In elderly patients with large cup-to-disc ratios (CDRs), a positive temporal raphe sign OCT imaging is associated with faster conversion to normal-tension glaucoma (NTG), a recent study suggests.

This retrospective cohort study evaluated 72 eyes of 72 untreated patients at least 65 years old with large vertical cup-to-disc ratios (≥0.7) and without any other glaucomatous findings. A team imaged the optic nerve head, peripapillary retinal nerve fiber layer (RNFL) and the macular ganglion cell-inner plexiform layer (GCIPL) thickness and defined conversion to NTG as structural or functional deterioration on either red-free RNFL photography or standard automated perimetry, respectively.

During 5.5 years of follow-up, the researchers found that 19 eyes (26.4%) converted to NTG. They observed no significant differences in demographics, systemic factors, intraocular pressures or OCT parameters between the non-converters and converters. They noted that the temporal raphe sign was seen in 94.7% of converters but only 5.7% of non-converters at baseline. They reported significant influences of temporal raphe sign positivity on conversion to NTG.

Ha A, Kim YK, Kim JS, et al. Temporal raphe sign in elderly patients with large optic disc cupping: its evaluation as a predictive factor for glaucoma conversion. Am J Ophthalmol. July 8, 2020. [Epub ahead of print].