Managing Myopic Glaucoma—Beyond Structural Fragility and Diagnostic Challenges: Review Article

IntroductIonGlaucoma is a progressive, multifactorial optic neuropathy characterized by the loss of retinal nerve fibers and excavation of the optic nerve head, accompanied by typical visual field defects. 1 While primary open-angle glaucoma (POAG) is the most common form, specific patient subgroups present distinct clinical features and pathophysiological mechanisms, which warrant customized diagnostic and management approaches. 1,2One such subgroup includes patients with high myopia, who exhibit a peculiar glaucoma phenotype-often referred to as myopic glaucomapresenting significant clinical and therapeutic challenges. 1,2 paradigmatic case is that of a 32-year-old female patient with high myopia and a history of tilted optic disc.For several years, she was monitored without a definitive glaucoma diagnosis due to consistently intraocular pressure (IOP) within "normal" limits (15-16 mm Hg) and structural ambiguity on fundus examination.Visual field progression with paracentral loss eventually led to a late