How do you monitor glaucoma progression in highly myopic patients with unreliable visual fields and atypical RNFL scans?

Monitoring glaucoma in highly myopic eyes with unreliable tests is a well-known challenge. Careful clinical examination of the optic nerve, supported by stereo disc photos, remains essential. Myopic discs are often tilted with shallow cupping, making glaucomatous change easy to miss. However, features such as the “crescent moon sign” and progression of beta-zone peripapillary atrophy can be important clues.

Although OCT RNFL measurements are frequently unreliable in these patients, the macular G...