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Retinal Nerve Fiber Layer Thickness in Healthy Eyes of Black, Chinese, and Latino Americans

A Population-Based Multiethnic Study
  • Darryl Nousome
    Affiliations
    Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
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  • Roberta Mckean-Cowdin
    Affiliations
    Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
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  • Grace M. Richter
    Affiliations
    USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California
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  • Bruce Burkemper
    Affiliations
    Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California
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  • Mina Torres
    Affiliations
    Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California
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  • Author Footnotes
    ∗ Both Dr Varma and Dr Jiang contributed equally as senior authors.
    Rohit Varma
    Correspondence
    Rohit Varma, MD, MPH, Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, 1300 North Vermont Avenue, Los Angeles, CA 90027.
    Footnotes
    ∗ Both Dr Varma and Dr Jiang contributed equally as senior authors.
    Affiliations
    Southern California Eye Institute, CHA Hollywood Presbyterian Medical Center, Los Angeles, California
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  • Author Footnotes
    ∗ Both Dr Varma and Dr Jiang contributed equally as senior authors.
    Xuejuan Jiang
    Correspondence
    Correspondence: Xuejuan Jiang, PhD, USC Roski Eye Institute, 1450 San Pablo Street, Room 3701, Los Angeles, CA 90033.
    Footnotes
    ∗ Both Dr Varma and Dr Jiang contributed equally as senior authors.
    Affiliations
    Department of Preventive Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, California

    USC Roski Eye Institute, Department of Ophthalmology, Keck School of Medicine of the University of Southern California, Los Angeles, California
    Search for articles by this author
  • Author Footnotes
    ∗ Both Dr Varma and Dr Jiang contributed equally as senior authors.
Published:November 17, 2020DOI:https://doi.org/10.1016/j.ophtha.2020.11.015

      Purpose

      To compare peripapillary retinal nerve fiber layer (RNFL) thickness among healthy adults by race and ethnicity and to identify determinants of RNFL thickness.

      Design

      Population-based cross-sectional study.

      Participants

      Data from 6133 individuals (11 585 eyes) from 3 population-based studies in Los Angeles County, California, 50 years of age or older and of self-described African, Chinese, or Latin American ancestry.

      Methods

      We measured RNFL thickness and optic nerve head parameters using the Cirrus HD-OCT 4000. Multivariate linear mixed regression was used to evaluate factors associated with RNFL thickness among participants without ocular diseases.

      Main Outcome Measures

      Determinants and modifiers of RNFL thickness.

      Results

      The mean age of the participants was 60.1 years (standard deviation, 7.4 years). Black Americans showed the lowest RNFL thickness and smallest cup-to-disc ratio (CDR), and Chinese Americans showed the largest CDR and disc area after adjusting for age and gender (all P < 0.05). Per each 10-year older age group, the average RNFL thickness was 2.5 μm (95% confidence interval [CI], 1.8–3.1 μm), 2.8 μm (95% CI, 2.3–3.3 μm), and 3.5 μm (95% CI, 2.9–4.1 μm) thinner for Black, Chinese, and Latino Americans, respectively (age trend P < 0.05 and interaction P = 0.041). Black Americans compared with Chinese Americans, older age, male gender, hypertension, diabetes, greater axial length (AL), bigger disc area, and lower scan signal strength were associated with thinner average RNFL. Race, age, AL, disc area, and scan signal strength consistently were associated with RNFL thickness in all quadrants, whereas gender, hypertension, and diabetes were associated with RNFL thickness in select quadrants. Age and race explained the greatest proportion of variance of RNFL thickness.

      Conclusions

      Clinically important differences in RNFL thickness are present in healthy adults 50 years of age or older from different racial and ethnic groups of the same age, with the thinnest measures observed in Black Americans. This difference remains after accounting for disc size and AL. Furthermore, age-related RNFL thinning differs by race and ethnicity. Longitudinal studies are needed to verify our findings and to assess the influence of race and ethnicity in the clinical application of RNFL thickness.

      Keywords

      Abbreviations and Acronyms:

      ADAGES (African Descent and Glaucoma Evaluation Study), AFEDS (African American Eye Disease Study), AIGS (Advanced Imaging for Glaucoma Study), AL (axial length), CDR (cup-to-disc ratio), CHES (Chinese American Eye Study), LALES (Los Angeles Latino Eye Study), ONH (optic nerve head), RNFL (retinal nerve fiber layer), VCDR (vertical cup-to-disc ratio)
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