{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:44:45Z","timestamp":1786729485143,"version":"build-2736575974"},"reference-count":30,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2026,7,17]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>To assess the cut-off value for an axial length-related increase in the prevalence of glaucomatous\/glaucoma-like (GON\/GLON) and non-glaucomatous (NGON) optic neuropathy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The project included the population-based Beijing Eye Study (n=3088; age: 40+ years), Ural Eye and Medical Study (n=5199 participants; age: 40+ years), Ural Very Old Study (n=428; age: 85+ years), Ural Children Eye Study (n=4185; school grade: 1+) and Central India Eye and Medical Study (CIEMS; n=4199; age: 30+ years). Using fundus photographs (all studies) and optical coherent tomographic images (all studies except for CIEMS), we assessed the prevalence of GON\/GLON and NGON, defined by optic nerve head appearance and absence of neurological perimetric defects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The total study population included 34\u2009864 eyes (17\u2009099 individuals; age: 46.1\u00b123.0 years; range: 6 to 100 years) (axial length: 23.19\u00b11.05\u2009mm; range: 18.22\u201334.20 mm). Prevalence of GON\/GLON and NGON were 438\/17\u2009099 (2.6%; 95%\u2009CI 2.0 to 3.0) and NGON 57\/17\u2009099 (0.3%; 95%\u2009CI 0.0 to 0.4) respectively. Higher GON\/GLON prevalence was correlated with longer axial length (OR: 1.45; 95%\u2009CI 1.35 to 1.56; p&lt;0.001) after adjusting for age and intraocular pressure. The increase in GON\/GLON prevalence started at an axial length of 27.0\u2009mm and 26.5\u2009mm for a younger subgroup aged \u226452 years and an older subgroup aged &gt;52 years respectively. Higher NGON prevalence was associated with longer axial length (OR: 4.35; 95%\u2009CI 3.58 to 5.29; p&lt;0.001) after adjusting for age. The increase in NGON prevalence started to rise at an axial length of 27.0\u2009mm and 26.5\u2009mm for the younger subgroup and older subgroup, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Prevalence of GON\/GLON and NGON started to increase at an axial length of 27.0\u2009mm and 26.5\u2009mm for individuals aged \u226452 years or &gt;52 years, respectively. These cut-off values may be helpful for the differentiation of moderate myopia versus high myopia.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2025-329214","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:25:16Z","timestamp":1786728316000},"page":"bjo-2025-329214","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Axial length-related cut-off value for increase in glaucomatous and non-glaucomatous optic neuropathy prevalence"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2972-5227","authenticated-orcid":false,"given":"Jost B","family":"Jonas","sequence":"first","affiliation":[{"name":"Institute Francais de Myopie, Rothschild Foundation Hospital, Paris, France"},{"name":"Singapore Eye Research Institute, Singapore"},{"name":"Ophthalmology, LV Prasad Eye Institute, Hyderabad, Telangana, India"},{"name":"Beijing Visual Science and Translational Eye Research Institute (BERI), Beijing Tsinghua Changgung Hospital, Tsinghua Medicine, Tsinghua University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul A","family":"Jonas","sequence":"additional","affiliation":[{"name":"Ophthalmology, LV Prasad Eye Institute, Hyderabad, Telangana, India"},{"name":"Department of Ophthalmology, University Hospital of Cologne, Cologne, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mukharram M","family":"Bikbov","sequence":"additional","affiliation":[{"name":"Ufa Eye Research Institute, Ufa, Russian Federation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gyulli M","family":"Kazakbaeva","sequence":"additional","affiliation":[{"name":"Ufa Eye Research Institute, Ufa, Russian Federation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellina M","family":"Iakupova","sequence":"additional","affiliation":[{"name":"Ufa Eye Research Institute, Ufa, Russian Federation"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Milea","sequence":"additional","affiliation":[{"name":"Rothschild Foundation Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7265-931X","authenticated-orcid":false,"given":"Alain M","family":"Bron","sequence":"additional","affiliation":[{"name":"Rothschild Foundation Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u00e9dric","family":"Lamirel","sequence":"additional","affiliation":[{"name":"Rothschild Foundation Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinay","family":"Nangia","sequence":"additional","affiliation":[{"name":"Suraj Eye Institute, Nagpur, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ya Xing","family":"Wang","sequence":"additional","affiliation":[{"name":"Beijing Visual Science and Translational Eye Research Institute (BERI), Beijing Tsinghua Changgung Hospital, Tsinghua Medicine, Tsinghua University, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Songhomitra","family":"Panda-Jonas","sequence":"additional","affiliation":[{"name":"Rothschild Foundation Hospital, Paris, France"},{"name":"Ophthalmology, University Heidelberg, Heidelberg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"2026081410251256000_bjo-2025-329214v1.1","doi-asserted-by":"crossref","DOI":"10.1167\/iovs.62.5.5","article-title":"IMI Pathologic Myopia","volume":"62","author":"Ohno-Matsui","year":"2021","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2026081410251256000_bjo-2025-329214v1.2","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1016\/j.ophtha.2023.07.014","article-title":"Prevalence and Associations of Nonglaucomatous Optic Nerve Atrophy in High Myopia: The Ural Eye and Medical Study","volume":"130","author":"Bikbov","year":"2023","journal-title":"Ophthalmology"},{"key":"2026081410251256000_bjo-2025-329214v1.3","doi-asserted-by":"crossref","first-page":"100114","DOI":"10.1016\/j.apjo.2024.100114","article-title":"Clinical and anatomical features of myopia","volume":"13","author":"Jonas","year":"2024","journal-title":"Asia Pac J Ophthalmol (Phila)"},{"key":"2026081410251256000_bjo-2025-329214v1.4","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2020-316648"},{"key":"2026081410251256000_bjo-2025-329214v1.5","doi-asserted-by":"crossref","DOI":"10.1167\/iovs.66.14.30","article-title":"Glaucomatous, Glaucoma-Like, and Non-Glaucomatous Optic Neuropathy in High Myopia: The Two-Continent Study","volume":"66","author":"Jonas","year":"2025","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2026081410251256000_bjo-2025-329214v1.6","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2021-320644"},{"key":"2026081410251256000_bjo-2025-329214v1.7","first-page":"6","article-title":"Axial length of the eye in the elderly population of the Southern Urals (according to the study Ural Very Old Study)","volume":"1","author":"Bikbov","year":"2022","journal-title":"POVE-W"},{"key":"2026081410251256000_bjo-2025-329214v1.8","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2020.0567","article-title":"Prevalence of Myopic Maculopathy Among Adults in a Russian Population","volume":"3","author":"Bikbov","year":"2020","journal-title":"JAMA Netw Open"},{"key":"2026081410251256000_bjo-2025-329214v1.9","doi-asserted-by":"crossref","DOI":"10.1001\/jamanetworkopen.2021.21138","article-title":"Prevalence Factors Associated With Vision Impairment and Blindness Among Individuals 85 Years and Older in Russia","volume":"4","author":"Bikbov","year":"2021","journal-title":"JAMA Netw Open"},{"key":"2026081410251256000_bjo-2025-329214v1.10","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1097\/APO.0000000000000639","article-title":"Prevalence and Associations of Keratoconus Among Children, Adults, and Elderly in the Population-Based Ural Eye Studies","volume":"12","author":"Bikbov","year":"2023","journal-title":"Asia Pac J Ophthalmol (Phila)"},{"key":"2026081410251256000_bjo-2025-329214v1.11","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2024.07.003"},{"key":"2026081410251256000_bjo-2025-329214v1.12","first-page":"1151","article-title":"Optic disc, cup and neuroretinal rim size, configuration and correlations in normal eyes","volume":"29","author":"Jonas","year":"1988","journal-title":"Invest Ophthalmol Vis Sci"},{"key":"2026081410251256000_bjo-2025-329214v1.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.preteyeres.2020.100933"},{"key":"2026081410251256000_bjo-2025-329214v1.14","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1097\/APO.0000000000000288","article-title":"High Myopia and Glaucoma-Like Optic Neuropathy","volume":"9","author":"Jonas","year":"2020","journal-title":"Asia Pac J Ophthalmol (Phila)"},{"key":"2026081410251256000_bjo-2025-329214v1.15","doi-asserted-by":"publisher","DOI":"10.1007\/BF02169199"},{"key":"2026081410251256000_bjo-2025-329214v1.16","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9394(69)91241-0"},{"key":"2026081410251256000_bjo-2025-329214v1.17","doi-asserted-by":"publisher","DOI":"10.1016\/S0161-6420(99)90416-5"},{"key":"2026081410251256000_bjo-2025-329214v1.18","doi-asserted-by":"publisher","DOI":"10.1159\/000310760"},{"key":"2026081410251256000_bjo-2025-329214v1.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2006.03.059"},{"key":"2026081410251256000_bjo-2025-329214v1.20","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-020-77344-z","article-title":"Prevalence and associated factors of glaucoma in the Russian Ural Eye and Medical Study","volume":"10","author":"Bikbov","year":"2020","journal-title":"Sci Rep"},{"key":"2026081410251256000_bjo-2025-329214v1.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2010.01.035"},{"key":"2026081410251256000_bjo-2025-329214v1.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2011.03.012"},{"key":"2026081410251256000_bjo-2025-329214v1.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2012.07.065"},{"key":"2026081410251256000_bjo-2025-329214v1.24","doi-asserted-by":"crossref","DOI":"10.1038\/srep19320","article-title":"Joint Effects of Intraocular Pressure and Myopia on Risk of Primary Open-Angle Glaucoma: The Singapore Epidemiology of Eye Diseases Study","volume":"6","author":"Tham","year":"2016","journal-title":"Sci Rep"},{"key":"2026081410251256000_bjo-2025-329214v1.25","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.ajo.2021.10.007","article-title":"Degree of Myopia and Glaucoma Risk: A Dose-Response Meta-analysis","volume":"236","author":"Ha","year":"2022","journal-title":"Am J Ophthalmol"},{"key":"2026081410251256000_bjo-2025-329214v1.26","doi-asserted-by":"crossref","first-page":"2631","DOI":"10.1007\/s00417-025-06827-4","article-title":"Exploration of the cutoff values of axial length that is susceptible to develop advanced primary open angle glaucoma in patients aged less than 50 years","volume":"263","author":"Suda","year":"2025","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"key":"2026081410251256000_bjo-2025-329214v1.27","first-page":"415","article-title":"Diagnosis and Treatment of Myopic Maculopathy","volume":"7","author":"Yokoi","year":"2018","journal-title":"Asia Pac J Ophthalmol (Phila)"},{"key":"2026081410251256000_bjo-2025-329214v1.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2017.12.005"},{"key":"2026081410251256000_bjo-2025-329214v1.29","doi-asserted-by":"publisher","DOI":"10.1111\/j.1755-3768.2009.01770.x"},{"key":"2026081410251256000_bjo-2025-329214v1.30","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.ajo.2017.09.018","article-title":"The ISNT Rule: How Often Does It Apply to Disc Photographs and Retinal Nerve Fiber Layer Measurements in the Normal Population?","volume":"184","author":"Poon","year":"2017","journal-title":"Am J Ophthalmol"}],"container-title":["British Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjo-2025-329214","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:25:18Z","timestamp":1786728318000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjo.bmj.com\/lookup\/doi\/10.1136\/bjo-2025-329214"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,14]]},"references-count":30,"alternative-id":["10.1136\/bjo-2025-329214"],"URL":"https:\/\/doi.org\/10.1136\/bjo-2025-329214","relation":{},"ISSN":["0007-1161","1468-2079"],"issn-type":[{"value":"0007-1161","type":"print"},{"value":"1468-2079","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,14]]}}}