Stereophotographic Assessment of Intraocular Pressure Reduction in Myopic Eyes with Glaucoma-Compatible Optic Neuropathy

INTRODUCTION: The aim of our work is to evaluate stereoscopic photographic changes in the optic nerve head among patients with glaucoma-compatible optic neuropathy in myopia (GCON-M) after intraocular pressure (IOP) reduction and to determine whether these changes represent true progressive glaucomatous damage. METHODS: This self-controlled, observational cohort study included 41 patients with bilateral normal-tension GCON-M. The eye with the worse baseline visual field (VF) mean deviation received intraocular pressure (IOP)-lowering treatment targeting a 30% reduction, while the fellow eye served as an untreated control. Participants underwent serial VF testing and stereophotographic imaging over a median follow-up of 48 months. Structural and functional progression was compared between the treated and control eyes. RESULTS: Among the 41 patients (82 eyes), the treatment group achieved a mean IOP reduction of 31.1%, significantly greater than that in the control group (P < 0.001). There was no significant difference between the groups in the change in VF mean deviation (P = 0.25) or structural progression scores (P = 0.37). Disease progression occurred in 9.7% of treated and 12.2% of control eyes. Kaplan-Meier analysis showed no significant difference in progression-free survival between the groups (P = 0.76), which was further confirmed by multivariate Cox regression analysis (P = 0.67). CONCLUSIONS: The long-term stability of GCON-M in many untreated eyes suggests that these changes may represent non-progressive remodeling rather than true glaucomatous damage. These findings argue against routine glaucoma therapy and support an individualized monitoring strategy to avoid overtreatment.