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Glaucoma conversion of the contralateral eye in unilateral normal-tension glaucoma patients: a 5-year follow-up study
  1. Jin-Soo Kim1,2,
  2. Hyuk Jin Choi1,3,4,
  3. Ki Ho Park1,3
  1. 1 Ophthalmology, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
  2. 2 Ophthalmology, Chungnam National University Sejong Hospital, Sejong, Korea (the Republic of)
  3. 3 Ophthalmolgy, Seoul National University Hospital, Seoul, Korea (the Republic of)
  4. 4 Ophthalmology, Seoul National University Hospital Healthcare System Gangnam Center, Seoul, Korea (the Republic of)
  1. Correspondence to Hyuk Jin Choi, Department of Ophthalmology, Seoul National University Hospital Healthcare System Gangnam Center, 39th Floor, Gangnam Finance Center, 152 Teheran-ro, Gangnam-gu, Seoul 06236, Republic of Korea; docchoi{at}


Background/Aims To investigate clinical characteristics and risk factors for glaucoma conversion of the contralateral eye in unilateral normal-tension glaucoma (NTG) patients.

Methods A retrospective observational cohort study was conducted on a total of 76 subjects who had been diagnosed with unilateral NTG at the baseline and followed up for more than 5 years. Glaucoma conversion in the contralateral eye was defined as increased thinning of neuro-retinal rim, development of retinal nerve fibre layer defect and/or development of glaucomatous visual field defect.

Results During the mean follow-up period of 7.3±2.4 years, 21 of 76 (27.6%) subjects were confirmed to have developed glaucoma in the non-glaucomatous contralateral eye. The 5-year rate of glaucoma conversion in contralateral eyes was 19.7%. The maximum width of β-zone parapapillary atrophy (MWβPPA)-disc diameter (DD) ratio at the baseline and the presence rate of disc haemorrhage during follow-up period were significantly greater in the contralateral eyes of the conversion group than in those of the non-conversion group (p=0.011, <0.001, respectively). A multivariate Cox-proportional hazard model revealed intraocular pressure (IOP) over 17 mm Hg (HR 5.05, p=0.031), central corneal thickness (CCT) under 491 μm (HR 4.25, p=0.025) and MWβPPA-DD ratio over 0.32 (HR 6.25, p=0.003) in contralateral eye at the baseline as the independent risk factors for glaucoma conversion.

Conclusions Among unilateral NTG patients, those with low CCT and high MWβPPA-DD ratio as well as high IOP in the contralateral eye are more likely to develop glaucoma in that eye during long-term follow-up.

  • Glaucoma

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  • Correction notice This paper has been corrected since it was published online. Throughout the manuscript, glaucoma conversion rate of contralateral eyes was indicated as ‘21 of 76 (27.6%) subjects’, but in the first sentence of the results in the abstract it stated: ‘21 of 79 (26.6%) subjects’. This has been corrected.

  • Contributors JSK, HJC, KHP: conception and design of the work; JSK, HJC: acquisition, analysis or interpretation of data for the work, drafting the work; HJC, KHP, revising the work. All authors have approved the version to be published and agreed to be accountable for all aspects of the work.

  • Funding Supported by grant no. 0420180870 from the SNUH Research Fund and grant no. 2019R1F1A1058426 from National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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