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Racial differences and determinants of macular thickness profiles in multiethnic Asian population: the Singapore Epidemiology of Eye Diseases Study
  1. Kah Hie Wong1,2,
  2. Yih-Chung Tham1,
  3. Duc Quang Nguyen1,
  4. Wei Dai1,
  5. Nicholas Y Q Tan1,
  6. Shivani Mathijia1,
  7. Kumari Neelam1,
  8. Carol Yim-lui Cheung1,3,
  9. Charumathi Sabanayagam1,4,
  10. Leopold Schmetterer1,5,6,7,
  11. Tien Yin Wong1,2,4,
  12. Ching-Yu Cheng1,2,4
  1. 1 Singapore National Eye Centre, Singapore Eye Research Institute, Singapore, Singapore
  2. 2 Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
  3. 3 Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
  4. 4 Duke-NUS Medical School, Singapore, Singapore
  5. 5 Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
  6. 6 Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
  7. 7 Center for Biomedical Engineering and Physics, Medical University of Vienna, Vienna, Austria
  1. Correspondence to Professor Ching-Yu Cheng, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore 168751, Singapore; chingyu.cheng{at}


Aim To evaluate racial differences, and ocular and systemic determinants of macular thickness (MT), measured by spectral-domain optical coherence tomography (SD-OCT) in a normal multiethnic Asian population.

Method MT was measured from a 6×6 mm2 central macular area using the Cirrus high-definition OCT (HD-OCT) (Carl Zeiss Meditec, Dublin, CA). The associations between ocular and systemic factors with MT were evaluated using linear regression analyses with generalised estimating equation models to account for intereye correlation.

Results 7447 healthy eyes (2577 Chinese, 2072 Malays and 2798 Indians) of 4510 subjects were included. Multivariable analysis showed that older age (per decade, β=−4.39), female gender (β=−5.74), diabetes (β=−1.10), chronic kidney disease (CKD) (β=−3.21), longer axial length (per mm, β=−2.34), flatter corneal curvature (per mm, β=−1.79) and presence of cataract (β=−0.94) were associated with thinner overall average MT (OMT) (all p≤0.026); higher total cholesterol (β=0.44; p=0.010) was associated with thicker OMT. All these factors were also associated with thinner central subfield MT (CSMT) (all p≤0.001), except for cataract, total cholesterol and CKD. Meanwhile, longer axial length (β=2.51; p<0.001) was associated with thicker CSMT. OMT (mean±SD) was thickest in Chinese (279.9±12.5 µm), followed by Malays (276.5±13.7 µm) and Indians (272.4±13.1 µm), with p≤0.003 for all interethnic comparisons. Similar trend was observed for CSMT.

Conclusion There are interethnic differences in MT profile among Asians, particularly between Chinese and Indians. Ocular and systemic factors affect MT measurements as well. This Asian-specific information may be incorporated into existing clinical interpretation of macular OCT scans to aid in improving the diagnostic and monitoring accuracy of macular diseases among Asians.

  • retina
  • macula
  • imaging

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  • KHW and Y-CT are joint first authors.

  • Contributors Conception and design: KHW, YCT, TYW, CYC. Data collection: KHW, YCT, WD, NYQT, SM, KN, CYLC, CS, CYC. Analysis and interpretation: KHW, YCT, DQN, CS, LS, TYW, CYC. Drafting of manuscript: KHW, YCT, CYC. Final revision of manuscript: KHW, YCT, DQN, WD, NYQT, SM, KN, CYLC, CS, LS, TYW, CYC.

  • Funding The study is funded by National Medical Research Council (grants 0796/2003, IRG07nov013, IRG09nov014, STaR/0003/2008; CG/SERI/2010) and Biomedical Research Council (grants 08/1/35/19/550, 09/1/35/19/616), Singapore. The sponsor or funding organization had no role in the design or conduct of this research. C-YC is supported by National Medical Research Council (NMRC/CSA/033/2012).

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval SingHealth Centralised Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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