Thicker Retinal Nerve Fiber Layer with Age among Schoolchildren: The Hong Kong Children Eye Study
Xiu-Juan Zhang1,2, Yi-Han Lau1, Yu-Meng Wang1
1Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong SAR, China.
Insights
Peripapillary retinal nerve fiber layer (p-RNFL) thickness increases with age in children aged 6-8 years, unlike in adults. This finding is crucial for interpreting OCT scans in pediatric patients.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Optical Coherence Tomography
Background:
- The peripapillary retinal nerve fiber layer (p-RNFL) is a key indicator of optic nerve health.
- Understanding age-related changes in p-RNFL thickness is essential for accurate diagnosis and monitoring in pediatric eye conditions.
Purpose of the Study:
- To investigate the effect of age on p-RNFL thickness in schoolchildren aged 6-8 years.
- To establish normative data for p-RNFL thickness in this age group.
- To explore associations between p-RNFL thickness and ocular/systemic factors.
Main Methods:
- A cross-sectional study involving 4034 children aged 6-8 years.
- p-RNFL thickness measured using spectral-domain optical coherence tomography (SD-OCT).
- Multivariate linear regression and generalized estimating equations (GEE) used for statistical analysis.
Main Results:
- Mean global p-RNFL thickness was approximately 106.3 μm.
- Age was positively correlated with p-RNFL thickness after adjusting for axial length (AL) and confounders (β = 0.509, p = 0.001).
- AL showed varied associations with temporal and non-temporal p-RNFL thickness.
Conclusions:
- p-RNFL thickness significantly increases with age in children aged 6-8 years, a trend opposite to that observed in adults.
- These findings provide essential reference values for OCT interpretation in children.
- Stable p-RNFL thickness in pediatric patients may not always indicate a stable disease status due to developmental changes.
Abstract:
This study aims to investigate the effect of age on the peripapillary retinal nerve fiber layer (p-RNFL) thickness among schoolchildren. A total of 4034 children aged 6-8 years old received comprehensive ophthalmological examinations. p-RNFL thickness was measured from a circular scan (⌀ = 3.4 mm) captured using spectral-domain optical coherence tomography (SD-OCT). Associations between p-RNFL thickness with ocular and systemic factors were determined by multivariate linear regression after adjusting potential confounders using generalized estimating equations (GEE). The mean global p-RNFL thickness was 106.60 ± 9.41 μm (range: 72 to 171 μm) in the right eyes, 105.99 ± 9.30 μm (range: 76 to 163 μm) in the left eyes, and 106.29 ± 9.36 μm (range: 72 to 171 μm) across both eyes. Age was positively correlated with p-RNFL after adjusting for axial length (AL) and confounding factors (β = 0.509; p = 0.001). Upon multivariable analysis, AL was positively associated with temporal p-RNFL thickness (β = 3.186, p < 0.001) but negatively with non-temporal p-RNFL thickness (β = (10.003, -2.294), p < 0.001). Sectoral p-RNFL was the thickest in the inferior temporal region (155.12 ± 19.42 μm, range 68 to 271 μm), followed by the superior temporal region (154.67 ± 19.99 μm, range 32 to 177 μm). To conclude, p-RNFL increased significantly with older age among children 6 to 8 years old in a converse trend compared to adults. Our results provide a reference for interpreting OCT information in children and suggest that stable p-RNFL thickness may not indicate a stable disease status in pediatric patients due to the age effects.
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