title: Associations with Retinal Pigment Epithelium Thickness Measures in a Large Cohort: Results from the UK Biobank.
abstract: To describe associations of ocular and systemic factors with retinal pigment epithelium (RPE)-Bruch's membrane (BM) complex thickness as measured by spectral-domain (SD) optical coherence tomography (OCT).
  
  
  
  Multisite community-based study. This research has been conducted using the UK Biobank Resource.
  
  
  
  Sixty-seven thousand three hundred eighteen people 40 to 69 years old received questionnaires, physical examination, and eye examination, including macular SD OCT. Systematic selection process identified 34 652 eyes with high-quality SD OCT images from normal individuals for analysis.
  
  
  
  We included people with no self-reported ocular disease, diabetes, or neurologic disorders; visual acuity of ≥20/25; refraction between -6 diopters (D) to 6 D, and IOP of 6 to 21 mmHg. Only high-quality, well-centered SD OCT images with central, stable fixation were included. Descriptive statistics, t tests, and regression analyses were performed. Multivariate regression modeling was used to adjust for covariates and to identify relationships between RPE-BM thickness and ocular and systemic features.
  
  
  
  Retinal pigment epithelium-BM thickness, as measured by SD OCT segmentation using Topcon Advanced Boundary Segmentation at 9 Early Treatment of Diabetic Retinopathy Study subfields.
  
  
  
  Mean RPE-BM thickness was 26.3 μm (standard deviation, 4.8 μm) at central subfield. Multivariate regression with age stratification showed that RPE thinning became apparent after age 45. Among those aged ≤45, RPE-BM was significantly thicker among those of black or mixed/other race (+3.61 and +1.77 μm vs. white, respectively; P < 0.001) and higher hyperopia (+0.4 μm/D; P < 0.001), but not for other variables considered. Among those age >45, RPE-BM was significantly thinner with older age (-0.10 μm/year; P < 0.001), Asian ethnicity (-0.45 μm vs. white; P = 0.02), taller height (-0.02 μm/cm; P < 0.001), higher IOP (-0.03 μm/mmHg; P < 0.001), and regular smoking (-0.27 μm vs. nonsmokers; P = 0.02). In contrast, RPE-BM was significantly thicker among black or mixed/other race (+3.29 μm and +0.81 μm vs. white, respectively; P < 0.001) and higher hyperopia (+0.28 μm/D; P < 0.001). There was no significant association with sex or Chinese ethnicity.
  
  
  
  We describe novel findings of RPE-BM thickness in normal individuals, a structure that varies with age, ethnicity, refraction, IOP, and smoking. The significant association with IOP is especially interesting and may have relevance for the etiology of glaucoma, while the association between age and smoking may have relevance for the etiology of age-related macular degeneration.
authors.affiliation: NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, United Kingdom.
authors.forename: Fang
authors.initials: F
authors.lastname: Ko
authors.affiliation: NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, United Kingdom.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Foster
authors.affiliation: NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, United Kingdom.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Strouthidis
authors.affiliation: NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, United Kingdom.
authors.forename: Yusrah
authors.initials: Y
authors.lastname: Shweikh
authors.affiliation: Topcon Advanced Biomedical Imaging Laboratory, Oakland, New Jersey.
authors.forename: Qi
authors.initials: Q
authors.lastname: Yang
authors.affiliation: Topcon Advanced Biomedical Imaging Laboratory, Oakland, New Jersey.
authors.forename: Charles A
authors.initials: CA
authors.lastname: Reisman
authors.affiliation: NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, United Kingdom.
authors.forename: Zaynah A
authors.initials: ZA
authors.lastname: Muthy
authors.affiliation: Optometry & Vision Science, Queens University of Belfast, Belfast, United Kingdom.
authors.forename: Usha
authors.initials: U
authors.lastname: Chakravarthy
authors.affiliation: Department of Ophthalmology, Southampton General Hospital, Hampshire, United Kingdom.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Lotery
authors.affiliation: NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, United Kingdom.
authors.forename: Pearse A
authors.initials: PA
authors.lastname: Keane
authors.affiliation: NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, United Kingdom.
authors.forename: Adnan
authors.initials: A
authors.lastname: Tufail
authors.affiliation: NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, United Kingdom.
authors.forename: Carlota M
authors.initials: CM
authors.lastname: Grossi
authors.affiliation: NIHR Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, University College London, London, United Kingdom. Electronic address: praveen.patel@moorfields.nhs.uk.
authors.forename: Praveen J
authors.initials: PJ
authors.lastname: Patel
mesh_terms: D000328:Adult; D000368:Aged; D000375:Aging / Q000473:pathology; D018070:Biological Specimen Banks; D016570:Bruch Membrane / Q000033:anatomy & histology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007429:Intraocular Pressure; D008266:Macula Lutea / Q000033:anatomy & histology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D055213:Retinal Pigment Epithelium / Q000033:anatomy & histology* / Q000473:pathology; D012907:Smoking / Q000009:adverse effects; D041623:Tomography, Optical Coherence / Q000379:methods; D006113:United Kingdom