We congratulate Han and associates for their study and appreciate their effort to identify focal lamina cribrosa (LC) defect and the microvascular dropout (MvD) as the biomarkers to reflect glaucoma severity. However, we have a few queries and seek your kind attention.

In your study, LC defect was considered significant if the size of the defect was more than 100 μm. You have cited a study by You and associates where they have reported that LC pore size was never found to be more than 100 μm in normal eyes. We are interested in knowing the possible explanation for LC defect (size more than 100 μm) found in 21.6% of the normal eyes in your study.

Second, in your previous study, you had reported that focal LC defects are associated with high myopia and increased axial length. In the present study, the mean axial length in open angle glaucoma (OAG) group is significantly more ( P = .002) than normal control participants, and this might be a confounding factor in study outcome. Matching of the study groups on the basis of myopia could have strengthened the results.

Third, Kiumehr and associates have reported that LC defect is associated with axonal loss in glaucomatous eyes. Your present study has shown that MvD is associated with the severity of glaucoma. We request you to share the correlation you found between LC defect and MvD. This can help find the LC defect value below which MvD is not expected.