Abstract
This retrospective study investigated the predictive value of OCT-derived color coding in assessing the risk of glaucoma conversion among normal-tension glaucoma (NTG) suspects, with a particular focus on highly myopic eyes. A total of 307 eyes underwent baseline spectral-domain OCT imaging, with RNFL and GCIPL thicknesses categorized by device-generated color codes (green: normal, yellow: borderline, red: abnormal). Glaucoma conversion was defined by the emergence of reproducible visual field defects over a mean follow-up of 76.0 ± 8.8 months, during which 23.8% of eyes progressed. Inferotemporal GCIPL thickness showed the strongest discriminative capacity (AUC = 0.68, cutoff = 62.0 μm), with further improvement in highly myopic eyes (AUC = 0.85). Red color coding in the inferotemporal sector was associated with a significantly increased risk of conversion (HR 2.473; p = 0.050), while eyes with green coding in both inferotemporal and average GCIPL sectors demonstrated high negative predictive values (85.0% overall, 90.2% in the myopic subgroup). These results highlight the clinical utility of GCIPL color coding on OCT as an accessible and practical tool for identifying early disease stability and stratifying risk of progression, even in anatomically challenging high myopia cases.
Similar content being viewed by others
Data availability
The datasets used and/or analyzed during the current study available from the corresponding author on reasonable request.
References
Weinreb, R. N., Aung, T. & Medeiros, F. A. The pathophysiology and treatment of glaucoma: a review. Jama 311(18), 1901–1911. https://doi.org/10.1001/jama.2014.3192 (2014).
Geevarghese, A., Wollstein, G., Ishikawa, H. & Schuman, J. S. Optical coherence tomography and glaucoma. Annu Rev. Vis. Sci Sep. 15, 7:693–726. https://doi.org/10.1146/annurev-vision-100419-111350 (2021).
Dong, Z. M., Wollstein, G. & Schuman, J. S. Clinical utility of optical coherence tomography in glaucoma. Invest Ophthalmol. Vis. Sci Jul. 1 (9), Oct556–567. https://doi.org/10.1167/iovs.16-19933 (2016).
Sun, M. T. et al. Glaucoma and Myopia: Diagnostic Challenges. Biomol. Mar. https://doi.org/10.3390/biom13030562 (2023).
Kudsieh, B. et al. Update on the Utility of Optical Coherence Tomography in the Analysis of the Optic Nerve Head in Highly Myopic Eyes with and without Glaucoma. J Clin. Med Mar. https://doi.org/10.3390/jcm12072592 (2023).
Zhang, Y. Q. et al. Exploring optical coherence tomography parameters in eyes with myopic Tilted disc. Eye Vis. (Lond) Nov. 2 (1), 47. https://doi.org/10.1186/s40662-024-00411-3 (2024).
Maslin, J. S., Mansouri, K. & Dorairaj, S. K. HRT for the diagnosis and detection of glaucoma progression. Open. Ophthalmol. J. 9, 58–67. https://doi.org/10.2174/1874364101509010058 (2015).
Trick, G. L., Calotti, F. Y. & Skarf, B. Advances in imaging of the optic disc and retinal nerve fiber layer. J Neuroophthalmol Dec. 26 (4), 284–295. https://doi.org/10.1097/01.wno.0000249327.65227.67 (2006).
Liu, L. et al. Optical coherence tomography angiography of the peripapillary retina in glaucoma. JAMA Ophthalmol Sep. 133 (9), 1045–1052. https://doi.org/10.1001/jamaophthalmol.2015.2225 (2015).
De Moraes, C. G., Liebmann, J. M. & Levin, L. A. Detection and measurement of clinically meaningful visual field progression in clinical trials for glaucoma. Prog Retin Eye Res Jan. 56, 107–147. https://doi.org/10.1016/j.preteyeres.2016.10.001 (2017).
Silverman, A. L. et al. Diagnostic accuracy of the spectralis and cirrus reference databases in differentiating between healthy and early glaucoma eyes. Ophthalmology Feb. 123 (2), 408–414. https://doi.org/10.1016/j.ophtha.2015.09.047 (2016).
Quiroz-Reyes, M. A., Quiroz-Gonzalez, E. A., Quiroz-Gonzalez, M. A. & Lima-Gomez, V. Comprehensive assessment of glaucoma in patients with high myopia: a systematic review and meta-analysis with a discussion of structural and functional imaging modalities. Int Ophthalmol Oct. 11 (1), 405. https://doi.org/10.1007/s10792-024-03321-4 (2024).
Jeong, Y., Kim, Y. K., Jeoung, J. W. & Park, K. H. Comparison of optical coherence tomography structural parameters for diagnosis of glaucoma in high myopia. JAMA Ophthalmol Jul. 1 (7), 631–639. https://doi.org/10.1001/jamaophthalmol.2023.1717 (2023).
Chang, P. Y., Wang, J. Y. & Wang, J. K. Optical coherence tomography angiography compared with optical coherence tomography for detection of glaucoma progression with high myopia. Sci Rep Mar. 21 (1), 9762. https://doi.org/10.1038/s41598-025-91880-6 (2025).
Mwanza, J. C., Warren, J. L. & Budenz, D. L. Utility of combining spectral domain optical coherence tomography structural parameters for the diagnosis of early glaucoma: a mini-review. Eye Vis. (Lond). 5, 9. https://doi.org/10.1186/s40662-018-0101-6 (2018).
Jiravarnsirikul, A. et al. Evaluating glaucoma in myopic eyes: challenges and opportunities. Surv Ophthalmol May-Jun. 70 (3), 563–582. https://doi.org/10.1016/j.survophthal.2024.12.003 (2025).
Leung, C. K. S., Guo, P. Y. & Lam, A. K. N. Retinal nerve fiber layer optical texture analysis: involvement of the papillomacular bundle and papillofoveal bundle in early glaucoma. Ophthalmology Sep. 129 (9), 1043–1055. https://doi.org/10.1016/j.ophtha.2022.04.012 (2022).
Zhang, X. et al. Predicting development of glaucomatous visual field conversion using baseline Fourier-Domain optical coherence tomography. Am J. Ophthalmol Mar. 163, 29–37. https://doi.org/10.1016/j.ajo.2015.11.029 (2016).
Nakanishi, H. et al. Effect of axial length on macular ganglion cell complex thickness and on early glaucoma diagnosis by Spectral-Domain optical coherence tomography. J Glaucoma May. 25 (5), e481–490. https://doi.org/10.1097/ijg.0000000000000330 (2016).
Sawada, A., Manabe, Y., Yamamoto, T. & Nagata, C. Long-term clinical course of normotensive preperimetric glaucoma. Br J. Ophthalmol Dec. 101 (12), 1649–1653. https://doi.org/10.1136/bjophthalmol-2016-309401 (2017).
Inuzuka, H. et al. Development of glaucomatous visual field defects in preperimetric glaucoma patients within 3 years of diagnosis. J Glaucoma Jun. 25 (6), e591–595. https://doi.org/10.1097/ijg.0000000000000260 (2016).
Tham, Y. C. et al. Profiles of ganglion Cell-Inner plexiform layer thickness in a Multi-Ethnic Asian population: the Singapore epidemiology of eye diseases study. Ophthalmology Aug. 127 (8), 1064–1076. https://doi.org/10.1016/j.ophtha.2020.01.055 (2020).
Funding
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIP; No. NRF-2021R1A2C2093617). The sponsor or funding organization had no role in the design or conduct of this research. Conflict of Interest: The authors have no conflicts of interest to disclose.
Author information
Authors and Affiliations
Contributions
H.J.S. and H-Y.L.P. conceptualized the research and wrote the main manuscript. H.J.S. and H-Y.L.P. curated the dataset and analyzed the data. C.K.P. supervised the research. All authors reviewed the manuscript.
Corresponding author
Ethics declarations
Competing interests
The authors declare no competing interests.
Additional information
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
About this article
Cite this article
Shin, H.J., Park, HY.L., Ryu, H.K. et al. GCIPL color coding on OCT predicts glaucoma conversion in normal-tension glaucoma suspects, including a high myopia subgroup. Sci Rep (2026). https://doi.org/10.1038/s41598-026-39779-8
Received:
Accepted:
Published:
DOI: https://doi.org/10.1038/s41598-026-39779-8
