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Authors: Jinho Lee, Young Kook Kim
Journal: Ophthalmology (2019)

We thank Borgohain et al for their comments regarding our article.1Lee J. Kim Y.K. Ha A. et al.Temporal raphe sign for discrimination of glaucoma from optic neuropathy in eyes with macular ganglion cell-inner plexiform layer thinning.Ophthalmology. 2019; 126: 1131-1139Abstract Full Text Full Text PDF PubMed Scopus (10) Google Scholar Their first query was whether the cohort included only normal tension glaucoma (NTG) subjects or, also, primary open-angle glaucoma (POAG) subjects on medication. They made the following valid point: considering that macular ganglion cell-inner plexiform layer thinning occurs more locally (mainly in the inferior area) in NTG than in POAG, studies that include POAG patients might overestimate temporal raphe sign positivity.2Jung H.-H. Sung M.-S. Heo H. Park S.-W. Macular inner plexiform and retinal nerve fiber layer thickness in glaucoma.Optom Vis Sci. 2014; 91: 1320-1327Google Scholar In this study, however, we included only NTG patients with a baseline intraocular pressure of ≤21 mmHg. The main purpose of this study was to find a clinically useful tool, other than intraocular pressure, for the discrimination of glaucomatous neuropathies from nonglaucomatous optic neuropathies. Considering that nonglaucomatous optic neuropathies typically have an intraocular pressure within the normal range, we authors had thought that NTG might be more difficult to discriminate than POAG in clinical practice. Hence, we considered only patients with NTG when we designed the study. In addition, Borgohain et al pointed out the temporal raphe sign’s potential utility for discriminating between nonarteritic anterior ischemic optic neuropathy and POAG. According to Fard et al,3Fard M.A. Afzali M. Abdi P. et al.Comparison of the pattern of macular ganglion cell-inner plexiform layer defect between ischemic optic neuropathy and open-angle glaucoma.Invest Ophthalmol Vis Sci. 2016; 57: 1011-1016Crossref PubMed Scopus (25) Google Scholar parafoveal macular ganglion cell-inner plexiform layer thickness is significantly lower in nonarteritic anterior ischemic optic neuropathy than in POAG. Also, considering that macular ganglion cell-inner plexiform layer thinning occurs more globally than locally in POAG,2Jung H.-H. Sung M.-S. Heo H. Park S.-W. Macular inner plexiform and retinal nerve fiber layer thickness in glaucoma.Optom Vis Sci. 2014; 91: 1320-1327Google Scholar the temporal raphe sign might be able to discriminate nonarteritic anterior ischemic optic neuropathy from POAG. However, we did not include POAG cases in this study. Certainly, further study would help to elucidate this issue. We appreciate the comments. Re: Lee et al.: Temporal raphe sign for discrimination of glaucoma from optic neuropathy in eyes with macular ganglion cell inner plexiform layer thinning (Ophthalmology. 2019;126:1131-1139)OphthalmologyVol. 126Issue 9PreviewWe congratulate Lee et al1 for their study and appreciate their effort to establish discrimination between glaucomatous optic neuropathy (GON) and non-GON using macular ganglion cell inner plexiform layer (mGCIPL) thickness. However, we have a few queries and seek your kind attention. Full-Text PDF