Peripapillary retinal nerve fiber layer thickness in hyperopic children

To evaluate the relationship between the spherical equivalent (SE)/axial length and peripapillary retinal nerve fiber layer (RNFL) thickness profile measured using Stratus optical coherence tomography (OCT) in hyperopic children.

One hundred and sixty-four children with hyperopia were analyzed in the study. Subjects were divided into three groups according to their SE values: +3.00 D ≥ SE ≥ +0.50 D were designated as the low hyperopia group, +6.00 D ≥ SE ≥ +3.25 D as moderate hyperopia group, and +9.50 D ≥ SE ≥ 6.25 D as high hyperopia group. RNFL thickness measurements were taken from the superior, inferior, nasal, and temporal quadrants in the peripapillary region by Stratus OCT. Axial length, visual acuity, and SE values were also determined for all patients.

There were 62 patients in the low hyperopia group, 60 patients in the moderate hyperopia group, and 42 patients in the high hyperopia group. The groups were similar concerning age and gender. The moderate and high hyperopia groups had lower mean BCVAs than low hyperopic group (both p < 0.001). SE and axial length were significantly different among all three groups (all p < 0.001). There were significant differences between low and high hyperopia groups concerning the mean RNFL thickness and the RNFL thicknesses of inferior and nasal quadrants (p = 0.045, p = 0.008, p = 0.03, respectively). However, when magnification attributable to SE/axial length is taken into account, the RNFL thickness differences disappear.

We have demonstrated that when measured using the Stratus OCT, which does not take magnification into account, measurements erroneously indicate that children with high hyperopia had thicker RNFLs in inferior and nasal quadrants than children with low hyperopia. The current Stratus OCT normative database may be misleading for correct diagnosis of glaucoma in highly hyperopic children.