Comparison of Associations with Different Macular Inner Retinal Thickness Parameters in a Large Cohort

Abstract

Purpose: To describe and compare associations with macular retinal nerve fiber layer (mRNFL), ganglion cell complex (GCC), and ganglion celleinner plexiform layer (GCIPL) thicknesses in a large cohort.Design: Cross-sectional study.Participants: We included 42 044 participants in the UK Biobank. The mean age was 56 years. Methods: Spectral-domain OCT macular images were segmented and analyzed. Corneal-compensated intraocular pressure (IOPcc) was measured with the Ocular Response Analyzer (Reichert, Corp., Buffalo, NY). Multivariable linear regression was used to examine associations with mean mRNFL, GCC, and GCIPL thicknesses. Factors examined were age, sex, ethnicity, height, body mass index (BMI), smoking status, alcohol intake, Townsend deprivation index, education level, diabetes status, spherical equivalent, and IOPcc.Main Outcome Measures: Thicknesses of mRNFL, GCC, and GCIPL.Results: We identified several novel independent associations with thinner inner retinal thickness. Thinner inner retina was associated with alcohol intake (most significant for GCIPL: e0.46 mm for daily or almost daily intake compared with special occasion only or never [95% confidence interval (CI), 0.61e0.30]; P ¼ 1.1Â10 e8 ), greater social deprivation (most significant for GCIPL: e0.28 mm for most deprived quartile compared with least deprived quartile [95% CI, e0.42 to e0.14]; P ¼ 6.6Â10 e5 ), lower educational attainment (most significant for mRNFL: e0.36 mm for less than O level compared with degree level [95% CI, e0.45 to 0.26]; P ¼ 2.3Â10 e14 ), and nonwhite ethnicity (most significant for mRNFL comparing blacks with whites: e1.65 mm [95% CI, e1.86 to e1.43]; P ¼ 2.4Â10 e50 ). Corneal-compensated intraocular pressure was associated most significantly with GCIPL (e0.04 mm/mmHg [95% CI, e0.05 to e0.03]; P ¼ 4.0Â10 e10 ) and was not associated significantly with mRNFL (0.00 mm/mmHg [95% CI, e0.01 to 0.01]; P ¼ 0.77). The variables examined explained a greater proportion of the variance of GCIPL (11%) than GCC (6%) or mRNFL (7%). Conclusions:The novel associations we identified may be important to consider when using inner retinal parameters as a diagnostic tool. Associations generally were strongest with GCIPL, particularly for IOP. This suggests that GCIPL may be the superior inner retinal biomarker for macular pathophysiologic processes and especially for glaucoma.

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“…The present study found that greater alcohol consumption was significantly associated with thinner macular GCIPL thickness after compensation for several confounding factors including baseline IOP, AXL, and optic nerve head parameters. This is consistent with a recent large UK cohort study reporting that frequent alcohol consumption is associated with thinner macular RNFL, GCC and GCIPL 16 . Speculative explanations for the present finding are as follows.…”

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“…24 These included poor SD OCT signal strength, 24 image quality score < 45, poor centration certainty, or poor segmentation certainty, when examining the association of ambient air pollution on GCIPL. 25…”

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“…8 Inner retinal measures were also significantly lower in participants with greater alcohol intake, more social deprivation and lower educational attainment. 8 The strongest association observed was between mGCIPL thinning and IOP elevation, highlighting the relevance of excluding glaucoma. With reference to the study by Filippatou et al, 3 it should be noted that ocular hypertension and primary open angle glaucoma are conditions five times more likely to affect African Americans than Caucasians, 9 which may have impacted their results since African Americans made up a third of their obese cohort.…”

“…Other factors related to lower mRNFL, mGCC and mGCIPL measures were age, male gender and non-Caucasian Editorial ethnicity. 8 The thinner mGCC thickness seen in Blacks compared with Whites in the UK Biobank study had a magnitude of 26% of the standard deviation of this measure, equivalent to being 10 years older. 8 Inner retinal measures were also significantly lower in participants with greater alcohol intake, more social deprivation and lower educational attainment.…”

“…8 The thinner mGCC thickness seen in Blacks compared with Whites in the UK Biobank study had a magnitude of 26% of the standard deviation of this measure, equivalent to being 10 years older. 8 Inner retinal measures were also significantly lower in participants with greater alcohol intake, more social deprivation and lower educational attainment. 8 The strongest association observed was between mGCIPL thinning and IOP elevation, highlighting the relevance of excluding glaucoma.…”