title: Modelling the normal retinal nerve fibre layer thickness as measured by Stratus optical coherence tomography.
abstract: BACKGROUND
  The variation in retinal nerve fibre layer thickness (RNFLT) as measured by Stratus optical coherence tomography (OCT) in healthy subjects may be reduced when the effect on RNFLT measurements of factors other than disease is corrected for, and this may improve the diagnostic accuracy in glaucoma. With this perspective we evaluated the isolated and combined effects of factors potentially affecting the Stratus OCT RNFLT measurements in healthy subjects.
  
  
  METHODS
  We included 178 healthy eyes of 178 subjects between 20 and 80 years of age. Participants underwent an extensive eye examination. Stratus OCT RNFLT was measured by three standard protocols, two with high and one with standard image resolution. Effects on RNFLT of age, gender, refractive error, axial length, lens nuclear colour and opalescence, intra-ocular pressure (IOP), and optic disc size were examined by univariate and multivariate analyses.
  
  
  RESULTS
  Age, refractive error, axial length, and lens nuclear colour and opalescence affected RNFLT in univariate analyses, whereas gender, IOP, and optic disc size had no significant effect. In multivariate analyses only age in combination with refractive error, or with axial length, was significant and explained 14.7-17.6% (R2) of the total variation of RNFLT, approximately 50% more than age alone. RNFLT decreased by 2.6-2.9 microm per increasing decade of age and increased by 1.5-1.8 microm per more positive diopter of spherical equivalent using full-circle measurements of the three standard protocols. These effects varied between measurement sectors.
  
  
  CONCLUSIONS
  RNFLT as measured by Stratus OCT standard protocols was significantly affected by age and refractive status. The effect on global RNFLT of a difference in refractive error of 10 diopters corresponded to the effect of a difference in age of 60 years. Theoretically, the effect of refractive status may be explained by artefacts of RNFLT measurement circle placement. The results suggest that the diagnostic accuracy of Stratus OCT may be improved by considering refractive status in addition to age when RNFLT is measured. For this purpose spherical equivalent seems as effective as axial length.
authors.affiliation: Department of Clinical Sciences, Ophthalmology, Malmö University Hospital, Lund University, 20502 Malmö, Sweden. jesper.hougaard@med.lu.se
authors.forename: Jesper Leth
authors.initials: JL
authors.lastname: Hougaard
authors.forename: Carl
authors.initials: C
authors.lastname: Ostenfeld
authors.forename: Anders
authors.initials: A
authors.lastname: Heijl
authors.forename: Boel
authors.initials: B
authors.lastname: Bengtsson
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009412:Nerve Fibers; D009898:Optic Disk / Q000033:anatomy & histology; D012030:Refractive Errors / Q000150:complications; D012165:Retinal Ganglion Cells / Q000166:cytology*; D012737:Sex Factors; D041623:Tomography, Optical Coherence / Q000379:methods*