摘要： Objective: Currently, spectral-domain optical coherence tomography (SD-OCT) can serve as a new tool for glaucoma diagnosis. This study evaluates the diagnostic performance of SD-OCT parameters in glaucoma detection among myopic patients with varying refractive errors. Methods: Cross-sectional study. A total of 248 subjects (248 eyes) were included: 51 with early open-angle glaucoma, 79 normal controls (within ±0.50D), 47 with low myopia (?0.50D to ?3.00D, excluding), 43 with moderate myopia (?3.00D to ?6.00D, excluding), and 28 with high myopia (≤?6.00D). All participants underwent routine ophthalmic examinations, Humphrey visual field testing, and SD-OCT. Retinal nerve fiber layer (RNFL) and ganglion cell complex (GCC) parameters from OCT were statistically analyzed, with receiver operating characteristic (ROC) curves plotted and areas under the curve (AUC) calculated. Results: AUC results: For normal controls and low myopia, the best parameters were inferior and inferotemporal RNFL thickness (both AUC > 0.94). For moderate and high myopia, the best parameters were inferotemporal (AUC 0.926 and 0.896, respectively), while the inferior parameter in moderate myopia had a lower AUC (0.864, ranking 15th among all RNFL parameters). Further analysis of widely recognized glaucoma-diagnostic parameters (inferior, inferotemporal, superotemporal) showed that at 85% sensitivity, these parameters had higher specificity (>80%) in emmetropic and low myopia groups but lower specificity (20%–60%) in moderate and high myopia groups. The green area from machine databases was also smaller in high myopia compared to other groups (P < 0.05). Conclusion: SD-OCT glaucoma diagnostic parameters perform less effectively in moderate-to-high myopia, with notably reduced specificity. Comprehensive analysis is needed for glaucoma diagnosis in these groups. It is also recommended to expand the SD-OCT normative database to include different refractive errors.