Health screening program revealed risk factors associated with development and progression of papillomacular bundle defect



The papillomacular bundle (PMB) area is an important anatomical site associated with central vision. As preventive medicine and health screening examinations are now becoming commonplace, the incidental detection of papillomacular bundle defect (PMBD) on fundus photography has been increasing. However, clinical significance of incidental PMBD has not been well documented to date. Thus, through long-term and longitudinal observation, we aimed to investigate the risk factors for the development and progression of PMBD and its predictive role associated with systemic diseases and glaucoma.


This longitudinal study included subjects who had undergone standardized health screening. We retrospectively reviewed patients for whom PMBD had been detected in fundus photography and followed up for more than 5 years. For a comparative analysis, non-PMBD groups of age- and gender-matched healthy controls were selected.


A total of about 67,000 fundus photographs were analyzed for 8.0 years, and 587 PMBD eyes were found. Among them, 234 eyes of 234 patients who had had fundus photographs taken for more than 5 years were finally included. A total of 216 eyes (92.3%) did not progress during the 8.1 ± 2.7 years, whereas 18 eyes (7.7%) showed progression at 7.6 ± 2.9 years after initial detection. A multivariate logistic regression analysis using 224 non-PMBD healthy controls revealed low body mass index (BMI < 20 kg/m2), systemic hypertension, and sclerotic changes of retinal artery as the significant risk factors for the development of PMBD. Regarding PMBD progression, low BMI, concomitant retinal nerve fiber layer defect (RNFLD) at non-PMB sites, optic disc hemorrhage, and higher vertical cup/disc ratio were individual significant risk factors.


PMBD is associated with ischemic effects. Although the majority of PMBD do not progress, some of cases are associated with glaucomatous damage in a long-term way. PMBD might be a personalized indicator representing ischemia-associated diseases and a predictive factor for diagnosis and preventive management of glaucoma.

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Alanine aminotransferase


Aspartate aminotransferase


Body mass index


Confidence intervals


Cotton wool spot


Optic disc hemorrhage


Flammer syndrome


Hazard ratios


Intraocular pressure


Papillomacular bundle


Papillomacular bundle defect


Predictive, preventive, and personalized medicine


Retinal nerve fiber layer


Retinal nerve fiber layer defect


Vertical cup to disc ratio


White blood cell


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This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean government (MSIT) (No. 2019R1F1A1058426).

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Correspondence to Hyuk Jin Choi.

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The project was approved by Institutional Review Board of Seoul National University Hospital (No. 1906-141-1043)

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The requirement to obtain written informed consent was waived by the Institutional Review Board, because our study was retrospective research based on medical records, and also because this research presented no more than minimal risk of harm to subjects

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Baek, S.U., Lee, W.J., Park, K.H. et al. Health screening program revealed risk factors associated with development and progression of papillomacular bundle defect. EPMA Journal 12, 41–55 (2021).

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  • Papillomacular bundle defect
  • Ophthalmology
  • Health screening examination
  • Program
  • Low body mass index
  • Ischemia-associated diseases
  • Risk assessment
  • Risk factors
  • Screening
  • Cardiovascular disease
  • Longitudinal study
  • Disease development and progression
  • Systemic effects and characteristics
  • Glaucoma
  • Predictive factors
  • Personalized indicator
  • Preventive management
  • Predictive preventive personalized medicine (PPPM/3PM)