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.