Peripapillary Optical Coherence Tomography Artifacts in Pathologic Myopia: Prevalence and Impact on Glaucoma Diagnosis

PRCIS: Peripapillary retinal nerve fiber layer thickness (pRNFLT) artifacts were more prevalent than Bruch's membrane opening-minimum rim width (BMO-MRW) artifacts in pathologic myopia. Considering artifacts, the diagnostic performance of pRNFLT and BMO-MRW was comparable. PURPOSE: To investigate the prevalence of peripapillary retinal nerve fiber layer thickness (pRNFLT) and Bruch's membrane opening-minimum rim width (BMO-MRW) artifacts in pathologic myopia (PM) and the impact of artifacts on the diagnostic ability for open-angle glaucoma (OAG). METHODS: This cross-sectional study was conducted at Zhongshan Ophthalmic Center. PM eyes were divided into two groups based on OAG diagnosis. Artifacts of pRNFLT and BMO-MRW were classified and their prevalences were compared. The diagnostic ability of pRNFLT and BMO-MRW for OAG was compared before and after the inclusion of eyes with artifacts. RESULTS: A total of 136 participants with PM were included from July 2023 to January 2025, with a median (interquartile range) age of 49 (16) years and mean (standard deviation) axial length of 28.03 (2.01) mm. Seventy-four (54.4%) eyes were diagnosed as OAG. Seven and three types of pRNFLT and BMO-MRW artifacts were observed, respectively. Presence of pRNFLT artifacts was identified in 74.2% of eyes in the PM group and 63.5% of eyes in the PM with OAG (PMG) group, which was more prevalent than BMO-MRW artifacts (27.4% in the PM group and 4.1% in the PMG group, both P<0.001). Before and after including eyes with artifacts, the AUC of global RNFLT decreased from 0.927 to 0.869, and the AUC of global BMO-MRW slightly decreased from 0.884 to 0.882. CONCLUSION: Artifacts of pRNFLT were more complex and prevalent than those of BMO-MRW. In PM, the diagnostic ability of pRNFLT and BMO-MRW were comparable when artifacts were considered.