Features of management of glaucoma patients with myopia

PURPOSE. To study the opinions of ophthalmologists on the management strategy for patients with concurrent myopia and glaucoma.
METHODS. This multicenter, scientific-analytical, descriptive, sample-based study was conducted by the "Scientific Vanguard" group of the Russian Glaucoma Society from July to September 2024 through an online survey of Russian ophthalmologists with varying experience, working in healthcare institutions of different ownership types. The developed questionnaire was hosted on a secure online platform. The study involved 302 ophthalmologists, with the overwhelming majority of clinicians (97%) working in the outpatient settings (89%) of state healthcare institutions (85%), with 6–15 years of work experience (48%), without a qualification category (44%), residing in large cities (41%) or cities with a population of over a million (44%).
RESULTS. According to respondents, patients with combined glaucoma and myopia present weekly (48%). Moderate myopia was most common (58%), as well as younger age (70%), advanced stages of glaucoma (55%), moderately elevated intraocular pressure (IOP) (71%), and normaltension glaucoma (58%), which were characterized by rapid progression (52%), absence of complaints (72%), and concurrent cardiovascular conditions (44%). IOP was most often measured using the Maklakov tonometry method (47%). Diagnosing glaucoma in these patients was considered difficult (51%), and ophthalmologists preferred lower target IOP levels (83%), which were harder to achieve (53%). Respondents avoided prescribing m-cholinomimetics (33%) and β-blockers (27%), opting more often for combination therapy (75%). Nearly all believed that these patients require additional neuroprotective treatment (97%). Most respondents considered selective laser trabeculoplasty to be less effective (44%); such patients were operated on more frequently (51%) but with lower success rates (53%) and higher complication rates (60%).
CONCLUSION. Glaucoma patients with myopia are frequently encountered and require careful long-term monitoring and personalized treatment strategies. The early onset of glaucoma and high risk of disability in this group underscore the medical and social significance of the problem and the need for a more detailed study.

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