正常成年人年龄相关性视盘周围视网膜神经纤维层厚度变化及影响因素
霍妍佼 郭彦 王怀洲 李蕾 王宁利
首都医科大学附属北京同仁医院 北京同仁眼科中心 北京市眼科学与视觉科学重点实验室 100730
Age-Related Changes in and Determinants of the Peripapillary Retinal Nerve Fiber Layer in Normal Adults
Yanjiao Huo, Yan Guo, Huaizhou Wang, Lei Li, Ningli Wang
Beijing Ophthalmology & Visual Science Key Laboratory, Beijing Institute of Ophthalmology, Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
摘要 目的:研究高分辨率光学相干断层扫描(HD-OCT)测得的正常成年人视盘周围视网膜神经纤维层(pRNFL)厚度随年龄的变化及其影响因素,从而为青光眼性视神经病变进展的诊断提供依据。方法:系列病例研究。选取2016 年6-9 月在北京同仁医院进行健康体检的某单位在职职工与退休职工,共195例(390眼),年龄21~90岁,以10岁为一组,分为7组(21~30岁、31~40岁、41~50岁、51~60岁、61~70 岁、71~80 岁、81~90 岁)。应用HD-OCT进行pRNFL厚度平均值及各个区域厚度参数测量,采用方差分析比较不同年龄组之间pRNFL厚度的差异,同时建立多元线性回归方程并用广义估计方程进行矫正,探讨年龄、性别、眼压、等效球镜度(SE)对pRNFL厚度平均值的影响。结果:最终195 例(352 眼)的数据用于分析,pRNFL厚度为(96±10)μm;在21~90 岁之间,随着年龄增加,pRNFL厚度平均值减少0.21 μm/年(χ2=46.34,P<0.001);pRNFL厚度在40 岁和70 岁后分别出现陡坡样下降,其间pRNFL保持相对稳定。除年龄因素外,pRNFL变薄与SE向负值方向发展有关(β=-1.49,χ2=11.93,P=0.001),而与性别(β=0.73,χ2=0.34,P=0.560)和眼压(β=-0.24,χ2=2.10,P=0.148)无关。结论:pRNFL厚度随年龄增长而逐渐变薄,在40 岁和70 岁后分别出现陡坡样下降。pRNFL变薄与年龄增长、近视屈光度增高有关,而与性别和正常范围内的眼压波动无显著相关。在青光眼性视神经病变的进展分析中需要考虑这些因素的作用。
关键词 :
视网膜神经纤维层 ,
年龄 ,
光学相干断层扫描
Abstract :Objective: To determine age-related changes in and the determinants of high-definition optical coherence tomography (HD-OCT) measurements of the peripapillary retinal nerve fiber layer (pRNFL) thickness in normal adults in order to provide evidence for the progressive analysis of glaucoma. Methods: This was a case series study. One hundred ninety-five (390 eyes) people were recruited from June 2016 to September 2016 in the Beijing Tongren Hospital Health Examination Center from specific groups, including staffs and retired staffs. Age ranged from 21 to 90 years. Participants underwent Cirrus HD-OCT measurements of the pRNFL. One-way analysis of variance was used to compare mean pRNFL thickness between 7 decade-based age groups (21-30 years, 31-40 years, 41-50 years, 51-60 years, 61-70 years, 71-80 years,81-90 years) and between sectors. Multiple regression analysis and linear regression determined the association between pRNFL thickness and age, gender, intraocular pressure (IOP) and spherical equivalent(SE). Results: Mean pRNFL thickness in the 352 eyes was 96±10 μm. Mean pRNFL thickness decreased by 0.21 μm (χ2=46.34, P<0.001) per year with an increase in age. It showed two steep drops with age, first in the 4th and next in the 7th decade with relative stability between them. pRNFL thickness was associated with SE (β=-1.49, χ2=11.93, P=0.001) but not with gender (β=0.73, χ2=0.34, P=0.560) or IOP (β=-0.24,χ2=2.10, P=0.148). Conclusions: Mean pRNFL thickness shows a small age-related linear decrease with two steep drops in the 4th and 7th decades. A thinner pRNFL was independently associated with age and a higher SE in myopia, but not with gender or IOP within the normal range. These factors should be considered if using pRNFL to detect the progression of glaucoma and other optic neuropathies.
Key words :
retinal nerve fiber layer
age
ptical coherence tomography
收稿日期: 2018-04-08
基金资助: 国家自然科学基金(11571031);首都医科大学附属北京同仁医院科研基金(2015-YJJZZL-011)
通讯作者:
王宁利(ORCID:0000-0002-8933-4482),Email:wningli@vip.163.com
[3]
Carpineto P, Nubile M, Agnifili L, et al. Reproducibility and
Ophthalmology, 1993, 100(5): 587-598.
[1]
Weinreb RN, Aung T, Medeiros FA. The pathophysiology and
repeatability of Cirrus? HD-OCT peripapillary retinal nerve
[3]
Carpineto P, Nubile M, Agnifili L, et al. Reproducibility and
treatment of glaucoma: a review. JAMA, 2014, 311(18): 1901-
19
11. DOI: 10.1001/jama.2014.3192.
fibre layer thickness measurements in young normal subjects.
Ophthalmologica, 2012, 227(3): 139-145. DOI: 10.1159/
repeatability of Cirrus? HD-OCT peripapillary retinal nerve
00
0334967.
[2]
Tuulonen A, Lehtola J, Airaksinen PJ. Nerve fiber layer defects
fibre layer thickness measurements in young normal subjects.
Ophthalmologica, 2012, 227(3): 139-145. DOI: 10.1159/
[4]
Wadhwani M, Bali SJ, Satyapal R, et al. Test-retest variability
00
0334967.
with normal visual field: do normal optic disc and normal
of retinal nerve fiber layer thickness and macular ganglion cellinner
[4]
Wadhwani M, Bali SJ, Satyapal R, et al. Test-retest variability
visual field indicate absence of glaucomatous abnormality?
Ophthalmology, 1993, 100(5): 587-598.
plexiform layer thickness measurements using spectraldomain
of retinal nerve fiber layer thickness and macular ganglion cellinner
[3]
Carpineto P, Nubile M, Agnifili L, et al. Reproducibility and
optical coherence tomography. J Glaucoma, 2015, 24(5):
e109-115. DOI: 10.1097/IJG.0000000000000203.
plexiform layer thickness measurements using spectraldomain
repeatability of Cirrus? HD-OCT peripapillary retinal nerve
[5]
Budenz DL, Anderson DR, Varma R, et al. Determinants of
optical coherence tomography. J Glaucoma, 2015, 24(5):
e109-115. DOI: 10.1097/IJG.0000000000000203.
fibre layer thickness measurements in young normal subjects.
Ophthalmologica, 2012, 227(3): 139-145. DOI: 10.1159/
normal retinal nerve fiber layer thickness measured by Stratus
OCT. Ophthalmology, 2007, 114(6): 1046-1052. DOI: 10.1016/
[5]
Budenz DL, Anderson DR, Varma R, et al. Determinants of
00
0334967.
j.ophtha.2006.08.046.
normal retinal nerve fiber layer thickness measured by Stratus
OCT. Ophthalmology, 2007, 114(6): 1046-1052. DOI: 10.1016/
[4]
Wadhwani M, Bali SJ, Satyapal R, et al. Test-retest variability
[6]
Harwerth RS, Wheat JL, Rangaswamy NV. Age-related losses
j.ophtha.2006.08.046.
of retinal nerve fiber layer thickness and macular ganglion cellinner
of retinal ganglion cells and axons. Invest Ophthalmol Vis Sci,
20
08, 49 (10): 4437-4443. DOI: 10.1167/iovs.08-1753.
[6]
Harwerth RS, Wheat JL, Rangaswamy NV. Age-related losses
plexiform layer thickness measurements using spectraldomain
[7]
Patel NB, Lim M, Gajjar A, et al. Age-associated changes in the
of retinal ganglion cells and axons. Invest Ophthalmol Vis Sci,
20
08, 49 (10): 4437-4443. DOI: 10.1167/iovs.08-1753.
optical coherence tomography. J Glaucoma, 2015, 24(5):
e109-115. DOI: 10.1097/IJG.0000000000000203.
retinal nerve fiber layer and optic nerve head. Invest Ophthalmol
Vis Sci, 2014, 55 (8): 5134-5143. DOI: 10.1167/iovs.14-14303.
[7]
Patel NB, Lim M, Gajjar A, et al. Age-associated changes in the
[5]
Budenz DL, Anderson DR, Varma R, et al. Determinants of
retinal nerve fiber layer and optic nerve head. Invest Ophthalmol
Vis Sci, 2014, 55 (8): 5134-5143. DOI: 10.1167/iovs.14-14303.
[8]
American academy of ophthalmology. Basic and clinical science
normal retinal nerve fiber layer thickness measured by Stratus
OCT. Ophthalmology, 2007, 114(6): 1046-1052. DOI: 10.1016/
[8]
American academy of ophthalmology. Basic and clinical science
course. Italy: FSC, 2014: 46-47.
j.ophtha.2006.08.046.
[9]
李晓宇, 潘英姿, 晏晓明, 等. 相干光断层扫描仪检测视网膜
神经纤维层厚度影响因素分析. 中国斜视与小儿眼科杂志,
20
07, 15(3): 106-112. DOI: 10.3969/j.issn.1005-328X.2007.03.004.
[6]
Harwerth RS, Wheat JL, Rangaswamy NV. Age-related losses
course. Italy: FSC, 2014: 46-47.
[9]
李晓宇, 潘英姿, 晏晓明, 等. 相干光断层扫描仪检测视网膜
神经纤维层厚度影响因素分析. 中国斜视与小儿眼科杂志,
20
07, 15(3): 106-112. DOI: 10.3969/j.issn.1005-328X.2007.03.004.
[10]
Parikh RS, Parikh SR, Sekhar GC, et al. Normal age-related
of retinal ganglion cells and axons. Invest Ophthalmol Vis Sci,
20
08, 49 (10): 4437-4443. DOI: 10.1167/iovs.08-1753.
[10]
Parikh RS, Parikh SR, Sekhar GC, et al. Normal age-related
decay of retinal nerve fiber layer thickness. Ophthalmology,
20
07, 114(5): 921-926. DOI: 10.1016/j.ophtha.2007.01.023.
[7]
Patel NB, Lim M, Gajjar A, et al. Age-associated changes in the
decay of retinal nerve fiber layer thickness. Ophthalmology,
20
07, 114(5): 921-926. DOI: 10.1016/j.ophtha.2007.01.023.
[11]
Diniz-Filho A, Abe RY, Zangwill LM, et al. Association between
retinal nerve fiber layer and optic nerve head. Invest Ophthalmol
Vis Sci, 2014, 55 (8): 5134-5143. DOI: 10.1167/iovs.14-14303.
[11]
Diniz-Filho A, Abe RY, Zangwill LM, et al. Association between
intraocular pressure and rates of retinal nerve fiber layer loss
[8]
American academy of ophthalmology. Basic and clinical science
intraocular pressure and rates of retinal nerve fiber layer loss
measured by optical coherence tomography. Ophthalmology,
20
16, 123(10): 2058-2065. DOI: 10.1016/j.ophtha.2016.07.006.
course. Italy: FSC, 2014: 46-47.
[9]
李晓宇, 潘英姿, 晏晓明, 等. 相干光断层扫描仪检测视网膜
神经纤维层厚度影响因素分析. 中国斜视与小儿眼科杂志,
20
07, 15(3): 106-112. DOI: 10.3969/j.issn.1005-328X.2007.03.004.
measured by optical coherence tomography. Ophthalmology,
20
16, 123(10): 2058-2065. DOI: 10.1016/j.ophtha.2016.07.006.
[12]
Kang SH, Hong SW, Im SK, et al. Effect of myopia on the
[10]
Parikh RS, Parikh SR, Sekhar GC, et al. Normal age-related
[12]
Kang SH, Hong SW, Im SK, et al. Effect of myopia on the
thickness of the retinal nerve fiber layer measured by Cirrus HD
decay of retinal nerve fiber layer thickness. Ophthalmology,
20
07, 114(5): 921-926. DOI: 10.1016/j.ophtha.2007.01.023.
optical coherence tomography. Invest Ophthalmol Vis Sci, 2010,
51
(8): 4075-4083. DOI: 10.1167/iovs.09-4737.
thickness of the retinal nerve fiber layer measured by Cirrus HD
[11]
Diniz-Filho A, Abe RY, Zangwill LM, et al. Association between
optical coherence tomography. Invest Ophthalmol Vis Sci, 2010,
51
(8): 4075-4083. DOI: 10.1167/iovs.09-4737.
[13]
Wübbolt IS1, von Alven S, Hülssner O,et al. Comparisons of
intraocular pressure and rates of retinal nerve fiber layer loss
[13]
Wübbolt IS1, von Alven S, Hülssner O,et al. Comparisons of
manual and automatic refractometry with subjective results. Klin
Monbl Augenheilkd, 2006, 223(11): 904-907. DOI: 10.1055/
s-2006-927212.
measured by optical coherence tomography. Ophthalmology,
20
16, 123(10): 2058-2065. DOI: 10.1016/j.ophtha.2016.07.006.
manual and automatic refractometry with subjective results. Klin
Monbl Augenheilkd, 2006, 223(11): 904-907. DOI: 10.1055/
s-2006-927212.
[14]
Zhang X, Francis BA, Dastiridou A, et al. Longitudinal and
[12]
Kang SH, Hong SW, Im SK, et al. Effect of myopia on the
[14]
Zhang X, Francis BA, Dastiridou A, et al. Longitudinal and
cross-sectional analyses of age effects on retinal nerve fiber layer
thickness of the retinal nerve fiber layer measured by Cirrus HD
cross-sectional analyses of age effects on retinal nerve fiber layer
and ganglion cell complex thickness by fourier-domain OCT. Transl
Vis Sci Technol, 2016, 5(2): 1. DOI: 10.1167/tvst.5.2.1.
optical coherence tomography. Invest Ophthalmol Vis Sci, 2010,
51
(8): 4075-4083. DOI: 10.1167/iovs.09-4737.
and ganglion cell complex thickness by fourier-domain OCT. Transl
Vis Sci Technol, 2016, 5(2): 1. DOI: 10.1167/tvst.5.2.1.
[13]
Wübbolt IS1, von Alven S, Hülssner O,et al. Comparisons of
manual and automatic refractometry with subjective results. Klin
Monbl Augenheilkd, 2006, 223(11): 904-907. DOI: 10.1055/
s-2006-927212.
[14]
Zhang X, Francis BA, Dastiridou A, et al. Longitudinal and
cross-sectional analyses of age effects on retinal nerve fiber layer
and ganglion cell complex thickness by fourier-domain OCT. Transl
Vis Sci Technol, 2016, 5(2): 1. DOI: 10.1167/tvst.5.2.1.
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唐敏, 罗丽颖, 傅扬. 屈光参差性弱视儿童治疗前后黄斑微循环的变化 [J]. 中华眼视光学与视觉科学杂志, 2023, 25(7): 512-517.
[2]
程荣, 余川, 王玉倩, 等. iOCT在玻璃体视网膜手术中的指导作用 [J]. 中华眼视光学与视觉科学杂志, 2023, 25(7): 530-535.
[3]
李琦, 金赣英, 胡东瑞, 等. 应用OCTA评估白内障患者超声乳化吸除术后视网膜厚度及血流密度的变化 [J]. 中华眼视光学与视觉科学杂志, 2023, 25(4): 271-277.
[4]
于焕凯, 黄天皓, 施策, 等. 基于SS-OCT探究急性高糖对明暗适应中视网膜脉络膜血流及结构改变的影响 [J]. 中华眼视光学与视觉科学杂志, 2023, 25(4): 264-270.
[5]
黄聪聪, 符爱存, 于世傲, 等. 正视儿童脉络膜厚度的分布特征及相关影响因素 [J]. 中华眼视光学与视觉科学杂志, 2023, 25(2): 125-132.
[6]
王忠叶,刘秀花,张敏,等. 角膜曲率区域分布及随年龄变化趋势分析 [J]. 中华眼视光学与视觉科学杂志, 2023, 25(1): 44-49.
[7]
李自杨, 李莎, 黄小勇.. 光学相干断层成像不同扫描信号强度对视盘
RNFL厚度分析的影响 [J]. 中华眼视光学与视觉科学杂志, 2022, 24(8): 610-614.
[8]
唐玉玲, 廖萱, 谭青青, 等.. 扫频OCTCASIA2测量白内障患者术前晶状体与术后人工晶状体偏心和倾斜的相关性 [J]. 中华眼视光学与视觉科学杂志, 2022, 24(6): 434-440.
[9]
张芬, 刘新婷, 吴文凤, 等.. 高度近视人群视盘周围血流密度与神经纤维层厚度的变化特征 [J]. 中华眼视光学与视觉科学杂志, 2022, 24(5): 321-328.
[10]
徐治成,史学锋. 弱视眼底光学相干断层扫描的研究进展 [J]. 中华眼视光学与视觉科学杂志, 2022, 24(12): 950-955.
[11]
翟晶,俞雪婷,方伟,等. 恒定性和间歇性外斜视黄斑区视网膜血流密度及厚度特征 [J]. 中华眼视光学与视觉科学杂志, 2022, 24(11): 854-861.
[12]
赖瑶,王耀华,廖洪斐. 光学相干断层扫描血流成像在眼科应用的研究现状 [J]. 中华眼视光学与视觉科学杂志, 2022, 24(11): 876-880.
[13]
杜虹, 王月麟, 戴荣平, 等. 视网膜大动脉瘤的多模态眼底影像和疾病 特征 [J]. 中华眼视光学与视觉科学杂志, 2022, 24(1): 46-51.
[14]
宋云红, 王绍莉. 折叠式人工玻璃体球囊植入严重视网膜脱离眼内的OCT特征 [J]. 中华眼视光学与视觉科学杂志, 2022, 24(1): 52-57.
[15]
. 年龄相关视功能和眼健康管理白皮书 [J]. 中华眼视光学与视觉科学杂志, 2022, 24(1): 1-9.