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Association of serum retinol concentration with normal-tension glaucoma



To evaluate the association between serum retinol concentration and normal-tension glaucoma (NTG).


A total of 345 study subjects were recruited in a prospective cross-sectional study: 101 patients with NTG, 106 patients with high-pressure primary open-angle glaucoma (POAG) and 138 healthy control subjects. Serum retinol concentration in fasting blood samples was determined by ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). All study subjects were given complete ophthalmic examinations and diagnosed by two glaucoma sub-specialists.


Serum retinol concentrations in NTG, POAG, and controls were 338.90 ± 103.23 ng/mL, 405.22 ± 114.12 ng/mL, and 408.84 ± 122.36 ng/mL respectively. NTG patients had lower serum retinol concentrations than POAG (p < 0.001) or healthy controls (p < 0.001). There was no statistical difference between the POAG and healthy controls (p = 0.780). Higher proportion of NTG patients (37.6%) than POAG (17.9%) or controls (21.7%) had serum retinol concentrations lower than 300 ng/mL. Serum retinol was positively correlated with optic nerve sheath diameter (ONSD) (r = 0.349, p = 0.001) in glaucoma patients and not associated with any other demographic features or ophthalmic biometric parameters in the NTG patients. Multivariate logistic regression showed that serum retinol (OR = 0.898, 95CI%: 0.851–0.947) was associated with incident NTG.


NTG patients had lower serum retinol concentrations. Serum retinol uniquely associated with NTG makes it a new potential option for the diagnosis and treatment of the disease.

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Fig. 1: Box plot showing the difference of the serum retinol concentrations in patients with normal-tension glaucoma, primary open-angle glaucoma and healthy subjects.
Fig. 2: Bar plot showing the percentage of serum retinol deficiency in normal-tension glaucoma, primary open-angle glaucoma and healthy groups.
Fig. 3: Scatter plot showing the relationship between the serum retinol concentration and the optic nerve sheath diameter at 3 mm behind globe.


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Authors and Affiliations



RP, SF, YS, YG, YX, and NW designed the study. NW acquired funding and supervised the research team. RP, DM, YZ, YF, JL, YW, HH, and JC recruited and examined study subjects. HL, QZ, YS and HW conducted ophthalmic examinations. XL and JQ conducted biochemical tests. JP and CC conducted the chromatographic and mass spectrometric assays. RP, SF, YS, YG, YX and KC performed data analysis. RP, CPP and NW interpreted the data. RP, SAL, and CX drafted the paper. RP, CPP, SAL, and RNW revised the paper.


This study was funded by the National Natural Science Foundation of China (81730027), Beijing University-CMU, Advanced Innovation Centre for Big Data-Based Precision Medicine, Ophthalmic Subcenter (BHME2018-2019) and Sanming Project of Medicine in Shenzhen (SZSM201512045). The funding organization had no role in the design or conduct of this research.

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Correspondence to Ningli Wang.

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The authors declare no competing interests. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the paper, or in the decision to publish the results.

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Pang, R., Feng, S., Cao, K. et al. Association of serum retinol concentration with normal-tension glaucoma. Eye 36, 1820–1825 (2022).

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