-->PONE-D-26-08321-->-->Relationship between Corvis ST tonometry parameters and mean blur rate in the optic nerve head tissue area in healthy eyes-->-->PLOS One

Dear Dr. Nakaniida,

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PLOS One

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Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #1: Partly

Reviewer #2: Yes

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-->2. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #1: Yes

Reviewer #2: Yes

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-->3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #1: Yes

Reviewer #2: Yes

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-->4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #1: Yes

Reviewer #2: Yes

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-->5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: This manuscript investigates the correlation between parameters obtained from Corvis ST (CST) and MBR-T measured by LSFG. However, there are several concerns regarding the study design and the interpretation of the results.

• The manuscript mentions sex differences, but the sample size appears insufficient for this analysis. Please either increase the number of male subjects or provide justification that the current sample size is adequate for a valid comparison.

• Why was corneal hysteresis excluded from this study? Compared with previous studies, it would be more interesting to examine whether corneal hysteresis correlates with MBR-T, rather than focusing only on individual parameters obtained from CST.

• How do the authors interpret the finding that greater central corneal thickness is associated with a decrease in MBR-T?

• How was blood pressure handled in this study? Should it not be considered as a potential factor associated with MBR-T?

Reviewer #2: This study investigated the relationship between Corvis ST tonometry parameters and MBR-T measured by LSFG in healthy eyes. The topic is very interesting, and the combination of corneal biomechanical assessment and optic nerve head blood flow analysis is valuable. Overall, the manuscript is well organized. However, several minor points should be addressed to improve the clarity and completeness of the manuscript before publication.

1. Please correct the inconsistency in the number of participants. The submission abstract states that the study included 100 eyes from 50 healthy participants, whereas the manuscript text and Table 1 state 100 eyes from 56 participants. This discrepancy should be corrected throughout the manuscript and submission documents.

2. The discussion about lamina cribrosa biomechanics is interesting and relevant. However, lamina cribrosa morphology was not directly evaluated in this study. Therefore, the authors should describe this interpretation more cautiously. The possible relationship among corneal deformability, lamina cribrosa biomechanics, and lower MBR-T should be presented as a hypothesis rather than a direct finding of this study. This point should also be added to the limitations. Future studies using OCT-based assessment of lamina cribrosa morphology, such as lamina cribrosa depth, curvature, or thickness, may help clarify the mechanism.

3.The manuscript describes the participants as healthy, but it does not clearly state whether systemic diseases or medication use were assessed. Because MBR-T may be influenced by systemic circulatory status and vasoactive medications, the authors should clarify this point. If participants were confirmed not to be taking systemic medications, such as antihypertensive agents, antidiabetic drugs, lipid-lowering drugs, antiplatelet/anticoagulant agents, or other vasoactive medications, this should be clearly stated in the inclusion or exclusion criteria. If information on medication use was not available, this should be acknowledged as a limitation.

4. The present study evaluated MBR-T, but regional peripapillary choroidal perfusion patterns were not assessed. Recent LSFG-based evidence suggests that the spatial distribution of choroidal watershed zones or peripapillary choroidal hypoperfusion zones may influence sectoral ONH tissue blood flow. Therefore, these regional perfusion patterns may be an unmeasured factor affecting overall MBR-T. The authors should consider adding this point to the limitations or future directions. Relevant recent work may be cited if appropriate: Hashimoto R, Kardon RH. Laser speckle flowgraph reveals dynamic characteristics and clinical relevance of choroidal watershed and peripapillary hypoperfusion zones. Scientific Reports. 2026. doi: 10.1038/s41598-026-47062-z.

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Reviewer #1: No

Reviewer #2: No

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Relationship between Corvis ST tonometry parameters and mean blur rate in the optic nerve head tissue area in healthy eyes

PONE-D-26-08321R1

Dear Dr. Nakaniida,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Daisuke Nagasato

Academic Editor

PLOS One

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

-->Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.-->

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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-->2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. -->

Reviewer #1: Yes

Reviewer #2: Yes

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-->3. Has the statistical analysis been performed appropriately and rigorously? -->

Reviewer #1: Yes

Reviewer #2: Yes

**********

-->4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.-->

Reviewer #1: Yes

Reviewer #2: Yes

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-->5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.-->

Reviewer #1: Yes

Reviewer #2: Yes

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-->6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)-->

Reviewer #1: After carefully reviewing the revised manuscript and the authors’ detailed responses to the reviewers’ comments, I believe that the manuscript has been substantially improved and now meets the standard for publication. Although some limitations remain, these have been appropriately acknowledged by the authors and do not significantly undermine the overall value of the study.

Therefore, I consider that the manuscript is acceptable for publication in its current form.

Reviewer #2: I appreciate the authors' responses, which have addressed all of my concerns. The manuscript has been sufficiently improved.

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-->7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review?  For information about this choice, including consent withdrawal, please see our Privacy Policy.-->

Reviewer #1: No

Reviewer #2: No

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