Association of Optical Coherence Tomography and Optical Coherence Tomography Angiography Retinal Features With Visual Function in Older Adults

Importance

Although there is abundant evidence relating neuronal and vascular optical coherence tomography (OCT) and OCT angiography (OCTA) measures to retinal disease, data on the normative distribution of retinal features and their associations with visual function in a healthy, older, community-based population are sparse.

Objectives

To characterize the normative OCT and OCTA measures in older adults and describe their associations with visual function.

Design, Setting, and Participants

This was a cross-sectional, observational study conducted from May 17, 2017, to May 31, 2019. The study included a community-based sample. Participants in the Atherosclerosis Risk in Communities study from Jackson, Mississippi (all self-reported Black participants), and Washington County, Maryland (all self-reported White participants), were recruited in the Eye Determinants of Cognition study (EyeDOC). Data analyses were conducted from June 14, 2020, to May 31, 2021.

Main Outcomes and Measures

Retinal measurements, including retinal nerve fiber layer (RNFL) thickness, macular ganglion cell complex (GCC) thickness, macular vessel density (VD) in the superficial capillary plexus (SCP) and deep capillary plexus (DCP), and foveal avascular zone (FAZ) area, were captured with spectral-domain OCT and OCTA. Visual function, including presenting distance vision, corrected distance vision, near visual acuity (VA), and contrast sensitivity (CS), was assessed.

Results

A total of 759 participants (mean [SD] age, 80 [4.2] years; 480 female participants [63%]; 352 Black participants [46%]) were included in the study. Mean (SD) GCC thickness (89.2 [9.3] μm vs 92.3 [8.5] μm) and mean (SD) FAZ (0.36 [0.16] mm²vs 0.26 [0.12] mm²) differed between Jackson and Washington County participants, respectively. Mean (SD) RNFL thickness and mean (SD) VD in SCP and DCP were greater for participants 80 years or younger than for participants older than 80 years (RNFL: ≤80 years, 93.2 [10.5] μm; >80 years, 91.1 [11.6] μm; VD SCP, ≤80 years, 44.3% [3.5%]; >80 years, 43.5% [3.8%]; VD DCP, ≤80 years, 44.7% [4.9%]; >80 years, 43.7% [4.8%]). Linear regression showed each 10-μm increment in RNFL thickness and GCC thickness was positively associated with 0.016 higher logCS among all participants (RNFL: 95% CI, 0.005-0.027;P = .004; GCC: 95% CI, 0.003-0.029;P = .02), with stronger associations among Jackson participants. The associations of VA and structural measures were found only in Jackson participants, with coefficients per 10-μm increment of 0.012 logMAR VA (RNFL: 95% CI, 0.000-0.023;P = .049) and 0.020 logMAR VA (GCC: 95% CI, 0.004-0.034;P = .04).

Conclusions and Relevance

In this cross-sectional study, better CS was associated with greater RNFL thickness and GCC thickness, but no visual measures were associated with angiographic features overall. These findings suggest that clinical application of normative references for OCT- and OCTA-based measures should consider demographic and community features.