Tilted Optic Discs More Common in Black Patients With Glaucoma

Ophthalmologist examining patient's eyes
Ophthalmologist examining patient’s eyes
Researchers evaluated patients who participated in the Primary Open Angle Glaucoma African American Glaucoma Genetics Study.

Tilted discs occur at substantial numbers among patients with glaucoma who are Black, according to research published in Ophthalmology Glaucoma.

Features of primary open angle glaucoma (POAG), which itself is more prevalent among patients who are Black compared with those who are White, have been linked with tilted discs. 

The investigators reviewed exam findings of 2563 eyes of 1308 patients who are Black living in Philadelphia. Nonphysician graders assessed stereo disc photos of optic nerves and evaluated optic disc tilt with Tilt Ovality Index (TOI) and stereoscopy.

Of 1251 patients with complete TOI data on both eyes, 8.3% had tilted discs (88 unilateral). Patients with tilted discs (defined as TOI of at least 1.30) compared with patients with a TOI lower than 1.30 were more likely to be female (76% vs 59%  P <.001). and had a higher body mass index (BMI 31±7 vs 30±7 P =.045). Approximately 22% of participants who are Black and who have glaucoma had bilateral tilted discs.

And while researchers report that it is well-established that patients with tilted discs have a higher prevalence of myopia, this is not necessarily the case for patients who are Black and have a glaucoma diagnosis. In fact, most patients who fit that description did not show an association with myopic refractive error. Patients who are Black have a lower prevalence of refractive errors, altogether. This suggests that any association between refractive error and glaucoma risk is weak at best. 

Researchers explained that, if tilted discs are not taken into account, “misclassifications and erroneous treatments are possible in this vulnerable group.”

Limitations of the study include inability to compare imaging with control individuals’ imaging and exclusion of patients with concomitant myopia greater than -8.00 D.

Disclosure: This research was supported by Regeneron Pharmaceuticals. Please see the original reference for a full list of disclosures.


Daniel E, Addis V, Maguire MG, et al. Prevalence and factors associated with optic disc tilt in the primary open-angle African American Glaucoma Genetics (POAAGG) study. Ophthalmol Glaucoma. Published online February 10, 2022. doi:10.1016/j.ogla.2022.02.004