Normative reference ranges for the retinal nerve fiber layer, macula, and retinal layer thicknesses in children

Am J Ophthalmol. 2013 Feb;155(2):354-360.e1. doi: 10.1016/j.ajo.2012.08.010. Epub 2012 Nov 3.


Purpose: To establish a normative database of peripapillary retinal nerve fiber layer (RNFL) thickness, macular thickness, and retinal layer thickness in healthy North American children, using spectral-domain optical coherence tomography (SD OCT).

Design: Prospective cross-sectional study.

Methods: This institutional study enrolled 83 healthy children (aged 5-15 years) as volunteer research subjects at the Retina Foundation of the Southwest (Dallas, Texas); all had normal visual acuity. Imaging was accomplished with the Spectralis SD OCT. Peripapillary RNFL thickness and macular thickness were assessed for 1 eye of each child using the Heidelberg Spectralis SD OCT software. Thicknesses of individual retinal layers and layer combinations were assessed using custom software to segment the line scans obtained with the Spectralis SD OCT.

Results: Average global peripapillary RNFL thickness was 107.6 ± 1.2 μm and average central subfield macular thickness was 271.2 ± 2.0 μm. Peripapillary RNFL thickness was thicker than has been reported in adults, particularly the superior and inferior sectors, and central subfield macular thickness was significantly correlated with age. While the thickness of most retinal layers was comparable with those of adults, the outer segment layer was 36% thinner in children than in adults.

Conclusions: SD OCT can be used to assess peripapillary RNFL thickness, macular thickness, and retinal layer thickness in children as young as 5 years. Pediatric means and normative reference ranges are provided for each measurement. The values presented herein can be used as a standard with which to compare those of children suspected of having retinal or optic nerve abnormalities.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Humans
  • Male
  • Nerve Fibers*
  • Optic Disk / anatomy & histology*
  • Prospective Studies
  • Reference Values
  • Retina / anatomy & histology*
  • Retinal Ganglion Cells / cytology*
  • Tomography, Optical Coherence
  • Visual Acuity / physiology