Diagnostic accuracy of optic disc microvasculature dropout for detecting glaucoma in eyes with high myopia.

PURPOSE To characterise microvasculature dropout (MvD) and assess the diagnostic efficacy of MvD in detecting glaucoma in eyes with high myopia (HM). METHODS This prospective cross-sectional study included 107 participants divided into HM group and HM with glaucoma group. Structural and vascular parameters were quantified using swept-source optical coherence tomography (SS-OCT) and OCT angiography (OCTA), including the peripapillary retinal nerve fibre layer (pRNFL), macular ganglion cell inner plexiform layer (mGCIPL), superficial capillary plexus, radial peripapillary capillaries, optic disc microvasculature dropout (MvD-D) and peripapillary microvasculature dropout. Receiver operating characteristic curves were employed to evaluate the diagnostic performance of each parameter. Univariate and multivariate linear regression analyses were conducted to examine associations between these parameters and mean deviations of the visual field test. RESULTS MvD-D outperformed all other structural and vascular metrics, achieving the highest area under the curve of 0.95. In multivariate regression analysis, MvD-D was identified as an independent factor associated with visual field loss (β=-0.42, p=0.02). CONCLUSIONS MvD-D demonstrates superior diagnostic performance compared with traditional structural markers such as pRNFL and mGCIPL in identifying glaucoma in highly myopic patients. Integrating MvD-D into routine clinical practice may provide a sightful value in detecting glaucoma with myopic discs.