). |
| Park et al. (92) | 40 Myopic eyes without RNFL defects and 64 myopic eyes with RNFL defects in the superonasal region of the optic disc | Myopic control: 42.54 ± 13.74, Myopic eyes without VF defects: 39.04 ± 13.41, myopic eyes with VF defects: 36.42 ± 13.51 | – | OCT, Fundus photograph | Disc tilt: ratio of disc diameter = longest/shortest Disc torsion: deviation of the longest axis of the optic disc from the perpendicular meridian. Tilt angle: Horizontal disc tilt: angle between a horizontal line and a line drawn manually to connect the two points where the height profile and disc margin met. Vertical disc tilt: angle between a vertical line and the line connecting the two points where the height profile and disc margin met. |
86–97% of the myopic eye with superonasal RNFL or inferotemporal VF defects had border tissue overhang at 1, 2, 11, and 12 o’clock positions. |
| Choi et al. (93) | 112 bilateral myopic NTG patients | 49.8 ± 11.3 | – | OCT | Tilt angle: angle between ONH plane and BMO plane. | There was a correlation between horizontal ONH tilt angle and angular location of maximal ONH tilt. Both of them were associated with more advanced VF defect in eyes with myopic NTG. The location of VF defect was associated with the horizontal ONH tilt direction and angular location of maximal ONH tilt. |
| Longitudinal | ||||||
| Kim et al. (102) | 56 Myopic eyes with NTG | Stable group: 46.75 ± 11.24, Progression group: 47.00 ± 10.83 | 72.63 ± 20.46 months |
Fundus photograph | Tilt angle: angle between the disc margin plane and BMO plane. Temporal tilt: positive degree of horizontal tilt, Nasal tilt: negative degree of horizontal tilt. Disc torsion: deviation of the longest axis of the optic disc from the perpendicular meridian. |
The vertical tilt angle (HR = 0.835, P = 0.026) and the DPE positioned temporal to fovea (HR = 4.314, P = 0.001) were associated with VF progression. |
| Seol et al. (104) | 56 Myopic eyes with POAG | 50.1 ± 11.7 | 90.8 ± 38.1 months |
Fundus photograph | Disc tilt: ratio of disc diameter = longest/shortest | Patients with non-tilted disc had a greater cumulative probability of progression than those with disc tilt. Lower disc tilt ratio was significantly associated with disease progression. |
| Lee et al. (22) | 85 Eyes of 85 myopic glaucoma patients | 48.3 ± 13.1 | 4.1 years | Fundus photograph | Disc tilt: ratio of disc diameter = longest/shortest Disc torsion: deviation of the longest axis of the optic disc from the perpendicular meridian. |
Eyes with VF progression showed smaller mean tilt ratio than eyes with stable VF. Eyes with disc tilt had lower cumulative probability of progression than eyes without disc tile (24.7% vs. 68.7%). The tilt ratio (HR = 0.110; P = 0.046) were association with the VF progression. |
| Kwon et al. (103) | 146 Myopic eyes with POAG | 50.1 ± 12.7 | 4.6 ± 1.3 years |
Fundus photograph | Disc tilt: ratio of disc diameter = longest/shortest Disc torsion: deviation of the longest axis of the optic disc from the perpendicular meridian. |
Eyes without optic disc tilt has faster VF progression than eyes with tilted disc. Less disc tilt was associated with superior and inferior VF progression (OR = 0.561; P = 0.018). |
| Sung et al. (107) | 92 Myopic eyes with NTG | 37.83 ± 10.89 | 55.78 ± 30.12 months |
Fundus photograph | Disc tilt: ratio of disc diameter = longest/shortest Disc torsion: deviation of the longest axis of the optic disc from the perpendicular meridian. |
Among the eyes with correspondence in direction optic disc torsion and location of VF defect, greater tilt ratio (HR, 73.412; P = 0.003) was independent predictive factors for VF progression. |
| Kwun et al. (98) | 66 Myopic eyes with NTG | No focal LC defects: 47.65 ± 9.61 Focal LC defects: 45.53 ± 9.57 |
93.74 months |
Fundus | Disc tilt: ratio of disc diameter = longest/shortest Disc torsion: deviation of the longest axis of the optic disc from the perpendicular meridian. |
The greater optic disc tilt and torsion in myopic eyes with NTG were not associated with VF progression. |
| Baek et al. (99) | 98 Eyes with pre-perimetric OAG | Non-progressor: 30.1 ± 6.4 Progressor: 31.3 ± 5.7 |
5.8 ± 1.7 years |
Fundus photograph | Disc tilt: ratio of disc diameter = longest/shortest | The tilt ratio was not associated with VF progression of OAG. |
| Seol et al. (101) | 109 Myopic eyes with NTG | 53.54 ± 9.17 | 7.55 ± 1.79 years |
Fundus photograph | Disc tilt: ratio of disc diameter = longest/shortest | The tilt ratio was not associated with VF progression of NTG. |
| Sawada et al. (105) | 144 Eyes with OAG | 56.2 ± 13.3 | 8.9 ± 4.4 years |
Fundus photograph | Disc tilt: ratio of disc diameter = longest/shortest Disc torsion: deviation of the longest axis of the optic disc from the perpendicular meridian. |
Tilt ratio was significantly greater in the eyes with faster VF progression than those with slower progression. This factor was significantly associated with faster VF progression, while SE and axial length were not associated with it. |
| Lee et al. (94) | 182 Myopic eyes with OAG and progressive VF deterioration | Horizontal disc tilt 48.6 ± 10.8, Vertical disc tilt 55.9 ± 7.8 | 7.43 years | Fundus photograph | Disc tilt: disc diameter ratio = longest/shortest. Disc torsion: deviation of the longest axis of the optic disc from the perpendicular meridian. Vertical disc tilt group (temporal/nasal tilting): the largest dimension of the β-zone PPA from disc margin were located in the temporal or nasal quadrant of the optic disc. Horizontal disc tilt group (superior/inferior tilting): the largest dimension of the β-zone PPA from disc margin were located in the superior or inferior quadrant of the optic disc. |
The vertical disc tilt group showed significantly faster VF progression at the inferior regional zones than the horizontal disc tilt group. Based on a multivariate linear mixed model, vertical disc tilt was associated with faster bi-hemifield VF progression, whereas horizontal disc tilt was associated with faster single-hemifield VF progression. |
| Han et al. (100) | 97 Myopic eyes with NTG | 53.8 ± 13.7 | 71.1 ± 29.7 months |
Fundus photograph | Disc tilt: ratio of disc diameter = longest/shortest. Disc torsion: deviation of the longest axis of the optic disc from the perpendicular meridian. |
In NTG with myopia, those aged ≤50 years had higher cumulative probability of progression than those aged >50 years. |
| LC defect | ||||||
| Sawada et al. (110) | 159 Myopic glaucomatous eyes with VF defect | Progression group: 46.3 ± 11.9 Non-progression group: 45.5 ± 10.5 |
7 years | Fundus photograph, OCT | Tilt angle: optic disc tilt angle was measured with the OCT B-scans; defined as the angle between the line connecting the BMO and the optic disc canal plane. Disc torsion: deviation of the longest axis of the optic disc from the perpendicular meridian. |
Presence of LC defect was associated with non-progressive VF defect (OR = 3.96; P = 0.002). The LC defect location and VF defect corresponded with each other. Non-progressive eyes with LC defect had greater myopic optic disc deformity, lower baseline IOP, and smaller% of IOP change than eyes without LC defect. Eyes with LC defect and higher baseline IOP exhibited progressive VF defect. |
| Kwun et al. (98) | 66 Eyes with NTG | No focal LC defects: 47.65 ± 9.61 Focal LC defects: 45.53 ± 9.57 |
93.74 months | Fundus photograph | Disc tilt: ratio of disc diameter = longest/shortest. Disc torsion: deviation of the longest axis of the optic disc from the perpendicular meridian. |
Eyes with focal LC defect were associated with greater torsion degree and tilt ratio. They also have deeper VF MD slopes and faster localized VF progression than eyes without LC defect. VF progression was associated with the presence of focal LC defects. |
| Sawada et al. (111) | 133 eyes with OAG and 83 eyes without OAG, axial length ≥24 mm | Myopic eyes with OAG: 52.5 ± 13.4, Myopic eyes without glaucoma: 49.4 ± 16.1 | – | Fundus photograph, OCT | Tilt angle: angle between the reference plane (connects the inner edge of the nasal and temporal BMO) and the optic disc canal plane (connects the inner edge of the nasal BM and temporal margin of the optic disc canal, defined as the end of externally oblique border tissue). Disc torsion: Deviation of the longest axis of the optic disc from the perpendicular meridian. |
The number of temporal LC defects and tilt angle were associated with the presence of paracentral scotoma, whereas the number of inferior and superior LC defects and torsion direction were associated with presence of superior and inferior VF defects. |
| DPE | ||||||
| Jeon et al. (113) | 97 Eyes of NTG with myopia | Central dominant VF defect group: 51.43 ± 11.47, Peripheral dominant VF defect: 48.87 ± 10.02 | – | Fundus photograph, OCT(3D) | Disc tilt: ratio of disc diameter = longest/shortest. Tilt angle: angle between the BMO plane and the line connecting the nasal BMO and innermost margin of the externally oblique border issue. Disc torsion: deviation of the longest axis of the optic disc from the perpendicular meridian |
The eyes with worse central VF defect had larger disc torsion and larger ONH tilt angle. Larger ONH tilt angle and smaller disc-DPE depth were related to the presence of central VF defect. |
VF, visual field; OCT-A, optical coherence tomography angiography; BCVA, best-corrected visual acuity; MD, mean deviation; OCT, optical coherence tomography; POAG, primary open angle glaucoma; RPE, retinal pigmentary epithelium; BMO, Bruch’s membrane opening; NTG, normal tension glaucoma; ONH, optic nerve head; HR, hazard ratio; DPE, deepest point of eyeball; OR, odd ratio; PPA, peripapillary atrophy; IOP, intraocular pressure; LC, laminar cribrosa.