Localized Retinal Nerve Fiber Layer Defects Detected by Optical Coherence Tomography: The Beijing Eye Study

Abstract

ObjectiveTo assess the prevalence of localized retinal nerve fiber layer defects (LRNFLD) and associated factors in adult Chinese.MethodsThe population-based Beijing Eye Study 2011 included 3468 individuals (mean age: 64.6±9.8 years (range: 50–93 years)). The study participants underwent a detailed ophthalmological examination including spectral-domain optical coherence tomography (SpectralisR-OCT) assisted measurement of the RNFL. A LRNFLD was defined as a sector in which the RNFL contour line dipped into the red zone for a length of <180°.ResultsReadable OCT images were available for 3242 (93.5%) subjects. LRNFLDs were detected in 640 eyes (9.9±0.4%) of 479 subjects (14.8±0.6%). In the age groups of 50–59 years, 60–69 years, 70–79 years, and 80+ years, the prevalence of LRNFLD per person increased from 9.9±0.9%, 11.6±1.0% and 20.6±1.4% to 33.0±3.2%, respectively. In multivariate analysis, prevalence of LRNFLDs was significantly associated with older age (P = 0.001; Odds Ratio (OR): 1.03; 95% Confidence Interval (CI): 1.01,1.05), myopic refractive error (P<0.001;OR:0.79;95%CI:0.74,0.85), larger beta zone of parapapillary atrophy (P<0.001; OR:1.34;95%CI:1.20,1.50), presence of glaucomatous optic neuropathy (P<0.001;OR:7.02;95%CI:3.87,12.7), presence of non-glaucomatous optic nerve damage (P = 0.001;OR:43.3;95%CI:8.24,227.1), and presence of diabetic retinopathy (P = 0.003;OR:2.79;95%CI:1.43,5.44).ConclusionsOCT-defined LRNFLDs were present in a prevalence of 14.8±0.6% in a population-based study sample of subjects aged 50+ years. Prevalence of LRNFLDs increased with higher age, myopic refractive error, and larger parapapillary beta zone. Major ocular diseases associated with LRNFLs were glaucoma, non-glaucomatous optic nerve damage and diabetic retinopathy. These data may be helpful for a semiautomatic assessment of the RNFL.

Ten-Year Incidence of Retinal Nerve Fiber Layer Defects: The Beijing Eye Study 2001/2011

“…In a similar manner, the other longitudinal population-based studies in ophthalmology have not yet presented such data and findings. 9,17,[30][31][32] Other recent studies by the Beijing Eye Study, such as the observed association between the estimated cerebrospinal fluid pressure and retinal vein diameter in arterial hypertension, and the 10-year mortality of ocular diseases, do not have a direct association with the topic of the current study. 33,34 From a practical point of view, one may raise the question whether brain imaging should be performed to exclude cerebral ischemic attacks in patients without glaucoma or diabetic retinopathy and who present with an incident RNFLD.…”

Characteristics of Retinal Nerve Fiber Layer Defect in Nonglaucomatous Eyes With Type II Diabetes

“…14 Many studies have demonstrated that, even in the absence of vascular changes, several layers in the retina and RNFL thickness around the optic disc become significantly thinner in eyes with type II diabetes compared with those without diabetes. 8,9 Our study demonstrated that average RNFL thickness and sector RNFL thickness in superior and inferior quadrants in diabetes were significantly thinner than those of nondiabetic, nonglaucomatous controls (Table 1).…”

“…Retinal nerve fiber layer (RNFL) abnormalities, manifesting as thinning or defects, are frequently encountered in subjects with diabetes. [3][4][5] Thinning of the RNFL around the optic disc and macula thinning have been reported, and these changes often occur before the development of DR. 3,[6][7][8][9] Retinal nerve fiber layer defects, first described by Hoyt et al 10 50 years ago, is one of the pathognomic findings in glaucomatous optic neuropathy. The RNFL defect may precede detectable changes on the optic disc and visual field (VF), 11 and RNFL-based assessments have been reported to be superior to optic disc-based assessments for the diagnosis of glaucoma.…”

Localized Retinal Nerve Fiber Layer Defects and Stroke

“…15,16 Because of unreliable RNFL measurements with respect to the detection of localized RNFLDs, 154 subjects were excluded, and data on previous stroke were not available for 150 additional subjects. Because glaucoma can lead to localized RNFLDs, we excluded all subjects (n=174) with glaucomatous optic neuropathy so that the study population provided by the Beijing Eye Study eventually included 2890 subjects (Table).…”

“…The Beijing Eye Study 2011 was a population-based cross-sectional study in Northern China and was described in detail previously. 15,16 Of an eligible population of 4403 individuals fulfilling the inclusion criterion of an age of 50+ years, 3468 (78.8%) individuals participated in the survey. The study design included an interview, a detailed ophthalmic examination, collecting of fasting blood samples, measurement of blood pressure, body height and weight, and spectral-domain OCT of the RNFL.…”