Aging plays role in retinal layer thinning in cognitively healthy older adults
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Key takeaways:
- Over 55.9 months, all locations of the ganglion cell-inner plexiform layer and outer nuclear layer were reduced.
- There was no association between baseline demographic factors and change in retinal thickness.
Retinal layer thickness gradually decreased over time in cognitively healthy older adults, but was not associated with baseline demographic factors such as age, sex, IOP or cognitive scores, according to a study published in Retina.
“Few published studies have conducted a longitudinal analysis of changes in the retinal layer especially in elderly individuals with normal cognitive function,” Hyeong Min Kim, MD, MSc, from Seoul National University College of Medicine, and colleagues wrote. “In this study, a post hoc longitudinal analysis was conducted on a community-based population cohort consisting of elderly individuals who underwent both baseline and final OCT and exhibited normal cognitive function at baseline.”
Kim and colleagues assessed 57 participants (mean age, 75.1 years; 49.1% women) from two Korean population-based longitudinal cohort studies to investigate changes in retinal layer thickness over 5 years. None of the participants had a genetic risk for APOEe4 or cognitive impairment at baseline.
During a mean follow-up of 55.9 months, the researchers reported that all locations in the ganglion cell-inner plexiform layer (GCIPL) and the outer nuclear layer (ONL) were significantly reduced.
At 1 mm from the center fovea, the GCIPL thickness went from an average of 85.31 m at baseline to 79.65 m (P < .001), with measurements of 73.69 m to 67.49 m at 2 mm (P < .001) and 51.33 m to 46.35 m at 3 mm (P < .001).
The outer nuclear layer thickness at 1 mm from the center fovea went from 70.68 m to 67.7 m, at 2 mm went from 55.89 m to 53.71 m and at 3 mm went from 45.48 m to 43.63 m.
No significant associations were reported between demographic characteristics at baseline, including age, sex, medical history, education, axial length, IOP and cognitive scores, and longitudinal changes in retinal thickness.
“The thickness of both the GCIPL and ONL gradually decreased in cognitively healthy elderly individuals over time,” Kim and colleagues wrote. “Therefore, researchers should consider the influence of aging when exploring the relationship between cognitive disorders and retinal layer thickness changes.”
Perspective
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As we age, our body tissues change, including the inner layers of the retina. Earlier studies have confirmed that truth and investigated its relationship to “neuropsychiatric diseases.”
This study looked at “normal cognitive” functioning adults and how their RNFL changes with age, compared with that of individuals with Parkinson’s disease, dementia and Alzheimer’s disease. The study was limited to individuals of Korean nationality with a mean age of 75 years, so results may not align perfectly with the patient populations typical to American optometric practices.
As eye care providers evaluating retinal health and often measuring RNFL thickness through OCT scans, we should be aware of normal thinning expectations in these tissues and be cautious about ascribing any RNFL thinning to neurological conditions or diseases. In the absence of a clinical diagnosis of neuropsychiatric disease, eye care providers should assume that mild thinning of nerve fiber layers of the retina is a normal part of the aging process. However, an astute provider will consider the systemic health and entire well-being of the patient at each visit to piece together any abnormal retinal thinning with suspected developing cognitive or other neurological conditions.
Coordination with primary care providers, neurologists and family members can best help these patients with their ocular health and cognitive function.
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