Abstract
PurposeTo examine the retinal nerve fiber layer (RNFL) ophthalmoscopically, to search for localized RNFL defects, and to assess factors associated with RNFL visibility in a population-based setting.MethodsThe population-based cross-sectional Beijing Eye Study 2006 included 3251 subjects. Using color fundus photographs, RNFL visibility was assessed in grades from 0 to 8 in 8 fundus sectors. Localized RNFL defects were defined as wedge-shaped defects running towards the optic disc.ResultsAfter exclusion of subjects with optic media opacities, 2602 subjects (mean age:58.1±9.0 years) were included. RNFL visibility score was highest (P<0.001) in the temporal inferior region, followed by the temporal superior region, nasal superior region, and nasal inferior region. In multivariate analysis, higher RNFL visibility score was associated with younger age (P<0.001;standardized coefficient beta:−0.44;regression coefficient B: −0.22; 95%CI: −0.24, −0.20), female gender (P<0.001;beta:0.11;B:1.00;95%CI:0.67,1.32), higher blood concentration of low-density lipoproteins (P = 0.002;beta:0.07;B:0.34;95%CI:0.13,0.56), absence of dyslipidemia (P = 0.001;beta: −0.07;B: −0.58;95%CI: −0.93, −0.24), lower blood glucose concentration (P = 0.006;beta: −0.05;B: −0.14;95%CI: −0.24, −0.04), hyperopic refractive error (P<0.001;beta:0.15;B:0.45;95%CI:0.34,0.56), smaller optic disc size (P<0.001;beta: −0.08; B:−0.72;95% CI:−1.04, −0.40), absence of glaucomatous optic neuropathy (P<0.001;beta: −0.06;B: −2.69;95%CI:–4.18, −1.21) and absence of non-glaucomatous optic nerve damage (P = 0.001;beta: −0.06;B: −4.80;95%CI:0. −7.64, −1.96). Localized RNFL defects were detected in 96 subjects (prevalence:3.7±0.45% (95% confidence interval(CI):3.0,4.4). In multivariate analysis, prevalence of localized RNFL defects was associated with higher blood pressure (P<0.001; odds ratio (OR):1.07;95%CI:1.03,1.10), higher concentration of low-density lipoproteins (P = 0.01;OR:1.42;95%CI:1.08,1.85), higher prevalence of glaucomatous optic neuropathy (P<0.001;OR:46.8;95%CI:19.4,113) and diabetic retinopathy (P = 0.002;OR:3.20;95%CI:1.53,6.67), and lower total RNFL visibility (P<0.001;OR:0.92;95%CI:0.88,0.96).ConclusionsIn Chinese aged 45+ years, a decreased RNFL visibility was associated with older age, male gender, dyslipidemia, hyperglycemia, myopia, larger optic disc, and glaucomatous or non-glaucomatous optic neuropathy. Localized RNFL defects (prevalence:3.7±0.45%) were correlated mainly with higher blood pressure, higher concentration of low-density lipoproteins, glaucomatous optic neuropathy and diabetic retinopathy. These data are helpful for the routine ophthalmoscopic examination of the RNFL.
Highlights
The retinal nerve fiber layer (RNFL) is part of the afferent visual pathway and contains the retinal ganglion cell axons
Higher RNFL visibility score was associated with younger age (P,0.001;standardized coefficient beta:20.44;regression coefficient B: 20.22; 95%CI: 20.24, 20.20), female gender (P,0.001;beta:0.11;B:1.00;95%CI:0.67,1.32), higher blood concentration of low-density lipoproteins (P = 0.002;beta:0.07;B:0.34;95%CI:0.13,0.56), absence of dyslipidemia (P = 0.001;beta: 20.07;B: 20.58;95%CI: 20.93, 20.24), lower blood glucose concentration (P = 0.006;beta: 20.05;B: 20.14;95%CI: 20.24, 20.04), hyperopic refractive error (P,0.001;beta:0.15;B:0.45;95%CI:0.34,0.56), smaller optic disc size (P,0.001;beta: 20.08; B:20.72;95% CI:21.04, 20.40), absence of glaucomatous optic neuropathy (P,0.001;beta: 20.06;B: 22.69;95%CI:–4.18, 21.21) and absence of non-glaucomatous optic nerve damage (P = 0.001;beta: 20.06;B: 24.80;95%CI:0. 27.64, 21.96)
Prevalence of localized RNFL defects was associated with higher blood pressure (P,0.001; odds ratio (OR):1.07;95%CI:1.03,1.10), higher concentration of low-density lipoproteins (P = 0.01;OR:1.42;95%CI:1.08,1.85), higher prevalence of glaucomatous optic neuropathy (P,0.001;OR:46.8;95%CI:19.4,113) and diabetic retinopathy (P = 0.002;OR:3.20;95%CI:1.53,6.67), and lower total RNFL visibility (P,0.001;OR:0.92;95%CI:0.88,0.96)
Summary
The retinal nerve fiber layer (RNFL) is part of the afferent visual pathway and contains the retinal ganglion cell axons. The RNFL loss occurs in a diffuse and/or in a localized pattern [1,2,3]. The importance of localized defects of the retinal nerve fiber layer for the diagnosis of glaucoma and other optic nerve disease has been demonstrated in many previous studies [3,4,5,6,7]. Previous studies have suggested that localized RNFL defects occur in about 20% of all glaucoma eyes, but that they can be found in other diseases of the optic nerve and retina, such as optic disk drusen, toxoplasmotic retinochoroidal scars, longstanding papilledema, diabetic retinopathy and arterial hypertensive retinopathy [8]. The special diagnostic importance of RNFL assessment is based on the findings that a localized RNFL defect is not found in a normal eye, that in glaucomatous eyes with small optic discs, a localized RNFL defect can point to a glaucomatous optic nerve damage even if the optic disc appears to be normal; and that in non-glaucomatous optic nerve damage the shape of the neuroretinal rim inside of the optic disc remains mostly unchanged while the RNFL can show localized RNFL defects or a diffuse RNFL loss [7]
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