Pseudophakic adult with progressive optic disc tilt and axial length elongation

PURPOSE: To describe a case of progressive optic disc tilt in a pseudophakic Asian adult associated with an increase in axial length. OBSERVATIONS: A 28-year-old man presented with high myopia in the right eye with an axial length of 30.4 mm and refraction of −13.75 diopters (D) spherical equivalent (SE). The refraction was plano sphere after LASIK and LASIK enhancement. The left eye was blinded by retinal detachment after phacoemulsification. Six years later, the right eye axial length was 31.65 mm when he underwent phacoemulsification with intraocular lens placement for nuclear sclerosis, after which the refraction was −0.50 D SE. The right eye refraction changed progressively over 13 years after cataract surgery to −4.00 D SE, at which time the axial length was 33.69 mm. A notable increase in optic disc tilt and peripapillary atrophy was evident on comparison of fundus photographs taken 11 years apart. CONCLUSIONS: Although progressive optic disc tilt in conjunction with increasing axial myopia in pediatric populations has been documented, it has not been reported in adults but may occur. Scleral stretching due to axial length elongation associated with loss of accommodation after cataract surgery and worsening peripapillary atrophy are possible causes of this finding.