Normative optical coherence tomography reference ranges of the optic nerve head, nerve fiber layer, and macula in healthy Saudi children

Lina Raffa; Salma Sadek AlSwealh

doi:10.15537/smj.2023.44.12.20230517

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Figure 1
- Flow chart depicting the data review process. HD-OCT: high definition optic coherence tomography
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Figure 2
- The mean macular thickness values in the 9 ETDRS for the left and right eyes. I: inferior, S: superior, N: nasal, T: temporal

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Table 1

- Percentile of the macular values.

Macular parameter	Mean (SD)	Median (min.–max.)	Percentile			95% confidence interval of the difference
Macular parameter	Mean (SD)	Median (min.–max.)	25	50	75	Lower	Upper
Cube volume, mm³	9.9 (0.6)	9.9 (7.4–11.2)	9.5	9.9	10.3	9.8	10
Central subfield thickness, μm	240.6 (28.2)	243 (162.5–304)	221.1	243	258.1	235.2	245.9
Central macular thickness, μm	240 (29)	243 (152.5–304)	221.5	243	259	234.6	245.5
Mean macular thickness, μm	275.9 (17.7)	276 (204–309.5)	264.8	276	287.8	272.6	279.2
Outer circle, μm
Inferior	269.7 (19.4)	268.50 (190.5–347.5)	259.4	268.5	280.3	266	273.5
Nasal	295.6 (18.9)	296.3 (207.5–335)	286.4	296.3	305.5	292.1	299.2
Superior	279.3 (19.8)	279.5 (190.5–331.5)	268.5	279.5	291.5	275.6	283.1
Temporal	261.57 (19.5)	262.00 (185.5–299.5)	252	262	275	257.6	265.6
Inner circle, μm
Inferior	312.9 (22.1)	312.5 (206–353)	300.5	312.5	328.5	308.7	317
Nasal	316.3 (20.7)	315.5 (245–357.5)	303	315.5	329	312.4	320.2
Superior	314.9 (22)	313.5 (232.5–357)	302.5	313.5	329.5	310.8	319
Temporal	303.4 (20.5)	302.5 (219.5–345.5)	290.5	302.5	319	299.5	307.2

SD: standard deviation, Min: minimum, Max: maximum

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Table 2

- Distribution of macular values by gender.

Macular measurement	Male Mean (SD) (range)	Female Mean (SD) (range)	P-value
Central macular thickness, μm	248 (27) (153–304)	230 (29) (163–287)	0.001^*
Central subfield thickness, μm	249 (26) (198–304)	230 (28) (163–287)	<0.001^*
Cube volume, mm³	10 (0.6) (7.4–11.2)	9.8 (0.6) (8.3–11.1)	0.122
Mean macular thickness, μm	278 (18) (204–310)	273 (17) (230–307)	0.144
Outer circle, μm
Inferior	270 (20) (191–331)	269 (19) (238–348)	0.851
Nasal	297 (20) (208–335)	294 (18) (246–330)	0.455
Superior	279 (21) (191–319)	280 (18) (225–332)	0.892
Temporal	263 (19) (186–297)	260 (20) (191–300)	0.560
Inner circle, μm
Inferior	316 (21) (251–353)	309 (24) (206–35)	0.118
Nasal	319 (20) (259–357)	312 (21) (245–358)	0.075
Superior	317 (23) (247–357)	312 (21) (233–357)	0.260
Temporal	306.3 (20) (245–346)	300 (21) (220–338)	0.090

SD: standard deviation

↵* Significant using independent t-test at <0.05 level.

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Table 3

- Retinal nerve fiber layer (RNFL) measurement percentiles.

RNFL parameter (μm)	Mean (SD)	Median (min.–max.)	Percentile			95% confidence interval of the difference
RNFL parameter (μm)	Mean (SD)	Median (min.–max.)	25	50	75	Lower	Upper
Mean RNFL thickness	93.88 (10.0)	94.50 (67.0–121.5)	88.6	94.5	100.4	92	95.7
RNFL-nasal	69.99 (10.9)	69.50 (46.0–100.0)	61.5	69.5	76.5	68	72
RNFL-temporal	67.07 (11.1)	67.00 (47.5–109.5)	59.5	67.0	72.5	65	69.1
RNFL-inferior	120.25 (16.9)	121.50 (76.0–160.0)	109.5	121.5	131.3	117	123.4
RNFL-superior	119.51 (14.5)	118.50 (90.0–167.5)	108.5	118.5	126.5	116.8	122.2

SD: standard deviation, min: minimum, max: maximum

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Table 4

- Distribution of optic nerve head (ONH) values according to age group.

ONH parameter	Mean (SD)	4–7 years					8–12 years				13–18 years
		Mean (SD)	Percentile			Mean (SD)	Percentile			Mean (SD)	Percentile			P-value
		Mean (SD)	25	50	75	Mean (SD)	25	50	75	Mean (SD)	25	50	75	P-value
Rim area, mm²	1.6 (0.3)	1.6 (0.3)^A	1.5	1.6	1.7	1.6 (0.3)^A	1.4	1.6	1.8	1.4 ± 0.2B	1.3	1.4	1.6	0.006^{^a,^b}
Disc area, mm²	2 (0.4)	2.1 (0.5)^A	1.8	2.0	2.2	2 (0.4)^AB	1.6	1.9	2.2	1.8 ± 0.3B	1.6	1.8	2.0	0.034^{^a,^b}
Cup volume, mm³	0.3 (1.1)	0.1 (0.2)	0.0	0.1	0.2	0.1 (0.1)	0.0	0.1	0.2	0.5 ± 1.9	0.1	0.1	0.3	0.309
Mean C/D ratio	0.4 (0.2)	0.4 (0.2)	0.3	0.4	0.5	0.4 (0.2)	0.2	0.4	0.5	0.4 ± 0.2	0.3	0.4	0.6	0.150
Vertical C/D ratio	0.4 (0.2)	0.4 (0.2)	0.3	0.4	0.5	0.3 (0.2)	0.2	0.3	0.5	0.4 ± 0.2	0.3	0.4	0.6	0.356

↵^a *Capital letters indicate post hoc multiple pairing summary indicator. The presence of the same letter indicates the same measure statistically. Significant using one-way ANOVA at <0.05 level.
↵^b Post hoc test: LSD.

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Table 5

- Mean macular thickness, macular volume and retinal nerve fiber layer thickness in the pediatric population in the literature compared to the results of the current study.

Source	OCT	Population	n	Age (years)	Mean macular thickness (μm) (SD)	Macular volume, mm³ (SD)	Mean RNFL thickness (μm) (SD)
Our study	Cirrus HD-OCT	Saudis	135	4-18	275.9 (17.7)	9.9 (0.6)	93.88 (10.0)
Al-Haddad et al ¹⁴	Cirrus HD-OCT	Lebanese	113	6-17	279.6 (12.5)	10.1 (0.5)	96 (8.7)
Barrio-Barrio et al ¹²	Cirrus HD-OCT	Spanish	283	4-17	283.6 (14.08)	10.2 (0.49)	97.4 (9.0)
Gürağaç et al ¹⁸	Cirrus HD-OCT	Turkish	318	3-17	279.27 (12.59)	9.97 (0.44)	96.49 (10)
QUEIRÓS et al ³	Cirrus HD-OCT	Caucasian	153	4-17	282.26 (11.59)	10.17 (0.41)	97.9 (9.32)
Ali et al ⁶	Topcon SD-OCT	Egyptian	50	6-17	276.4 (17.8)	7.84 (0.48)	111.26 (20.46)
Söhnel et al ⁵	Spectralis SD-OCT	German	695	4-<19	320.53 (12.29)	8.88 (0.35)	102.88 (8.79)
Krumova et al ¹⁹	SOCT Copernicus REVO SD-OCT	Caucasian	270	6-17	286.7 (9.82)	8.01 (0.28)	117.11 (9.51)