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Determinants of lamina cribrosa depth in healthy Asian eyes: the Singapore Epidemiology Eye Study
  1. Tin A Tun1,2,
  2. Xiaofei Wang2,3,
  3. Mani Baskaran1,
  4. Monisha Esther Nongpiur1,4,
  5. Yih Chung Tham5,
  6. Duc Quang Nguyen5,
  7. Nicholas G Strouthidis6,
  8. Tin Aung1,4,
  9. Ching-Yu Cheng4,5,
  10. Craig Boote7,
  11. Michael J A Girard2
  1. 1 Glaucoma, Singapore Eye Research Institute, Singapore
  2. 2 Department of Biomedical Engineering, National University of Singapore, Singapore
  3. 3 Biological Science and Medical Engineering, Beihang University, Beijing, China
  4. 4 Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  5. 5 Ocular Epidemiology Research Group and Data Science, Singapore Eye Research Institute, Singapore
  6. 6 NIHR Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, London, UK
  7. 7 Optometry and Vision Sciences, Cardiff University, Cardiff, UK
  1. Correspondence to Dr Michael J A Girard, Department of Biomedical Engineering, National University of Singapore, Singapore 117583, Singapore; mgirard{at}


Aim To investigate the determinants of lamina cribrosa depth (LCD) in healthy eyes of Chinese and Indian Singaporean adults.

Methods The optic nerve head (ONH) of the right eye of 1396 subjects (628 Chinese and 768 Indian subjects) was imaged with optical coherence tomography (OCT, Spectralis, Heidelberg, Germany). LCD was defined as the distance from the Bruch’s membrane opening (LCD-BMO) or the peripapillary sclera (LCD-PPS) reference plane to the laminar surface. A linear regression model was used to evaluate the relationship between the LCD and its determinants.

Results Both LCDs were significantly different between the two races (LCD-BMO: 421.95 (95% CI 365.32 to 491.79) µm in Chinese vs 430.39 (367.46–509.81) µm in Indians, p=0.021; and LCD-PPS: 353.34 (300.98–421.45) µm in Chinese vs 376.76 (313.39–459.78) µm in Indians, p<0.001). In the multivariable regression analysis, the LCD-PPS of the whole cohort was independently associated with females (β=−31.93, p<0.001), Indians subjects (β=21.39, p=0.004) (Chinese as the reference), axial length (Axl) (β=−6.68, p=0.032), retinal nerve fibre layer thickness (RNFL) (β=0.71, p=0.019), choroidal thickness (ChT) (β=0.41, p<0.001), vertical cup disc ratio (VCDR) (β=24.42, p<0.001) and disc size (β=−60.75, p=0.001). For every 1 year older in age, the LCD-PPS was deeper on average by 1.95 µm in Chinese subjects (p=0.01) but there was no association in Indians subjects (p=0.851).

Conclusions The LCD was influenced by age, gender, race, Axl, RNFL, ChT, VCDR and disc size. This normative LCD database may facilitate a more accurate assessment of ONH cupping using OCT in Asian populations.

  • imaging
  • optic nerve
  • glaucoma

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  • TAT and XW contributed equally.

  • Contributors Design of study (MB, TA, C-YC, CB, NGS and MJAG); Conduct of the study (TAT, YCT, MB and MEN); Collection and management of data (TAT, XW, DQN, YCT and C-YC); Analysis and Interpretation of data (TAT, XW, DQN and YCT); Preparation of manuscript (TAT, XW, DQN, CB, C-YC and MJAG); Review or approval of manuscript (YCT, MB, MEN, NGS, TA, C-YC, CB and MJAG).

  • Funding The study was supported by the Singapore Ministry of Education Academic Research Funds Tier 1 (R-397-000-294-114 [MG]) and Tier 2 (R-397-000-280-112 and R-397-000-308-114 [MG]), by Beijing Municipal Natural Science Foundation (7194288[XW]), by the National Medical Research Council (TA; NMRC/STAR/0023/2014), and by the National Institute for Health Research, Biomedical Research Centre, Moorfields Eye Hospital National Health Service, Foundation Trust and University College London, Institute of Ophthalmology (NGS).

  • Disclaimer The sponsor or funding organisation had no role in the design or conduct of this research. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the UK Department of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study had the approval of the SingHealth Centralised Institutional review board and adhered to the tenets of the Declaration of Helsinki.

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

  • Data availability statement Data are available on reasonable request. The deidentified participant data were generated at the Singapore Eye Research Institute, Singapore and derived data supporting the findings of this study are available from the corresponding author (MJAG) on request.

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