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Central Macular Thickness in Diabetic Patients

A Sex-based Analysis

Arthur, Edmund, OD, PhD1; Young, Stuart B., OD2; Elsner, Ann E., PhD, FAAO1*; Baskaran, Karthikeyan, PhD, FAAO3; Papay, Joel A., BA1; Muller, Matthew S., MS, MBA4; Gast, Thomas J., MD, PhD1,4; Haggerty, Bryan P., AA1; Clark, Christopher A., OD, PhD1; Malinovsky, Victor E., OD, FAAO1; Brahm, Shane G., OD5; Litvin, Taras V., OD, PhD, FAAO6; Ozawa, Glen Y., OD7; Cuadros, Jorge A., OD, PhD, FAAO7

doi: 10.1097/OPX.0000000000001363
ORIGINAL INVESTIGATIONS
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SIGNIFICANCE The pathological changes in clinically significant diabetic macular edema lead to greater retinal thickening in men than in women. Therefore, male sex should be considered a potential risk factor for identifying individuals with the most severe pathological changes. Understanding this excessive retinal thickening in men may help preserve vision.

PURPOSE The purpose of this study was to investigate the sex differences in retinal thickness in diabetic patients. We tested whether men with clinically significant macular edema had even greater central macular thickness than expected from sex differences without significant pathological changes. This study also aimed to determine which retinal layers contribute to abnormal retinal thickness.

METHODS From 2047 underserved adult diabetic patients from Alameda County, CA, 142 patients with clinically significant macular edema were identified by EyePACS-certified graders using color fundus images (Canon CR6-45NM). First, central macular thickness from spectral domain optical coherence tomography (iVue; Optovue Inc.) was compared in 21 men versus 21 women without clinically significant macular edema. Then, a planned comparison contrasted the greater values of central macular thickness in men versus women with clinically significant macular edema as compared with those without. Mean retinal thickness and variability of central macular layers were compared in men versus women.

RESULTS Men without clinically significant macular edema had a 12-μm greater central macular thickness than did women (245 ± 21.3 and 233 ± 13.4 μm, respectively; t 40 = −2.18, P = .04). Men with clinically significant macular edema had a 67-μm greater central macular thickness than did women (383 ± 48.7 and 316 ± 60.4 μm, P < .001); that is, men had 55 μm or more than five times more (t 20 = 2.35, P = .02). In men, the outer-nuclear-layer thickness was more variable, F 10,10 = 9.34.

CONCLUSIONS Underserved diabetic men had thicker retinas than did women, exacerbated by clinically significant macular edema.

1School of Optometry, Indiana University, Bloomington, Indiana

2Bowersox Vision Center, Shelbyville, Kentucky

3Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden

4Aeon Imaging, LLC, Bloomington, Indiana

5Peter Christensen Health Center, Lac Du Flambeau, Wisconsin

6Department of Ophthalmology, University of California, San Francisco, San Francisco, California

7School of Optometry, University of California Berkeley, Berkeley, California

* aeelsner@indiana.edu

Submitted: July 24, 2018

Accepted: December 26, 2018

Funding/Support: National Eye Institute (EY020017; to MSM) and the National Institutes of Health (EY020017; to AEE).

Conflict of Interest Disclosure: This study was sponsored by the National Eye Institute (grant EY020017) to Aeon Imaging, LLC, with subcontracts to Indiana University and the University of California Berkeley. Several of the authors have financial conflicts of interest; that is, they receive financial support from, have been employed by, are an officer of, or have used materials supplied by either Aeon Imaging, LLC (AEE, MSM, TJG, JAP), or EyePACS (JAC, SBY, GYO, and TVL), but these are not related to whether men have thicker retinas than do women. The authors' methods used a device that, to the best of their knowledge, none of them developed or sells, that is, iVue, made by Optovue, an optical coherence tomography device. For those authors who may have received funding for normative data from Optovue, this article does not have normal control data as part of the study; that is, this study was not supported by Optovue. All authors had full access to study data.

Author Contributions and Acknowledgments: Conceptualization: AEE, KB, JAC; Data Curation: EA, SBY, AEE, KB, JAP, MSM, BPH, SGB; Formal Analysis: EA, SBY, AEE, KB, JAP, TJG, BPH, CAC, VEM, SGB, GYO; Funding Acquisition: AEE, MSM, JAC; Investigation: SBY, AEE, KB, MSM, TJG, CAC, VEM, TVL, GYO; Methodology: AEE, JAP, MSM, BPH, CAC, VEM, SGB, TVL, GYO; Project Administration: AEE, MSM, TVL, JAC; Resources: AEE, MSM, JAC; Software: JAP, MSM, BPH, SGB; Supervision: AEE, KB, MSM, TJG, VEM, TVL, GYO, JAC; Validation: EA, AEE, BPH, CAC, SGB; Visualization: AEE; Writing – Original Draft: EA, AEE; Writing – Review & Editing: EA, SBY, AEE, KB, JAP, MSM, TJG, BPH, CAC, VEM, SGB, TVL, GYO, JAC.

This study was presented in the form of a scientific paper (160012) at the annual meeting of the American Academy of Optometry in Anaheim, CA; November 9, 2016.

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