{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:44:43Z","timestamp":1786729483970,"version":"build-2736575974"},"reference-count":31,"publisher":"BMJ","funder":[{"name":"Seoul National University Hospital (SNUH) Lee Kun-Hee Child Cancer & Rare Disease Project, Republic of Korea","award":["26B-019-0100"],"award-info":[{"award-number":["26B-019-0100"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2026,7,27]]},"abstract":"<jats:sec>\n                    <jats:title>Background\/aims<\/jats:title>\n                    <jats:p>To investigate glaucoma prevalence and diagnostic discrepancies\u2014undiagnosed glaucoma, missed diagnostic opportunities and false-positive diagnoses\u2014in South Korea and to identify factors contributing to these errors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This nationwide cross-sectional study used data from the Korea National Health and Nutrition Examination Survey 2019\u20132021. Participants aged \u226520 years who had gradable ophthalmic examinations were included. Glaucoma was adjudicated by specialists using International Society of Geographical and Epidemiological Ophthalmology criteria. Survey-weighted logistic regression analyses were performed to identify factors associated with undiagnosed glaucoma and missed diagnostic opportunities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The final analytical cohort comprised 18\u2009710 participants. The weighted prevalence of glaucoma was 3.9% (95% CI 3.6% to 4.2%). The awareness rate was only 17.1%, leaving 82.9% (95% CI 80.4% to 85.4%) of cases undiagnosed. Notably, 44.7% (95% CI 41.0% to 48.3%) of undiagnosed cases represented a missed diagnostic opportunity. Multivariable analysis identified high myopia as the strongest predictor of a missed diagnostic opportunity (OR 23.53, 95%\u2009CI 5.65 to 98.09, p&lt;0.001), alongside younger age (OR 0.98, p=0.039), rural residence (OR 1.97, p=0.047) and thicker retinal nerve fibre layer (OR 1.09, p&lt;0.001). The lowest household income quartile was associated with undiagnosed glaucoma (OR 1.87, p=0.019).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Diagnostic discrepancies present a dual burden: profound underdiagnosis coexists with frequent false-positive diagnosis. High myopia, milder disease phenotype and rural residence are central drivers of missed diagnostic opportunities. Reducing discrepancies will therefore require efforts at both the clinical-professional and health system levels.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2026-329939","type":"journal-article","created":{"date-parts":[[2026,8,14]],"date-time":"2026-08-14T17:25:11Z","timestamp":1786728311000},"page":"bjo-2026-329939","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic discrepancies in glaucoma: underdiagnosis, overdiagnosis and missed opportunities in a nationwide South Korean population"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-1630-8101","authenticated-orcid":false,"given":"Sung Do","family":"Cho","sequence":"first","affiliation":[{"name":"Department of Ophthalmology, Seoul National University College of Medicine, Jongno-gu, Korea (the Republic of)"},{"name":"Department of Statistics and Data Science, Korea National Open University, Jongno-gu, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9005-850X","authenticated-orcid":false,"given":"Se Hie","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Seoul National University College of Medicine, Jongno-gu, Korea (the Republic of)"},{"name":"Department of Ophthalmology, Kyung Hee University Hospital at Gangdong, Gangdong-gu, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6037-8449","authenticated-orcid":false,"given":"Young Kook","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Seoul National University College of Medicine, Jongno-gu, Korea (the Republic of)"},{"name":"Department of Ophthalmology, Seoul National University Hospital, Jongno-gu, Korea (the Republic of)"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,14]]},"reference":[{"key":"2026081410250843000_bjo-2026-329939v1.1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2020.10.022"},{"key":"2026081410250843000_bjo-2026-329939v1.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2007.09.013"},{"key":"2026081410250843000_bjo-2026-329939v1.3","doi-asserted-by":"crossref","first-page":"532","DOI":"10.1016\/j.ophtha.2015.11.004","article-title":"Prevalence, Awareness, and Risk Factors of Primary Open-Angle Glaucoma: Korea National Health and Nutrition Examination Survey 2008-2011","volume":"123","author":"Kim","year":"2016","journal-title":"Ophthalmology"},{"key":"2026081410250843000_bjo-2026-329939v1.4","doi-asserted-by":"publisher","DOI":"10.1167\/iovs.15-18469"},{"key":"2026081410250843000_bjo-2026-329939v1.5","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1001\/jamaophthalmol.2015.1478","article-title":"Prevalence, Risk Factors, and Visual Features of Undiagnosed Glaucoma: The Singapore Epidemiology of Eye Diseases Study","volume":"133","author":"Chua","year":"2015","journal-title":"JAMA Ophthalmol"},{"key":"2026081410250843000_bjo-2026-329939v1.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2021.04.009"},{"key":"2026081410250843000_bjo-2026-329939v1.7","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2010.10.016"},{"key":"2026081410250843000_bjo-2026-329939v1.8","first-page":"1641","article-title":"The prevalence of primary open-angle glaucoma in Japanese: the Tajimi Study","volume":"111","author":"Iwase","year":"2004","journal-title":"Ophthalmology"},{"key":"2026081410250843000_bjo-2026-329939v1.9","doi-asserted-by":"crossref","first-page":"53","DOI":"10.3341\/kjo.2025.0109","article-title":"Trends in Widefield Fundus Photography and Optical Coherence Tomography Examination in South Korea (2015-2024)","volume":"40","author":"Jeon","year":"2026","journal-title":"Korean J Ophthalmol"},{"key":"2026081410250843000_bjo-2026-329939v1.10","doi-asserted-by":"crossref","DOI":"10.4178\/epih.e2024015","article-title":"An epidemic of cataract surgery in Korea: the effects of private health insurance on the National Health Insurance Service","volume":"46","author":"Lee","year":"2024","journal-title":"Epidemiol Health"},{"key":"2026081410250843000_bjo-2026-329939v1.11","doi-asserted-by":"crossref","unstructured":"Lee Y , Lee J , An D , et al . 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