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. 2018 Dec 31;13(12):e0209276.
doi: 10.1371/journal.pone.0209276. eCollection 2018.

Thickness of Retina and Choroid in the Elderly Population and Its Association With Complement Factor H Polymorphism: KLoSHA Eye Study

Free PMC article

Thickness of Retina and Choroid in the Elderly Population and Its Association With Complement Factor H Polymorphism: KLoSHA Eye Study

Na-Kyung Ryoo et al. PLoS One. .
Free PMC article


Purpose: To analyze the associations of retinal and choroidal thickness on enhanced-depth imaging optical coherence tomography (EDI-OCT) with clinical, ophthalmic and genetic factors in the normal elderly population (aged 65 years or older).

Methods: In this prospective, population-based cohort study, people aged 65 years or older were enrolled in the baseline study of the Korean Longitudinal Study on Health and Aging (KLoSHA) Eye Study. All participants underwent spectral domain-OCT scan using the EDI technique. A topographic map of the retina was obtained and subfoveal choroidal thickness (SFCT) was measured manually. Blood samples from all subjects were genotyped for major age-related macular degeneration (AMD)-associated single nucleotide polymorphisms (SNPs) the major AMD-associated SNPs; CFH Y402H rs1061170, CFH I62V rs800292, ARMS2 A69S rs10490924. A statistical analysis was conducted to compare the retinal thickness, choroidal thickness, and AMD risk genotypes.

Results: Among the three hundred eighty people enrolled, the mean age was 76.6 years (range 65-99 years). Factors that showed correlation with either tomographic retinal parameters, retinal nerve fiber layer, or SFCT, were age and gender. Significant age-related decrease in thickness was observed in the RNFL, mean central thickness (MCT) and SFCT. Gender differences existed in central foveolar thickness (CFT) and MCT, where it was thicker in men. While chorioretinal parameters were not related with other genotypes, CFH rs1061170 risk genotype was significantly associated with thin SFCT. The group containing the AMD- risk allele (CT) had a 14.7% reduction in the SFCT compared to the non-risk TT group.

Conclusions: In addition to the well-known association with AMD, CFH rs1061170 is a significant genetic risk factor associated with choroidal thinning in normal eyes of the elderly population. Such findings may provide further insight into the pathogenesis of age-related macular degeneration as well as normal aging. In addition, our study provides the first normative data on retinal and choroidal thickness in population-based aged groups with a mean age over seventy-five.

Conflict of interest statement

The authors have declared that no competing interests exist.


Fig 1
Fig 1. Flow diagram of the subject selection process.
KLoSHA = Korean Longitudinal Study on Health and Aging; AMD = age-related macular degeneration, BRVO = branch retinal vein occlusion; VMTS = vitreomacular traction syndrome; PDR = Proliferative Diabetic Retinopathy; OCT = Optical Coherence Tomography.
Fig 2
Fig 2. Diagram of the retinal and choroidal thickness measurement areas obtained with SD-OCT (EDI) System.
A, Diagram of the macular areas on the SD-OCT scan. The 9 standard ETDRS regions are converted into areas of interest, i.e. MMFT, CFT, MCT, MPT, MTT. Each ring, centered on the fovea, has a diameter of 6, 3, 1 millimeters, respectively. MMFT = mean minimal foveolar thickness = F0; CFT = central foveolar thickness = F1, MCT = mean central thickness = (S1+N1+I1+T1) / 4; MPT = mean peripheral thickness = (S2+N2+I2+T2) / 4; MTT = mean total region thickness = (F1+ S1~T1 + S2~T2) / 9; S = superior; I = inferior; N = nasal; T = temporal; ETDRS = Early Treatment Diabetic Retinopathy Study. B. Representative EDI image used in measuring SFCT. SFCT = subfoveal choroidal thickness.
Fig 3
Fig 3. Scatter plot and the regression line of RNFL, MCT, SFCT against age.
RNFL = retinal nerve fiber layer; MCT = mean central thickness; SFCT = subfoveal choroidal thickness.
Fig 4
Fig 4. Retinal and choroidal thickness measurements by gender.
Error bars represent standard error of the mean. MMFT = mean minimal foveolar thickness; CFT = central foveolar thickness; MCT = mean central thickness; MPT = mean peripheral thickness; MTT = mean total region thickness; RNFL = retinal nerve fiber layer; SFCT = subfoveal choroidal thickness;
Fig 5
Fig 5. Subfoveal choroidal thickness and its genetic distribution according to polymorphism of complement factor H gene (rs1061170 and rs800292) and age-related maculopathy susceptibility 2 gene (rs10490924).
Error bars represent standard error of the mean. *ANOVA analysis; ANCOVA analysis. P-values after adjustment of age, gender and axial length.
Fig 6
Fig 6. Representative images of subfoveal choroidal thickness measured on SD-OCT (EDI technique) between patients with CT and TT genotypes of CFH gene polymorphism (rs1061170).
SD-OCT = spectral-domain optical coherence tomography; EDI = enhanced-depth imaging.

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This study was supported by Seoul National University Bundang Hospital Research Funds (grant nos. 11-2008-002, 03-2009-008, 11-2009-037, 11-2010-037, 18-2018-024 [PMC]), a National Research Foundation of Korea (NRF) grant funded by the Ministry of Education, Science, and Technology (2009-0072603), NRF grant 2016R1D1A1B03934724 and the NRF Bio & Medical Technology Development Program (grant no. 2018M3A9B5021319) funded by the Korean government (MSIP and MSIT), and grants from the Korea Health Technology R&D Project, Ministry of Health & Welfare, Republic of Korea (grant nos. HI09C1379 [A092077] and A111161). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.