Glaucoma in Very Nearsighted Eyes: What New French Guidelines Recommend

High myopia, or strong nearsightedness, is more than a need for thick glasses. High myopia is an independent risk factor for glaucoma, and it can also make glaucoma harder to diagnose. In 2026, the French Glaucoma Society and the French-speaking Retina Specialists’ Club published consensus guidelines on managing glaucoma in highly myopic eyes.

Why diagnosis is harder

According to the guidelines, high myopia adds complexity to glaucoma diagnosis, follow-up, and treatment. In some highly myopic eyes, extensive changes in the retina and the layers beneath it interfere with examining the back of the eye and with interpreting the tests used to detect glaucoma. That can make it hard to tell which changes come from myopia and which come from glaucoma.

What the guidelines recommend

• Treatment and follow-up are similar to standard open-angle glaucoma: the goal is a target eye pressure low enough to prevent new or worsening glaucoma damage.
• When eye pressure is high but the diagnosis is uncertain because of extensive myopic changes in the back of the eye, pressure-lowering treatment may be started anyway, to avoid adding glaucoma damage to the damage myopia may already cause.
• If surgery is considered, the higher rate of complications after glaucoma surgery in highly myopic eyes should be taken into account.

What this means if you are very nearsighted

• Have regular comprehensive eye exams that include an eye pressure check and an optic nerve evaluation, even if your glasses or contacts work well.
• Tell your eye doctor about any family history of glaucoma.
• Ask whether your baseline optic nerve scans and visual fields are on file, so future changes can be compared with your own starting point.
• If you are started on drops “to be safe,” use them as directed and keep your follow-up visits.
• Report sudden flashes, a shower of floaters, or a curtain over your vision right away.

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Source: Management of glaucoma in high myopia: Guidelines from the French Glaucoma Society (SFG) and the French-speaking Retina Specialists’ Club (CFSR) (Journal Français d’Ophtalmologie (PubMed), epub 08/26/2026). This article is an educational summary written by Khanna Vision Institute and is not a substitute for medical advice.