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Normative profiles of neuroretinal rim area in a multiethnic Asian population: the Singapore Epidemiology of Eye Diseases study
  1. Zhi Wei Lim1,2,
  2. Miao-Li Chee1,
  3. Sing Hui Lim1,
  4. Sahil Thakur1,
  5. Shivani Majithia1,
  6. Zhi Da Soh1,
  7. Zhen Ling Teo1,
  8. Tyler Hyungtaek Rim1,3,
  9. Charumathi Sabanayagam1,3,
  10. Yih-Chung Tham1,3,
  11. Ching-Yu Cheng1,3,4
  1. 1Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
  2. 2Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  3. 3Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
  4. 4Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  1. Correspondence to Dr Yih-Chung Tham, Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore; tham.yih.chung{at}seri.com.sg

Abstract

Aims To evaluate the normative profiles for neuroretinal rim area (RA) in a multiethnic Asian population.

Methods Subjects were recruited from the Singapore Epidemiology of Eye Diseases (2009–2015) study and underwent standardised examinations. RA measurements were performed using Cirrus high-definition optical coherence tomography (Carl Zeiss Meditec). Multivariable linear regression with generalised estimating equation model was used to evaluate the associations between demographic, systemic and ocular factors with RA.

Results A total of 9394 eyes from 5116 subjects (1724 Chinese, 1463 Malay, 1929 Indian) were included in the final analysis. The mean (±SD) of RA was 1.28 (±0.23) mm2 for Chinese, 1.33 (±0.26) mm2 for Malays, and 1.23 (±0.23) mm2 for Indians. The 5th percentile value for RA was 0.94 mm2 for Chinese, 0.96 mm2 for Malay, and 0.89 mm2 for Indian. In multivariable analysis, following adjustment for age, gender, body mass index, diabetes mellitus, hyperlipidaemia, history of cataract surgery, axial length, intraocular pressure (IOP) and disc area, Indian eyes have smaller RA when compared with Malays (β=−0.074; 95% CI −0.090 to −0.058; p<0.001) and Chinese (β=−0.035; 95% CI −0.051 to −0.019; p<0.001), respectively. Additionally, older age (per decade, β=−0.022), male gender (β=−0.031), longer axial length (per mm, β=−0.025), spherical equivalent (per negative dioptre, β=−0.005), higher IOP (per mm Hg, β=−0.009) were associated with smaller RA (all p≤0.004).

Conclusion In this multiethnic population-based study, we observed significantly smaller RA in Indian eyes, compared with Chinese and Malays. This indicates the need of a more refined ethnic-specific RA normative databases among Asians.

  • glaucoma
  • optic nerve
  • epidemiology
  • imaging

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Footnotes

  • Y-CT and C-YC contributed equally.

  • Contributors ZWL, MLC, SHL, CS, YCT and CYC conceived and designed the study. ST, SM, ZDS, and ZLT collected data. ZWL, MLC and YCT analysed and interpreted the data. ZWL, SHL and YCT wrote the manuscript. MLC, ST, SM, ZDS, ZLT, THR, CS and CYC reviewed the manuscript.

  • Funding YCT is supported by the National Medical Research Council, Singapore (NMRC/MOH-TA18nov-0002). C-YC is supported by the National Medical Research Council, Singapore (NMRC/CSA-SI/0012/2017).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All study procedures adhered to the principles of the Declaration of Helsinki. Ethics approval was obtained from the Singapore Eye Research Institute Institutional Review Board.

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

  • Data availability statement No data are available.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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