{
  "abstract": "Purpose To characterize the biomechanical response of the optic nerve head (ONH) in myopic versus non-myopic individuals with normal-tension glaucoma (NTG), and to evaluate the association between ONH strains and the rate of visual field (VF) progression. Design Retrospective clinical cohort study. Participants A total of 118 NTG eyes from 77 patients with ≥ 2 years of follow-up and 5 VF tests were enrolled, including 66 eyes with myopia and 52 eyes without. Methods Each participant underwent three-dimensional (3D) optical coherence tomography (OCT) imaging of the ONH under three mechanical loading conditions: 20° adduction, 30° abduction and acute intraocular pressure (IOP) elevation by applying a 0.80 N force to the lower eyelid. Effective strains across the global ONH complex and within specific segmented tissues (pre-lamina, lamina cribrosa, choroid, and sclera) were quantified using a validated 3D strain-mapping algorithm. Results Myopic NTG eyes exhibited significantly higher ONH strains compared to non-myopic eyes under acute IOP elevation (10.1±2.7% vs. 9.3±1.8%, P = 0.044) and abduction (9.2±2.3% vs. 8.4±2.1%, P = 0.048). In the non-myopic group, ONH strains varied significantly across conditions (P < 0.001), with adduction (9.9± 2.0%) and acute IOP elevation (9.3±1.8%) eliciting greater strains than abduction (8.4±2.1%). These condition-dependent variations were less pronounced in the myopic group (10.1±2.7% vs. 9.8±2.7% vs. 9.2±2.3%, P = 0.07). Multivariable linear mixed-effects analysis revealed that in myopic NTG, higher ONH strains induced by adduction were significantly associated with faster MD decline (estimate: -0.139 dB/year per 1% increase, P = 0.03, adjusted for age, spherical equivalent and baseline perimetric mean defect). Conversely, larger strains during acute IOP elevation were associated with slower progression (estimate: 0.184 dB/year per 1% increase, P = 0.004). Tissue-specific analysis confirmed that adduction-induced strains in the choroid and pre-lamina tissue as well as IOP-induced strains across all ONH tissues were significantly correlated with the rate of perimetric progression in myopic eyes (all P < 0.05). Conclusions In this cohort, greater adduction-induced ONH strain was associated with faster perimetric deterioration in myopic NTG. These findings support further investigation of gaze-related optic nerve traction as a potential non-IOP-related biomechanical factor in myopic NTG.",
  "abstract_shown": true,
  "affiliations": [
    "National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China"
  ],
  "article_type": "PUBLISHAHEADOFPRINT",
  "arxiv": null,
  "author_total": 12,
  "authors": [
    {
      "name": "D.-F. Chen"
    },
    {
      "name": "Z. Xiong"
    },
    {
      "name": "J. Zhang"
    },
    {
      "name": "C. Deng"
    },
    {
      "name": "J. Li"
    },
    {
      "name": "G. Liu"
    },
    {
      "name": "T. Wang"
    },
    {
      "name": "Q. Huang"
    },
    {
      "name": "J. Jonas"
    },
    {
      "name": "M. J. A. Girard"
    },
    {
      "name": "X. Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Y. Liang"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ar5nqb42nnxx5.bib",
  "cited_by": 0,
  "doi": "10.64898/2026.10.15.26365686",
  "fulltext_url": "https://www.medrxiv.org/content/10.64898/2026.10.15.26365686v1.full",
  "id": "ar5nqb42nnxx5",
  "issns": [],
  "landing_url": "https://www.medrxiv.org/content/10.64898/2026.10.15.26365686v1",
  "language": null,
  "licence": "PDM-1.0",
  "licence_label": "Public domain",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/publicdomain/mark/1.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "medrxiv",
      "ophthalmology"
    ],
    [
      "openalex",
      "2731|Glaucoma and retinal disorders"
    ]
  ],
  "openalex": "W7222942543",
  "pdf_url": "https://www.medrxiv.org/content/10.64898/2026.10.15.26365686v1.full.pdf",
  "pmcid": null,
  "pmid": null,
  "published": "2026-10-15",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/ar5nqb42nnxx5.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:21:10Z",
      "native_id": "10.64898/2026.10.15.26365686",
      "source": "medrxiv",
      "url": "https://www.medrxiv.org/content/10.64898/2026.10.15.26365686v1"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "medrxiv:ophthalmology",
      "subfield": "general"
    }
  ],
  "title": "Association of Adduction-Induced Optic Nerve Head Strain with Visual Field Loss Progression in Myopic Normal-Tension Glaucoma: The Wenzhou Glaucoma Progression Study",
  "title_text": "Association of Adduction-Induced Optic Nerve Head Strain with Visual Field Loss Progression in Myopic Normal-Tension Glaucoma: The Wenzhou Glaucoma Progression Study",
  "type": "preprint",
  "updated_at": "2026-10-30T12:21:10Z",
  "url": "https://research.draconitic.com/paper/ar5nqb42nnxx5",
  "venue": "medRxiv",
  "versions": []
}