Comparison of RNFL Thickness among Normal, Glaucoma Suspect and Glaucoma in Children

Sang Won Yoon; Sung Mo Kang

doi:10.3341/jkos.2009.50.1.113

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Yoon and Kang: Comparison of RNFL Thickness among Normal, Glaucoma Suspect and Glaucoma in Children

Original Article

J Korean Ophthalmol Soc 2009;50(1):113-119.

Published online: 7 September 2009

DOI: https://doi.org/10.3341/jkos.2009.50.1.113

Comparison of RNFL Thickness among Normal, Glaucoma Suspect and Glaucoma in Children

Sang Won Yoon, M.D., Sung Mo Kang, M.D.

Department of Ophthalmology, Inha University College of Medicine, Incheon, Korea

Address reprint requests to Sung Mo Kang, MD Department of Ophthalmology, Inha University Hospital #7‐206 3‐ga, Shinheung‐dong, Jung‐gu, Incheon 400-711, Korea Tel: 82-32-890-2408, Fax: 82-32-890-2403, E-mail: ksm0724@medimail.co.kr

Received 9 December 2008 Accepted 2 May 2008

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To compare the retinal nerve fiber layer (RNFL) thickness among normal children, glaucoma suspects, and children with glaucoma, using optical coherence tomography (OCT).

Methods

Ninety‐ four eyes of 47 normal children, 62 eyes of 38 glaucoma suspects and 33 eyes of 21 children with glaucoma, from the ages of 5 to 15 years were examined at the Ophthalmology Center at the Inha University Hospital. The RNFL thickness was measured with OCT. Patient cooperation and signal strength of the OCT scans were assessed. The mean, superior, inferior, nasal, and temporal RNFL thicknesses were measured by OCT in all three groups.

Results

After adjustment by refractive error, the RNFL thicknesses of the mean, superior, inferior, nasal, and temporal areas were 110.8±10.1 µm, 140.1±17.5 µm, 134.1±14.8 µm, 79.9±14.5 µm, and 89.2±16.8 µm, respectively, in the normal group; 107.9±10.8 µm, 134.8±15.5 µm, 130.2±18.8 µm, 75.4±17.1 µm, and 91.2±18.7 µm, respectively, in the glaucoma suspect group; and 102.8±18.1 µm, 129.5±16.5 µm, 126.1±20.2 µm, 70.3±19.7 µm, and 85.1±16.9 µm, respectively, in the glaucoma patient group. There was a significant difference among the three groups in all locations except in the temporal area (p=0.003).

Conclusions

RNFL thickness in children measured by OCT may be useful in the diagnosis and follow‐ up of glaucoma in children.

Keywords: Glaucoma suspect, Optical coherence tomography, Pediatric retinal nerve fiber layer thickness, Refractive error

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Figure 1.

Retinal nerve fiber layer (RNFL) thickness OCT scan and visual field defect of glaucomatous eye in a 6-year-old child (left eye). (Left) Thin RNFL thickness OCT scan for glaucomatous eye. (Right) Visual field defect at Humphrey 30-2 system.

Figure 2.

Retinal nerve fiber layer (RNFL) thickness for normal, glaucoma suspect, and glaucoma eyes in children after adjusted by refractive error.

Table 1.

Demographics of the subjects’

		Normal	Glaucoma suspect	Glaucoma	p-value
Age (yr)		12.5±3.97	13.2±3.24	12.9±4.19	0.182^#
Sex (n,eye)	male	54	34	19	0.942^∗∗
	Female	40	28	14	0.942^∗∗
Ref. error (D)^∗		-1.54±0.97	-2.41±1.13	-2.53±1.52	0.016^#
	Hyper. (n)^†	13	7	3
	Emetr. (n)^‡	15	5	4	0.564^∗∗
	Myo. (n)^§	66	50	26
IOP (mmHg)^∏		11.4±5.16	16.3±7.32	19.2±9.02	<0.001^#
	Max	7	8	10
	Min	20	28	29

^∗ Ref.=refractive; test

^† Hyper.=hyperopia

^‡ Emetr.=emetropia

^§ Myo.=myopia

^∏ IOP=intraocular pressure

^＃ One-way ANOVA test

^∗∗ Chi-square test.

Table 2.

Compositions of glaucoma suspect eyes in children

	n (eyes) P	Percentage (%)
Total	62	100
Large CD^∗	28	45.1
Raised IOP^†	8	12.9
Large CD^∗+Medi.^‡	6	9.7
Raised IOP^†+Medi.^‡	10	16.1
Large CD^∗+Raised IOP^†+Medi.^‡	8	12.9
CD^∗ ratio asymmetry	2	3.3

^∗ CD=cup-disc ratio

^† IOP=intraocular pressure

^‡ anti-glaucomamedication: Cosopt & Xalatan=2 eyes; Xalatan=14 eyes; 0.5% Timoptic=8 eyes.

Table 3.

RNFL Thickness among three groups before adjusted by refractive error

Location	Normal	p-value^#	Glaucoma suspect	p-value^∗∗	Glaucoma	p-value^††
SUP (µm)^∗	145.2±18.2	0.009	132.1±15.2	0.032	127.4±15.4	0.012
INF (µm)^†	138.5±15.4	0.005	129.5±18.4	0.044	124.2±19.9	0.039
NAS (µm)^‡	81.7±15.2	0.013	74.4±16.8	0.022	68.1±19.2	0.015
TEMP (µm)^§	91.1±17.5	0.872	90.4±18.1	0.013	83.4±16.5	0.045
Avg. Thickness (µm)^∏	114.1±10.8	0.017	106.6±10.5	0.002	100.8±17.7	<0.001

^∗ SUP=superior RNFL thickness

^† INF=inferior RNFL thickness

^‡ NAS=nasal RNFL thickness

^∏ Avg.=average

^# Comparison between normal and glaucoma suspect by student t-test; thickness; glaucoma suspect and glaucoma by student t-test

^†† Comparison among three groups by one-way ANOVA.

^§ TEMP=temporal RNFL

^∗∗ Comparison between

Table 4.

RNFL thickness among three groups after adjusted by refractive error

Location	Normal	p-value^#	Glaucoma suspect	p-value^∗∗	Glaucoma	p-value^††
SUP (µm)^∗	140.1±17.5	0.021	134.8±15.5	0.037	129.5±16.5	0.030
INF (µm)^†	134.1±14.8	0.026	130.2±18.8	0.048	126.1±20.2	0.047
NAS (µm)^‡	79.9±14.5	0.024	75.4±17.1	0.031	70.3±19.7	0.032
TEMP (µm)^§	89.2±16.8	0.902	91.2±18.7	0.017	85.1±16.9	0.064
Avg. Thickness (µm)^∏	110.8±10.1	0.039	107.9±10.8	0.011	102.8±18.1	0.003

There is a significant difference between normal and glaucoma. p=0.015 by student t-test

^∗ SUP=superior RNFL thickness

^† INF=inferior RNFL thickness

^‡ NAS=nasal RNFL thickness

^§ TEMP=temporal RNFL thickness

^∏ Avg. thickness; =average

^# Comparison between normal and glaucoma suspect by student t-test

^∗∗ Comparison between glaucoma suspect and glaucoma by student t-test

^†† Comparison among three groups by one-way ANOVA.

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