y The Prevalence of Optical Coherence Tomography Artifacts in High Myopia and its Influence on Glaucoma Diagnosis

Precis: Optical coherence tomography (OCT) artifacts occur much more frequently in highly myopic eyes compared with non-highly myopic eyes. A longer axial length is predictive of having OCT artifacts. Purpose: To investigate the types and prevalence of artifacts on OCT scans in patients with and without high myopia. Materials and Methods: Patients were divided into 4 groups based on whether they had glaucoma and/or high myopia. All peripapillary retinal nerve fiber layer (RNFL) scan images were individually inspected for the presence of artifacts. Results: Two hundred twenty-six patients were enrolled. The prevalence of OCT artifacts was 18.6% in non-high myopes and 51.9% in high myopes (P < 0.001). Outer RNFL border misidentification was the most common type of artifact for non-high myopes, whereas retinal pathology-related artifact was the most common in high myopes. Univariable regression analysis showed that a longer axial length [ odds ratio (OR) 1.815, P < 0.001], a higher pattern standard deviation (OR 1.194, P < 0.001), and thinner RNFL (OR 0.947, P < 0.001) were predictive factors for the presence of OCT artifacts. The diagnostic capability of global RNFL thickness before and after manual correction of segmentation errors did not differ for both non-high myopes [area under the receiver operating curve 0.915-0.913 (P = 0.955)] and high myopes [area under the receiver operating curve 0.906-0.917 ( P = 0.806)]. Conclusion: The prevalence of OCT artifacts was the highest in patients with both high myopia and glaucoma. The most common type of OCT artifact is different for non-high myopes and high myopes. Physicians need to be aware of a higher likelihood of OCT artifacts, particularly in those with a longer axial length, worse visual field, and thinner RNFL thickness.