African Ancestry-Specific OCT Normative Database Alters Retinal Nerve Fiber Layer Classification in Primary…

Cohort studyJournal of glaucoma· Jul 2026

African Ancestry-Specific OCT Normative Database Alters Retinal Nerve Fiber Layer Classification in Primary Open-Angle Glaucoma.

Tzuriel Sapir, Chun Yin Chow, Mina Halimitabrizi … Joan M O'Brien

RetinaCohort studyDiagnosisQ1IF 2.2

Ancestry-specific OCT norms reclassified nearly a quarter of borderline scans as normal in Black glaucoma patients.

African Ancestry-Specific OCT Normative Database Alters Retinal Nerve Fiber Layer Classification in Primary Open-Angle Glaucoma.

Tzuriel Sapir … Joan M O'Brien

Journal of glaucoma · Jul 2026 · Q1 in Ophthalmology

Purpose

This study compares color-code classification between the Cirrus database and our reclassification for African ancestry primary open-angle glaucoma cases.

Methods

Eyes were staged using the Enhanced Glaucoma Staging System (GSS2), and retinal nerve fiber layer thickness color codes were reclassified based on an African ancestry-specific cohort.

n = 787 eyes

Results

reclassifying by ancestry moved about 1 in 4 borderline results to normal

6.3%

POAAGG red

9.4%

Cirrus red

More results

The POAAGG reclassification model reported fewer abnormal yellow and red color codes (16.4% and 6.3%) than Cirrus (18.0% and 9.4%, P<0.001).

Among stage 1 glaucoma eyes, 19.0% of red codes and 23.1% of yellow codes shifted to greener classifications (P=0.04).

Similar patterns were seen in quadrant- and stage-specific analyses.

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Conclusion · 1 of 2

The discrepancy in primary open-angle glaucoma color-code classification suggests that an ancestry-conscious normative database may reduce overdiagnosis in African ancestry individuals.

Conclusion · 2 of 2

PRECIS: Our study showed lower occurrence of primary open-angle glaucoma in African ancestry patients when taking their ancestry into consideration compared to the Cirrus HD-OCT classification.

African Ancestry-Specific OCT Normative Database Alters Retinal Nerve Fiber Layer Classification in Primary Open-Angle Glaucoma.

African Ancestry-Specific OCT Normative Database Alters Retinal Nerve Fiber Layer Classification in Primary Open-Angle Glaucoma.

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