Elsevier

Ophthalmology

Volume 127, Issue 2, February 2020, Pages 177-185
Ophthalmology

Original Article
Differential Effects of Aging in the Macular Retinal Layers, Neuroretinal Rim, and Peripapillary Retinal Nerve Fiber Layer

https://doi.org/10.1016/j.ophtha.2019.09.013Get rights and content

Purpose

We determined the differential aging effects of the inner 6 layers of the macula in contrast to the minimum neuroretinal rim width (MRW) and peripapillary retinal nerve fiber layer (RNFL) thickness.

Design

Cross-sectional, multicenter study.

Participants

An approximately equal number of white subjects with a normal ocular and visual field examination in each decade group from 20 to 90 years.

Methods

OCT of the macula, optic nerve head, and peripapillary retina.

Main Outcome Measures

Sectoral measurements of the inner 6 layers of the macula; age-related decline of each of these layers; strength of the associations with age of the macular parameters, MRW, and peripapillary RNFL thickness; and association between ganglion cell layer (GCL) thickness and MRW and peripapillary RNFL thickness.

Results

The study sample comprised 1 eye of 246 subjects with a median (range) age of 52.9 (19.8–87.3) years. Of the 6 layers, there was a statistically significant decline with age of only the GCL, inner plexiform layer, and inner nuclear layer thickness with rates of −0.11 μm/year, −0.07 μm/year, and −0.03 μm/year, respectively. These rates corresponded to 2.82%, 2.10%, and 0.78% loss per decade, respectively, and were generally uniform across sectors. The rate of loss of MRW and peripapillary RNFL thickness was −1.22 μm/year and −0.20 μm/year, corresponding to 3.75% and 2.03% loss per decade. However, the association of GCL thickness change with age (R2 = 0.28) was approximately twice that of MRW and RNFL thickness (R2 = 0.14 for each).

Conclusions

In concordance with histopathologic studies showing age-related loss of retinal ganglion cell axons, we showed a significant decline in GCL thickness, as well as MRW and peripapillary RNFL thickness. The stronger relationship between aging and GCL thickness compared with the rim or peripapillary RNFL may indicate that GCL thickness could be better suited to measure progression of structural glaucomatous loss.

Section snippets

Participants

We included subjects who self-identified as being white in 5 centers (1 in Canada and 2 each in the United States and Germany). Subjects were recruited by advertisement in local media, on bulletin boards, and from a registry of subjects who had taken part in other studies. Approximately equal numbers of subjects were recruited in each decade group from 20 to 90 years. The Ethics Review Board of each institution approved the study, and in accordance with the Declaration of Helsinki, all subjects

Results

A total of 259 subjects were enrolled and underwent the study procedures. Of these, 13 (5.0%) were excluded because the OCT images did not meet the image quality criteria. The median age of the remaining 246 subjects was 52.9 years, with a range of 19.8 to 87.3 years. There were no differences among the decade groups in sex distribution, IOP, or BMO area (P > 0.24). However, there was a statistically significant difference in axial length among the age groups, ranging from a mean of 23.45 mm in

Discussion

The results of this study confirm previous histologic13, 14, 15 and OCT14,16 evidence that the central foveal RNFL GCL, IPL, INL, and OPL thicknesses are less compared with adjacent macular areas, corresponding to the displacement of these layers to form the foveal pit. In contrast, the ONL is substantially thicker, corresponding to the high density of photoreceptors in the foveal avascular zone.

The recent emphasis on macular visual field testing and imaging in glaucoma diagnostics is logical

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    Supplemental material available at www.aaojournal.org.

    Financial Disclosure(s): The author(s) have made the following disclosure(s): B.C.C., S.D., C.A.G., C.Y.M., A.F.S., C.F.B.: Support – Heidelberg Engineering.

    B.C.C.: Support – Topcon, Centervue.

    J.R.V.: Support – EadieTech.

    Financial Support: Canadian Institutes of Health Research: MOP11357 (B.C.C.); National Eye Institute: EY021281 (C.F.B.); Centers for Disease Control (C.A.G.); Heidelberg Engineering (B.C.C., S.D., C.A.G., C.Y.M., A.F.S., C.F.B.). The sponsor of the funding organization had no role in the design or conduct of this research.

    HUMAN SUBJECTS: Human subjects were included in this study. The human ethics committees at each institution approved the study. All research adhered to the tenets of the Declaration of Helsinki. All participants provided informed consent.

    No animal subjects were used in this study.

    Author Contributions:

    Conception and design: Chauhan, Burgoyne

    Data collection: Sharpe, Demirel, Girkin, Mardin, Scheuerle

    Analysis and interpretation: Chauhan, Vianna, Burgoyne

    Obtained funding: Chauhan, Burgoyne

    Overall responsibility: Chauhan, Burgoyne

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