Journal List > J Korean Ophthalmol Soc > v.52(11) > 1008920

Kim, Park, Park, and Ohn: Use of Spectral-Domain Optical Coherence Tomography to Analyze Macular Thickness According to Refractive Error

Abstract

Purpose

To investigate the correlation of macular retinal thickness and refractive error using spectral-domain optical coherence tomography (SD-OCT).

Methods

A total of 120 eyes with no posterior abnormalities were enrolled in the present study. Subjects were divided into 3 groups based on their spherical equivalent. Visual acuity, refraction, slit lamp examination, tonometry and fundus examination were performed. Retinal thickness between the RPE and IS/OS junction was measured at the fovea, 1 mm (inner ring) and 2 mm (outer ring) superiorly, inferiorly, nasally and temporally using SD-OCT. Overall average thickness, average foveal thickness, and the inner and outer ring macular thickness were measured.

Results

The average foveal thickness was significantly greater in the high myopic eyes than in the low to moderate myopic and emmetropic eyes (p = 0.001). However, the RPE-IS/OS junction thickness of the foveola and the outer macular thickness were significantly lower (p = 0.001, p = 0.002) in the high myopic eyes. There was a weak, but significant negative correlation between refractive error and average foveal thickness (r = −0.38, p = 0.001). A positive correlation was found between refractive error and the RPE-IS/OS junction thickness (r = 0.40, p = 0.001).

Conclusions

Macular retinal thickness is related to refractive error in normal subjects. Effects of eyeball elongation are more apparent in high myopic eyes than in low to moderate myopic eyes. A significant decline in the RPE-IS/OS junction thickness suggests the photoreceptor outer segments in the foveola are damaged in high myopic eyes.

References

1. Katz J, Tielsch JM, Sommer A. Prevalence and risk factors for refractive errors in an adult inner city population. Invest Ophthalmol Vis Sci. 1997; 38:334–40.
2. Wang Q, Klein BE, Klein R, Moss SE. Refractive status in the Beaver Dam Eye Study. Invest Ophthalmol Vis Sci. 1994; 35:4344–7.
3. Wong TY, Foster PJ, Hee J, et al. Prevalence and risk factors for refractive errors in adult Chinese in Singapore. Invest Ophthalmol Vis Sci. 2000; 41:2486–94.
4. Kang SH, Kim PS, Choi DG. Prevalence of myopia in 19-year-old Korean males: The relationship between the prevalence and education or urbanization. J Korean Ophthalmol Soc. 2004; 45:2082–7.
5. Apple DJ, Fabb MF. Clinicopathologic Correlation of Ocular Disease: a Text and Stereoscopic Atlas. St. Louis: CV Mosby;1978. p. 39–44.
6. Yanoff M, Fine BS. Ocular Pathology: A Text and Atlas. Philadelphia: Harper & Row;1982. p. 513–4.
7. Lim MC, Hoh ST, Foster PJ, et al. Use of optical coherence tomography to assess variations in macular retinal thickness in myopia. Invest Ophthalmol Vis Sci. 2005; 46:974–8.
crossref
8. Göbel W, Hartmann F, Haigis W. Determination of retinal thickness in relation to the age and axial length using optical coherence tomography. Ophthalmologe. 2001; 98:157–62.
9. Wakitani Y, Sasoh M, Sugimoto M, et al. Macular thickness measurements in healthy subjects with different axial lengths using optical coherence tomography. Retina. 2003; 23:177–82.
crossref
10. Zou H, Zhang X, Xu X, Yu S. Quantitative in vivo retinal thickness measurement in Chinese healthy subjects with retinal thickness analyzer. Invest Ophthalmol Vis Sci. 2006; 47:341–7.
crossref
11. Chan CM, Yu JH, Chen LJ, et al. Posterior pole retinal thickness measurements by the retinal thickness analyzer in healthy Chinese subjects. Retina. 2006; 26:176–81.
crossref
12. Lim MC, Hoh ST, Foster PJ, et al. Use of optical coherence tomography to assess variations in macular retinal thickness in myopia. Invest Ophthalmol Vis Sci. 2005; 46:974–8.
crossref
13. Lam DS, Leung KS, Mohamed S, et al. Regional variations in the relationship between macular thickness measurements and myopia. Invest Ophthalmol Vis Sci. 2007; 48:376–82.
crossref
14. Wu PC, Chen YJ, Chen CH, et al. Assessment of macular retinal thickness and volume in normal eyes and highly myopic eyes with third-generation optical coherence tomography. Eye. 2008; 22:551–5.
crossref
15. Sayanagi K, Ikuno Y, Soga K, Tano Y. Photoreceptor inner and outer segment defects in myopic foveoschisis. Am J Ophthalmol. 2008; 145:902–8.
crossref
16. Kleinstein RN, Jones LA, Hullett S, et al. Refractive error and ethnicity in children. Arch Ophthalmol. 2003; 121:1141–7.
crossref
17. Lin LL, Shih YF, Hsiao CK, et al. Epidemiologic study of the prevalence and severity of myopia among schoolchildren in Taiwan in 2000. J Formos Med Assoc. 2001; 100:684–91.
18. Ho J, Castro DP, Castro LC, et al. Clinical assessment of mirror artifacts in spectral-domain optical coherence tomography. Invest Ophthalmol Vis Sci. 2010; 51:3714–20.
crossref
19. Early Treatment Diabetic Retinopathy Study design and baseline patient characteristics. ETDRS Report No. 7. Ophthalmology. 1991; 98:741–56.
20. Zejmo M, Formiń ska-Kapuś cik M, Pieczara E, et al. Etiopathogenesis and management of high-degree myopia. Part I. Med Sci Monit. 2009; 15:199–202.
21. Kempen JH, Mitchell P, Lee KE, et al. The prevalence of refractive errors among adults in the United States, Western Europe, and Australia. Arch Ophthalmol. 2004; 122:495–505.
22. Saw SM, Gazzard G, Shih-Yen EC, Chua WH. Myopia and associated pathological complications. Ophthalmic Physiol Opt. 2005; 25:381–91.
crossref
23. Ikuno Y, Tano Y. Retinal and choroidal biometry in highly myopic eyes with spectral-domain optical coherence tomography. Invest Ophthalmol Vis Sci. 2009; 50:3876–80.
crossref
24. Ikuno Y, Jo Y, Hamasaki T, Tano Y. Ocular risk factors for choroidal neovascularization in pathologic myopia. Invest Ophthalmol Vis Sci. 2010; 51:3721–5.
crossref
25. Curtin BJ, Karlin DB. Axial length measurements and fundus changes of the myopic eye. Am J Ophthalmol. 1971; 71:42–53.
crossref
26. Grossniklaus HE, Green WR. Pathologic findings in pathologic myopia. Retina. 1992; 12:127–33.
crossref
27. Jonas JB, Berenshtein E, Holbach L. Lamina cribrosa thickness and spatial relationships between intraocular space and cerebrospinal fluid space in highly myopic eyes. Invest Ophthalmol Vis Sci. 2004; 45:2660–5.
crossref
28. McDonnell JM. Ocular embryology and anatomy. Ogden TE, editor. Retina. 1. St Louis: CV Mosby;1989. p. 5–16.
29. Choi SW, Lee SJ. Thickness changes in the fovea and peripapillary retinal nerve fiber layer depend on the degree of myopia. Korean J Ophthalmol. 2006; 20:215–9.
crossref
30. Song WK, Lee SC, Lee ES, et al. Macular Thickness Variations with Sex, Age, and Axial Length in Healthy Subjects: a Spectral Domain-Optical Coherence Tomography Study. Invest Ophthalmol Vis Sci. 2010; 51:3913–8.
crossref
31. Li KY, Tiruveedhula P, Roorda A. Intersubject variability of foveal cone photoreceptor density in relation to eye length. Invest Ophthalmol Vis Sci. 2010; 51:6858–67.
crossref
32. Liang H, Crewther DP, Crewther SG, Barila AM. A role for photoreceptor outer segments in the induction of deprivation myopia. Vision Res. 1995; 35:1217–25.
crossref
33. Rostgaard J, Qvortrup K. A note about retinal structure and visual acuity. A light microscopic study of the cones in fovea centralis. Acta Ophthalmol Scand. 1999; 77:45–9.
crossref
34. Kawabata H, Adachi-Usami E. Multifocal electroretinogram in myopia. Invest Ophthalmol Vis Sci. 1997; 38:2844–51.
35. Wolsley CJ, Saunders KJ, Silvestri G, Anderson RS. Investigation of changes in the myopic retina using multifocal electroretinograms, optical coherence tomography and peripheral resolution acuity. Vision Res. 2008; 48:1554–61.
crossref
36. Abbott CJ, Grünert U, Pianta MJ, McBrien NA. Retinal thinning in tree shrews with induced high myopia: optical coherence tomography and histological assessment. Vision Res. 2011; 51:376–85.
crossref
37. Teakle EM, Wildsoet CF, Vaney DI. The spatial organization of tyrosine hydroxylase-immunoreactive amacrine cells in the chicken retina and the consequences of myopia. Vision Res. 1993; 33:2383–96.
crossref
38. Kanai K, Abe T, Murayama K, Yoneya S. Retinal thickness and changes with age. Nippon Ganka Gakkai Zasshi. 2002; 106:162–5.
crossref
39. Kang JH, Kim SA, Song UG, Yun HS. Macular thickness changes with age in normal subjects measured by optical coherence tomography. J Korean Ophthalmol Soc. 2004; 45:592–8.
40. Kang MS, Kyung SE, Chang MH. Mean macular volume in normal Korean eyes measured by spectral-domain optical coherence tomography. J Korean Ophthalmol Soc. 2010; 51:1077–83.
crossref
41. Kelty PJ, Payne JF, Trivedi RH, et al. Macular thickness assessment in healthy eyes based on ethnicity using Stratus OCT optical coherence tomography. Invest Ophthalmol Vis Sci. 2008; 49:2668–72.
crossref

Figure 1.
Intraretinal measurements in Cirrus HD-OCT. Retinal thickness between RPE and IS/OS junction was measured at the fovea, 1.0 mm superiorly, 1.0 mm inferiorly, 1.0 mm nasally, 1.0 mm temporally, 2.0 mm superiorly, 2.0 mm inferiorly, 2.0 mm nasally and 2.0 mm temporally (Blue bar in figure 1A), by manually using the scale supplied with the software (Black arrow in figure 1B). Note that measurements in 1.0 mm superiorly, inferiorly, nasally and temporally represent inner circle and measurements in 2.0 mm superiorly, inferiorly, nasally and temporally represent outer circle, similarly.
jkos-52-1286f1.tif
Figure 2.
ETDRS subfields within standard 1, 3 and 6 mm diameter concentric circles on the right used for reporting retinal thickness. F = fovea; SI = superior Inner; NI = nasal inner; II = inferior inner; TI = temporal inner; SO = superior outer; NO = nasal outer; IO = inferior outer; TO = temporal outer.
jkos-52-1286f2.tif
Figure 3.
Scatterplots show the relationship between spherical equivalent and macular measurements. As myopia became more severe, average foveal thickness (B) increased. In contrast, thickness between RPE-IS/OS junction (A), average outer thickness (C) and total macular volume (D) decreased as myopia became more severe.
jkos-52-1286f3.tif
Table 1.
Baseline data of the four groups
Group 1(Emmetropia) Group 2(Low to moderate myopia) Group 3(High myopia) p
Subjects (eye) 40 40 40
Sex (M/F) 25/15 21/19 30/10
Age (yr) 39.7 ± 8.1 40.0 ± 10.3 36.0 ± 12.3 0.14
Spherical equivalent (D) −0.05 ± 0.55 −3.36 ± 1.51 −8.19 ± 1.99 0.000*
BCVA (log MAR) 0.02 ± 0.05 0.03 ± 0.06 0.04 ± 0.05 0.3

Data are presented as mean ± SD.

* Analysis of variance with Bonferroni correction. Significance differences were noted between group 1 and group 2 (p < 0.001) and group 2 ersus group 3 (p < 0.001)

BCVA = best corrected visual acuity.

Table 2.
Retinal thickness between RPE and IS/OS junction in photoreceptor layer (µm) in the 4 groups
Group 1(Emmetropia) Group 2(Low to moderate) Group 3(High myopia) p*
Central fovea 62.00 ± 3.21 (p = 0.001) 60.03 ± 3.51 (p = 0.03) 57.85 ± 4.45 0.001
1.0 mm superior§ 40.92 ± 6.80 39.23 ± 8.93 38.79 ± 8.05 0.84
1.0 mm inferior§ 41.42 ± 6.33 40.68 ± 6.8 39.24 ± 8.1 0.39
1.0 mm nasal§ 42.17 ± 5.72 40.88 ± 8.02 40.17 ± 10.3 0.33
1.0 mm temporal§ 42.10 ± 5.29 40.56 ± 8.13 38.57 ± 10.5 0.10
2.0 mm superior 39.80 ± 6.80 38.23 ± 8.55 38.44 ± 7.63 0.40
2.0 mm inferior 38.75 ± 7.96 39.05 ± 7.35 39.20 ± 7.19 0.87
2.0 mm nasal 38.57 ± 5.45 39.91 ± 7.46 38.91 ± 7.46 0.78
2.0 mm temporal 42.03 ± 7.09 41.24 ± 9.31 40.40 ± 10.65 0.29

Data are presented as mean ± SD.

* One way analysis of variance

Statistically significant difference between group 1 and group 3 with Bonferroni post hoc test (p < 0.05)

Statistically significant difference between group 2 and group 3 with Bonferroni post hoc test (p < 0.05)

§ Retinal thickness between RPE and IS/OS junction measured at the 1.0 mm superiorly, inferiorly, nasally and temporally from the fovea respectively (μ m)

Retinal thickness between RPE and IS/OS junction measured at the 2.0 mm superiorly, inferiorly, nasally and temporally from the fovea respectively (μ m).

Table 3.
Relationship between macular thickness (μ m) and myopia
Group 1 (Emmetropia) Group 2 (Low to moderate) Group 3 (High myopia) p*
Average foveal (1.0 mm) 251.1 ± 14.6 (p = 0.001) 252.4 ± 18.8 (p = 0.001) 269.1 ± 20.7 0.000
Superior inner 326.7 ± 12.8 324.9 ± 12.8 319.6 ± 16.2 0.07
Inferior inner 318.7 ± 11.1 320.8 ± 15.4 319.4 ± 17.5 0.82
Nasal inner 330.1 ± 12.6 325.1 ± 13.8 324.7 ± 17.3 0.19
Temporal inner 315.5 ± 12.5 314.7 ± 12.9 310.9 ± 16.3 0.30
Average inner 322.7 ± 10.8 321.4 ± 12.5 318.7 ± 15.6 0.37
Superior outer 282.8 ± 16.0 (p = 0.04) 281.6 ± 14.4 (p = 0.14) 274.6 ± 16.3 0.04
Inferior outer 275.3 ± 16.3 (p = 0.02) 270.2 ± 13.6 (p = 0.57) 265.7 ± 15.7 0.02
Nasal outer 303.6 ± 16.6 303.4 ± 23.3 296.8 ± 19.1 0.23
Temporal outer 269.9 ± 15.2 (p = 0.006) 266.3 ± 13.7 (p = 0.12) 259.3 ± 16.0 0.01
Average outer 282.9 ± 14.3 (p = 0.02) 280.4 ± 14.5 (p = 0.17) 274.1 ± 14.7 0.02
Overall average macula 284.3 ± 13.8 281.8 ± 13.9 279.15 ± 14.72 0.28
TMV (mm3)§ 10.3 ± 0.5 (p = 0.008) 10.2 ± 0.5 (p = 0.10) 9.9 ± 0.5 0.01

Data are presented as mean ± SD.

* One way analysis of variance

Statistically significant difference between group 1 and group 3 with Bonferroni post hoc test (p < 0.05)

Statistically significant difference between group 2 and group 3 with Bonferroni post hoc test (p < 0.05)

§ TMV = total macular volume.

Table 4.
Correlations between RPE-IS/OS junction thickness and refractive error
r p r* p*
Central fovea 0.40 0.001 0.42 0.001
1.0 mm superior 0.03 0.85 0.10 0.71
1.0 mm inferior 0.13 0.29 0.08 0.53
1.0 mm nasal 0.16 0.10 0.13 0.28
1.0 mm temporal 0.16 0.12 0.11 0.39
2.0 mm superior§ 0.07 0.57 0.1 0.44
2.0 mm inferior§ 0.15 0.34 0.08 0.53
2.0 mm nasal§ 0.06 0.58 0.05 0.87
2.0 mm temporal§ 0.12 0.25 0.09 0.49

* Correlation coefficients of partial correlation analysis adjusted by age and gender

Significant at p-value < 0.05 by Pearson's correlation

Retinal thickness between RPE and IS/OS junction measured at the 1.0 mm superiorly, inferiorly, nasally and temporally from the fovea respectively (μ m)

§ Retinal thickness between RPE and IS/OS junction measured at the 2.0 mm superiorly, inferiorly, nasally and temporally from the fovea respectively (μ m).

Table 5.
Correlations between macular measurements and refractive error
r p r* p*
Average foveal (1.0 mm) −0.38 0.001 −0.40 0.001
Superior inner 0.18 0.08 0.17 0.09
Inferior inner 0.03 0.72 0.03 0.77
Nasal inner 0.15 0.11 0.15 0.11
Temporal inner 0.16 0.09 0.13 0.18
Average inner 0.16 0.09 0.14 0.12
Superior outer 0.23 0.01 0.22 0.01
Inferior outer 0.25 0.01 0.25 0.01
Nasal outer 0.15 0.09 0.14 0.12
Temporal outer 0.28 0.01 0.26 0.01
Average outer 0.25 0.01 0.24 0.01
Overall average macula 0.13 0.17 0.11 0.25
TMV (mm3) 0.34 0.001 0.33 0.001

* Correlation coefficients of partial correlation analysis adjusted by age and gender

Significant at p-value < 0.05 by Pearson's correlation

TMV = total macular volume.

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