Association of Adduction-Induced Optic Nerve Head Strain with Visual Field Loss Progression in Myopic Normal-Tension Glaucoma: The Wenzhou Glaucoma Progression Study
- 1National Clinical Research Center for Ocular Diseases, Eye Hospital, Wenzhou Medical University, Wenzhou, 325027, China
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.
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BibTeX
@misc{chen2026association,
title = {{Association of Adduction-Induced Optic Nerve Head Strain with Visual Field Loss Progression in Myopic Normal-Tension Glaucoma: The Wenzhou Glaucoma Progression Study}},
author = {D.-F. Chen and Z. Xiong and J. Zhang and C. Deng and J. Li and G. Liu and T. Wang and Q. Huang and J. Jonas and M. J. A. Girard and X. Wang and Y. Liang},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.15.26365686},
url = {https://www.medrxiv.org/content/10.64898/2026.10.15.26365686v1},
note = {Public domain},
}
RIS
TY - UNPB
TI - Association of Adduction-Induced Optic Nerve Head Strain with Visual Field Loss Progression in Myopic Normal-Tension Glaucoma: The Wenzhou Glaucoma Progression Study
AU - D.-F. Chen
AU - Z. Xiong
AU - J. Zhang
AU - C. Deng
AU - J. Li
AU - G. Liu
AU - T. Wang
AU - Q. Huang
AU - J. Jonas
AU - M. J. A. Girard
AU - X. Wang
AU - Y. Liang
PY - 2026
DA - 2026/10/15
PB - medRxiv
DO - 10.64898/2026.10.15.26365686
UR - https://www.medrxiv.org/content/10.64898/2026.10.15.26365686v1
AB - 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.
ER -