title: Analysis of normal retinal nerve fiber layer thickness by age, sex, and race using spectral domain optical coherence tomography.
abstract: OBJECTIVE
  To determine the effects of age, sex, and race on the retinal nerve fiber layer (RNFL) in the normal human eye as measured by the spectral domain optical coherence tomography (SD-OCT) Spectralis machine (Heidelberg Engineering).
  
  
  METHODS
  Peripapillary SD-OCT RNFL thickness measurements were determined in normal subjects seen at a university-based clinic. One randomly selected eye per subject was used for analysis in this cross-sectional study. Multiple regression analysis was applied to assess the effects of age, sex, ethnicity, and mean refractive error on peripapillary RNFL thickness. Results are expressed as means±SD wherever applicable.
  
  
  RESULTS
  The study population consisted of 190 healthy participants from 9 to 86 years of age. Of the 190 participants, 62 (33%) were men, 125 (66%) Caucasians, 26 (14%) African Americans, 14 (7%) Hispanics, 16 (8%) Asians, and 9 (5%) other races. The mean RNFL thickness for the normal population studied was 97.3 ± 9.6 µm. Normal RNFL thickness values follow the ISNT rule with decreasing RNFL thickness values starting from the thickest quadrant inferiorly to the thinnest quadrant temporally: inferior quadrant (126 ± 15.8), superior quadrant (117.2±16.13), nasal quadrant (75 ± 13.9), and temporal quadrant (70.6 ± 10.8 µm). Thinner RNFL measurements were associated with older age (P<0.001); being Caucasian, versus being either Hispanic or Asian (P=0.02 and 0.009, respectively); or being more myopic (P<0.001). For every decade of increased age, mean RNFL thickness measured thinner by approximately 1.5 µm (95% confidence interval, 0.24-0.07). Comparisons between ethnic groups revealed that Caucasians had mean RNFL values (96 ± 9.2 µm) slightly thinner than those of Hispanics (102.9 ± 11 µm; P=0.02) or Asians (100.7 ± 8.5 µm; P=0.009). African Americans RNFL values (99.2 ± 10.2 µm) were not significantly different when compared with Caucasians. There was no relationship between RNFL thickness and sex.
  
  
  CONCLUSIONS
  The thickest RNFL measurements were found in the inferior quadrant, followed by the superior, nasal, and temporal quadrants (ISNT rule applied to the RNFL). Thinner RNFL measurements were associated with older age and increasing myopia. Caucasians tend to have thinner RNFL values when compared with Hispanics and Asians. SD-OCT analysis of the normal RNFL showed results similar to time domain OCT studies.
authors.affiliation: Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Massachusetts General Hospital and the Harvard Catalyst Program, Boston, MA, USA.
authors.forename: Tarek
authors.initials: T
authors.lastname: Alasil
authors.forename: Kaidi
authors.initials: K
authors.lastname: Wang
authors.forename: Pearse A
authors.initials: PA
authors.lastname: Keane
authors.forename: Hang
authors.initials: H
authors.lastname: Lee
authors.forename: Neda
authors.initials: N
authors.lastname: Baniasadi
authors.forename: Johannes F
authors.initials: JF
authors.lastname: de Boer
authors.forename: Teresa C
authors.initials: TC
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology*; D002648:Child; D003430:Cross-Sectional Studies; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers; D009898:Optic Disk / Q000033:anatomy & histology*; D012016:Reference Values; D012165:Retinal Ganglion Cells / Q000166:cytology*; D012189:Retrospective Studies; D012737:Sex Factors; D041623:Tomography, Optical Coherence / Q000379:methods*; D055815:Young Adult