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1 대한안과학회지 2011 년제 52 권제 3 호 J Korean Ophthalmol Soc 2011;52(3): pissn: eissn: DOI : /jkos = 증례보고 = 정시안에서스펙트럼영역빛간섭단층촬영기를이용한연령과성별에따른황반두께의변화 김승훈 최경식 이성진 순천향대학교의과대학안과학교실 목적 : 스펙트럼영역빛간섭단층촬영기를사용하여정시안에서의연령과성별에따른황반두께를비교하였다. 대상과방법 : 전신적및안과적질환이없으며정시안을가진 90 명 162 안을대상으로연령에따라 1 군 (0-19 세 ), 2 군 (20-39 세 ), 3 군 (40-59 세 ), 4 군 (60-80 세 ) 으로나누어영역별황반두께를비교하였다. 결과 : 정시안에서중심와를포함한 1 mm 직경내중심원의평균두께는 ± μm 였으며연령증가에따른유의한차이는없었다 (p>0.05). 하지만 3 mm 직경내안쪽원과 6 mm 직경내바깥쪽원의평균두께는연령이증가함에따라감소하였다 (p<0.05). 남성에서중심원과안쪽원의황반두께가여성보다유의하게두꺼웠으나바깥쪽원은차이가없었다. 연령군에따른성별의차이를알아본결과 3 군과 4 군에서 1 mm 직경내중심원의두께는남성이여성보다매우두꺼웠으며, 안쪽원의황반두께는 3 군에서남성이여성보다유의하게두꺼웠다 (p<0.05). 결론 : 정시안에서측정된황반두께는연령과성별에따른차이가있으며이는황반부질환에서진단및치료경과의관찰에유용한지표가될수있을것이다. < 대한안과학회지 2011;52(3): > 빛간섭단층촬영기 (Optical Coherence Tomography; OCT) 는비침습적으로망막의구조를높은해상력으로보여줄수있으며정량적으로평가할수있는장점을가지고있다. 1,2 이러한 OCT는연령관련황반변성, 당뇨병성망막병증과같은황반및망막질환을진단하고치료의효과를판단하며추가적인치료계획을세우는데중요한역할을하고있다. 최근에는이전에널리쓰이던시간영역빛간섭단층촬영기 (Time-Domain OCT; TD OCT) 보다해상력이더높아망막의구조를훨씬정밀하게보여줄수있는스펙트럼영역빛간섭단층촬영기 (Spectrum-Domain OCT; SD OCT) 가개발되어널리사용되고있다. 3-5 OCT를임상에서효율적으로활용하기위해서는정상적인황반의특성을아는것이중요하다. 특히연령이증가함에따라변하는여러안수치들은황반부위또한노화의과정을피해갈수없다는것을예측하게해주며 6 이에 OCT에서연령에따른특성을이해하는것이필요하다. 연령이증가함에따라망막의광수용체층, 신경절세포층, 망막색소 접수일 : 2010년 5월 19일 게재허가일 : 2011년 1월 17일 심사통과일 : 2010 년 9 월 20 일 책임저자 : 이성진서울시용산구대사관길 22 순천향대학교서울병원안과 Tel: , Fax: wismile@unitel.co.kr 상피층의밀도가감소한다는사실은조직학적인실험을통해알려져있다 이러한결과들은연령의증가에따라망막의두께가점차감소할것이라는가정을가능케하며 OCT는생체조건내 (In vivo) 에서비침습적으로망막의두께를측정할수있게해주어연령에따른망막의두께, 특히황반부의두께를비교할수있게되었다. 11 하지만생체조건내에서연령에따른황반두께에관한견해는차이가있다. Gobel et al 12 과 Zou et al 13 은자신들의연구를통해연령과황반의두께는관련이없음을보고하고있으나몇몇의연구에서는연령과황반두께의상관관계를보고하고있다. Kanai et al 14 과 Alamouti and Funk 15 는연령이증가할수록황반의두께가감소한다고보고하였으며, 최근에는 Neuville et al 16 과 Erikson and Alm 11 는 TD OCT 인 Stratus OCT 를이용하여황반의두께와연령과의일부상관관계를보고한바있다. 성별에따른황반두께에관한연구에서는남성이여성보다황반두께가더두껍다는결과가대부분을차지한다. 17,18 하지만지정학적으로황반의어떤부분이성별에따른차이가있는지는연구마다다른결과를보이고있다. 위의연구들과더불어정상한국인을대상으로 TD OCT 를통해황반두께를연구하려는시도는여러번있었다. 하지만현재까지 SD OCT로정상한국인에서연령의증가에따른황반두께를연구한결과가많지않으며특히정시 299

2 - 대한안과학회지 2011 년제 52 권제 3 호 - 안을가진눈에서연령별로남성과여성의황반두께에대 한비교연구는되어있지않다. 이에본연구에서는 SD OCT를이용하여측정한정시안 SO 에서의황반의두께, 총황반부피가연령과어떤관련이있으며성별에따라어떤차이가존재하는지에대해알아 SI 보고자하였다. TO TI F NI NO 대상과방법 II 전신적및안과적질환이없고안과적수술의과거력이없으며동시에정시안을가진 90명 162안을대상으로하여전향적연구를시행하였다. 연령은 4세부터 80세사이였으며연령별로 4개의군으로나누었다. 대상은 20세간격으로 1군 (0-19 세 ), 2군 (20-39세), 3군 (40-59세), 4군 (60-80세) 의 4개의군으로분류하였다. 숙련된단일검사자가검사대상자모두에게 SD OCT를시행하였다. OCT 시행전모든검사자를대상으로시력검사, 자동굴절검사, 안압검사, 세극등검사및안저검사등의안과검사를시행하였다. 검사상나안시력 0.8 이하인경우와구면렌즈대응치 (Spherical equivalent) 가 -0.75D 이하인경우그리고 +1.25D 이상인경우는검사대상에서제외하여정시안을가진대상자만을연구에포함시켰다. 정시안의기준은 CLEERE (Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error Study) 기준을따랐다. 19 또한안압이 21 mmhg 이상이거나안저검사상특이소견이보이는경우도검사대상에서제외하였다. 본연구는본원의임상연구심사위원회 (Institutional Review Board) 의심의를거쳤으며헬싱키선언을준수하였다. OCT는 Cirrus HD OCT (Carl Zeiss Meditec, Inc., Dublin, CA) 를사용하였고 Macular cube scan을이용하였다. macular cube scan은황반부 6 6 mm에해당하는부위를 512 A-scan과 128 B-scan의점으로스캔하는방식으로라스터스캔 (raster scan) 방식이다. 결과분석은 Cirrus HD-OCT에서제공되는황반두께지도 (Macular thickness map) 를이용하였다. 이황반두께지도에서황반두께와황반부피는 Early Treatment of Diabetic Retinopathy Study (ETDRS) 지도로표현되는데중심와를중심으로직경 1 mm 이내의중심원 (central circle) 과 3 mm의안쪽원 (inner circle), 6 mm의바깥쪽원 (outer ring) 등 3개의동심원으로구성된다. ETDRS subfield는한개의중심원을비롯하여안쪽원과바깥쪽원은상측 (Superior), 비측 (Nasal), 하측 (Inferior), 이측 (Temporal) 의 4분역으로나누어모두 9개구역이된다 (Fovea=F; Superior inner=si; Nasal inner=ni; Inferior inner=ii; IO Central circle: F, Inner ring: SI + NI + II + TI, Outer ring: SO + NO + IO + TO Figure 1. ETDRS subfields within standard 1, 3, and 6 mm diameter concentric circles on the right used for reporting retinal thickness. ETDRS = Early Treatment of Diabetic Retinopathy Study (F = fovea; SI = superior inner; NI = nasal inner; II = inferior inner; TI = temporal inner; SO = superior outer; NO = nasal outer; IO = inferior outer; TO = temporal outer). Temporal inner=ti; Superior outer=so; Nasal outer=no; Inferior outer=io; Temporal outer=to) (Fig. 1). 각영역의황반두께, 전체평균황반두께 (Overall average macular thickness) 및총황반부피 (Total macular volume) 는 Cirrus HD-OCT 내의소프트웨어를통해서분석하였으며신호강도 (signal strength) 6 이상만을결과에포함시켰다. 통계적분석은 SPSS version (SPSS, Inc., Chicago, IL, USA) 을사용하였으며각군별의유의성을파악하기위해 ANOVA-test 를사용하였으며남성과여성의황반두께비교를위하여 T-test 를사용하였다. 또한연령과황반두께와의연관성을파악하기위해서선형회귀분석 (Linear regression analysis) 을이용하였다. 모든측정치는유의수준 p<0.05 일때유의하다고판단하였다. 결 검사대상자는 1군 (0-19 세 ) 39안, 2군 (20-39세) 46 안, 3군 (40-59세) 42안, 4군 (60-80세) 35안이었으며 4 세부터 80세까지의연령이포함되었다. 남자는 42명 78안, 여자는 48명 84안이었으며전체검사대상자의평균연령은 ± 21.41였다. 평균구면렌즈대응치는 ± 0.50D였으며각연령군간구면렌즈대응치는차이가없었다. 연령군의특성은 Table 1과같다. 중심와를중심으로직경 1 mm 이내의중심원에서황반 과 300

3 - 김승훈외 : 정시안에서의황반두께변화 - Table 1. Study population demographics No. of eyes Age (mean ± SD) Age (range) Spherical equivalent (D) All Male Male Male All All Female Female Female All Group 1 (0-19) ± ± ± ± Group 2 (20-39) ± ± ± ± Group 3 (40-59) ± ± ± ± Group 4 (60-80) ± ± ± ± Total ± ± ± ± p-value <0.001* <0.001* * * Analysis of variance. <0.001* Table 2. Macular thickness (μm) and volume (mm 3 ) measurements using spectral domain optical coherence tomography in emmetropic eyes by 4 age groups (mean ±SD) Central Average SI NI II TI SO NO IO TO Average Overall circle inner outer average TMV Group ± ± ± ± 12 ± ± ±0.38 Group ± ±0.48 Group ± ±0.45 Group ± ± ± ± ±0.55 Total 253 ± ± ±0.51 ANOVA 0.95 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 <0.01 SI = superior inner; NI = nasal inner; II = inferior inner; TI = temporal inner; SO = superior outer; NO = nasal outer; IO = inferior outer; TO = temporal outer; TMV = total macular volume. 의두께는 1군부터 4군까지각각 ± μm, ± μm, ± μm, ± μm로나타났으며네군간의유의한차이는보이지않았다 (p=0.95). 3 mm의안쪽원에서의평균황반두께 (Average inner macular thickness) 는 1군부터 4군까지각각 μm, μm, μm, μm의값을보였고 2군을최대로그이전과이후로는감소하는양상을보였으며, 군간의차이는통계학적으로유의하였다 (Table 2). 안쪽원을연령에따라네개의군으로분류하였을때는네군모두에서비측의황반두께가가장두꺼웠으며이후상측, 하측, 이측의순이었다. 6 mm의바깥쪽원에서의평균황반두께 (Average outer macular thickness) 는 1군부터네군간까지 ± 9.42 μm, μm, μm, μm로나타나점차적으로감소하는양상을보였으며 4군간유의한차이가있었다 (p<0.05) (Table 2). 바깥쪽원을상측, 하측, 비측, 이측의네개의영역으로분류하였을때도네군모두에서비측의황반두께가가장두꺼웠으며이후상측, 하측, 이측순이었다 (Table 2). 성별에따라황반의두께를분석해보았을때중심원의평균두께는남성의경우 ± μm였으며, 여성의경우 ± μm였다. 안쪽원의평균두께는남성 μm, 여성 μm로측정되었으며중심원과안쪽원에서황반의두께는성별에따른유의한차이를보여주었다 ( 각각 p<0.01, p=0.02). 반면바깥쪽원의평균두께는남성 μm, 여성 μm였으며전체평균황반두께는남, 여각각 μm, μm로측정되었다. 총황반부피는남성에서 ± 0.49 mm 3, 여성에서 9.96 ± 0.52 mm 3 였다. 바깥쪽원과전체평균황반두께그리고총황반부피는성별에따른유의한차이가없었다 (p=0.48, p=0.42, p=0.23) (Table 3)

4 - 대한안과학회지 2011 년제 52 권제 3 호 - Table 3. Macular thickness (μm) and volume (mm 3 ) measurements using spectral domain optical coherence tomography in emmetropic eyes by gender in each age group (mean ±SD) Central circle Male Group ± 22 Group ±20 Group Group ±22 Total 259 Female Group ±32 Group ±25 Group Group Total 249 ±25 SI NI II TI 321 ± ± ± Average inner SO NO IO TO Average outer ± ± ± ± ± ± ± ± Overall average ± ± ± TMV ± ± ± ± ± ± ± ± ± ±0.52 Male VS Female * <0.01 <0.01 <0.01 <0.01 <0.01 < (p-value) SI = superior inner; NI = nasal inner; II = inferior inner; TI = temporal inner; SO = superior outer; NO = nasal outer; IO = inferior outer; TO = temporal outer; TMV = total macular volume. * Paired t- test. 가장컸으며통계적으로유의하였다 (p=0.012) (Table 3, Fig. 2). 전연령비교시남성과여성과의유의한차이를찾 Figure 2. Bar graph showing the changes in macular thickness by age group and gender. In group 3, the average inner macular thickness in males was significantly larger than in females. M = male; F = female. * Statistically significant with paired t-test (p=0.05). 정시안을가진각연령군에서남성과여성의차이가있는지알아본결과중심원의두께는 3군 (40-59세) 과 4군 (60-80세) 에서남성과여성의차이가크게났으나 ( 각각 13, 16 μm) 통계적으로유의하진않았다 (p=0.057, 0.077). 안쪽원의평균황반두께는 3군에서남성과여성의차이가 을수없었던바깥쪽원의평균황반두께, 전체평균황반두께, 총황반부피는어떤군에서도남, 여간의유의한차이를볼수없었다 (Fig. 2). 연령이증가함에따라서황반두께및총황반부피가어떻게변화하는지알아보기위해서선형회귀분석을시행하였다. 이결과 ETDRS 9개영역중중심원부분을제외한 8개영역에서연령이증가함에따라황반두께는유의하게감소하였다 (Table 4, Fig. 3). 총황반부피도연령이증가함에따라유의하게감소하였다. 각각의결과에서회귀계수를구한결과황반의두께는중심원을제외한영역에서 μm/year씩감소하였으며총황반부피는세대 (decade) 당 0.09 mm 3 씩감소한다는것을알수있었다 (Table 4). 남성과여성을나누어선형회귀분석을시행한결과남성의경우중심원의황반두께는연령에따라증가하는양상을보였으나여성의경우는연령이증가함에따라감소하는양상을보여주었다. 하지만이두결과모두통계학적유의성은없었다 ( 남성 : r=0.06, p>0.05, 여성 : r=-0.24, 302

5 - 김승훈외 : 정시안에서의황반두께변화 - Table 4. Linear regression of macular thickness (μm) and volume (mm 3 ) with age in 162 eyes between 4 and 80 years of age Area Loss per year R 2 p-value Central circle μm SI μm NI μm II μm TI μm Average inner macula μm SO μm 0.17 <0.001 NO μm 0.08 <0.001 IO μm 0.18 <0.001 TO μm 0.12 <0.001 Average outer macula μm 0.17 <0.001 Overall average macula μm 0.15 <0.001 Total macular volume mm <0.001 SI = superior inner; NI = nasal inner; II = inferior inner; TI = temporal inner; SO = superior outer; NO = nasal outer; IO = inferior outer; TO = temporal outer. Figure 3. Scatter plots and regression line of the macular thickness (Central circle, Inner circle, Outer circle, Overall macula) and total macular volume against age. p=0.056) (Table 5). 중심원을제외한영역에서의황반두께및총황반부피는남성과여성모두에서연령의증가에따라유의하게감소하였으며이때남성보다는여성에서의 회귀계수가더커서연령증가에따른감소폭이더클것으로예상되었다 (Table 5). 구면렌즈대응치와황반두께는어떤영역에서도통계학적인연관성을찾을수없었다 (p>0.05).

6 - 대한안과학회지 2011 년제 52 권제 3 호 - Table 5. Linear regression of macular thickness (μm) and volume (mm 3 ) with age in male and female gender Area Loss per year R 2 p-value Male Female Male Female Male Female Central circle Average inner macula Average outer macula <0.001 <0.001 Overall average macula <0.001 <0.001 Total macular volume <0.001 고찰 OCT를이용해황반부의현상태를파악하고두께를측정하는것은연령관련황반변성, 당뇨병성망막병증, 망막혈관폐쇄질환등의황반질환에서이제필수적인검사가되었다. 특히황반두께는시력과직접적인상관관계를갖기에황반질환의경과를판단하고예측하는데중요한인자라고할수있다. 20 이에정시안을가진정상안에서연령과성별에따라객관적인기준을정립하는것은중요한일이라할수있다. 본연구에서연령과황반두께를비교한결과중심원을제외한모든영역에서연령이증가함에따라두께가유의하게감소함을볼수있었다. 이와더불어총황반부피또한연령이증가함에따라감소함을알수있었으며이또한통계적으로유의했다. 이는 Kanai et al 14 과 Neuville et al 16 이중심와를제외한주변부망막두께가연령이증가함에따라유의하게감소한다는연구결과와일치한다. 이와반대로 Gobel et al 12 및 Zou et al 13 은연령의증가와황반의두께와는변화가없음을발표하였으며, Eriksson and Alam 11 은중심와의가장얇은부위 (foveal minimum area) 를제외하고서중심와를포함한주변부망막두께모두연령의증가에따라감소한다는연구결과를발표한바있다. 하지만 Gobel et al 12 은 Humphrey 모델을이용했다는점과 Zou et al 13 는연령군의분포가 20대에서 50대로넓지않았다는점이한계로작용할수있겠다. Eriksson and Alam 11 의연구와비교해보면연령군이 12세에서 74세까지로넓었다는점이본연구와유사하나대상안이 67안으로많지않으며구면렌즈대응치의범위가 ±6디옵터로비교적넓어정시안이아닌검사대상자가포함되어있어황반두께의근시에따른영향을배제할수없다는문제가있다. 또한직경 1 mm 이내의중심원의평균두께와연령과의상관관계는 p=0.04 로통계적으로는유의하였으나다른황반부위보다상대적으로높은 p-value를보여주어표본선택에따라결과가변할수있다는것을추측해볼수있다. 한국인에서의연령에따른황반두께를비교한연구또한보고되어있는데 Kang et al 21 은 OCT III (OCT model 3000, Zeiss- Humphrey, Dublin, CA, USA) 를이용하여 112안의정상 한국인을분석한결과중심와와 1 mm 직경내지역을제외한영역에서연령이증가함에따라황반두께는감소한다는결과를발표하였다. 중심와와 1 mm 직경내지역은본연구에서의중심원에해당하는곳으로중심원을제외한나머지영역에서연령의증가에따른황반두께의감소를보여준저자들의결과와같았다. 또한본연구에서사용한 SD OCT와동일기종인 Cirrus HD-OCT를통하여한국인의황반두께와연령과의상관관계를살펴본연구에서중심원을제외한안쪽원의평균황반두께, 바깥쪽원의평균황반두께, 전체평균황반두께, 총황반부피가연령이증가할수록감소한다는결과를보여주어저자들의연구결과와동일하였다. 22 다른나라의연구결과와달리정상한국인에서의연령에따른황반두께연구결과는 TD OCT 나 SD OCT 모두동일한결과를보여주어종족특히민족간차이가있을수있음을예측할수있게해주어이에추가적인연구가필요하겠다. 중심원바깥쪽부위의두께가연령이증가함에따라감소하는것은노화에따른신경절세포의손상과망막신경섬유층의감소때문이라고가정할수있다. 23 반면중심와를포함한중심원부위가연령이증가함에따라감소하지않는이유는중심와부위가다른황반부위보다신장된모양의원뿔세포가많은조직학적인특징, 연령증가에따라감소하는망막신경섬유층이중심와부위에는영향을미치지않는점, 내경계막이연령의증가에따라두꺼워지면서신경절세포층, 광수용체층의손실로인한두께감소를상쇄시켜줄수있다는점등을들수있다. 또한가지가설은시력에중요한역할을담당하는중심와를보전하기위해서보상적으로주변황반부가얇아진다는것 (Centripetal force) 이다. 24 성별에따른차이를비교해보았을때남성의경우중심원, 안쪽원의 4개영역모두와평균황반두께는여성보다유의하게더두꺼웠다. 하지만바깥쪽원의 4개영역과평균황반두께, 전체평균황반두께, 총황반부피는성별에따른유의한차이가없었다. 이는 Stratus OCT (Carl Zeiss Meditec, Inc.) 이용하여남녀간의황반두께를비교한 Huynh et al 25 의결과와일치하나 SD OCT로황반부용적을비교한 Kang et al 26 의황반부용적이남성에서여성보 304

7 - 김승훈외 : 정시안에서의황반두께변화 - 다크다는연구결과와는상이한양상을보였는데이는본연구가 20세이하의검사대상자를포함하고있으며정시안으로한정지은것과연관이있을것이라추측된다. SD OCT로정시안을가진각연령군내에서성별에따른차이를살펴보면중심원평균두께의성별차이가가장큰군은 3군과 4군이었다. 즉 40대이상의고령에서남성의황반중심부두께가여성보다매우두껍다는것을의미한다. 실제로여성의경우중심원에서연령의증가에따른황반두께의회귀계수를구했을때통계학적으로유의성은없었지만 (p=0.06), 중심원의황반두께 (μm)=-0.24 나이 (age) 와같은공식이나와연령이증가할수록중심원의두께가감소하는것처럼보였다. 하지만남성의경우에는중심원황반두께 (μm)=0.06 나이 (age) (p>0.05) 라는양의회귀계수를갖는것으로나타나차이가있었다. 이와같은두성별에서나타나는점진적인차이는결과적으로 40대이상에서가장두드러지는데이는 40 대이상의여성에서여성호르몬인에스트로겐이감소하기때문이라고생각할수있다. 여성의경우노화과정은내분비계의변화와같이수반되며이중에스트로겐의감소가가장먼저관찰되는특징이다. 27 폐경후나타나는홍조나근력의감소와같은현상은바로이에스트로겐의감소때문이다. 28 망막에서에스트로겐수용체는망막색소상피층에서주로발견이되는데 29 에스트로겐은이에스트로겐수용체에결합한후, 연령이증가함에따라늘어나는 oxidative stress를줄여주어망막색소상피세포의세포자멸사 (apoptosis) 를막아준다. 30 하지만 40대이상의여성에서는폐경전에에스트로겐의감소가나타나며이는 oxidative stress에민감한황반의중심부분에영향을주어여기에위치한망막색소상피세포의세포자멸사를촉진시켜망막내층의손상을일으킬수있다. 이러한망막내미세구조의손상이 OCT 상의두께감소로나타나는것이라추측된다. 안쪽원의평균황반두께는 3군에서남성과여성의차이가가장컸으며통계적으로도유의하였는데이또한 40대이상의여성에서나타나는호르몬의감소때문이라고생각된다. 60대이후에서는성별에따른안쪽원의평균황반두께차이가다시줄어들고있는데이는 40대이후호르몬의부족으로인해생긴여성에서의중심황반두께감소를주변부에서보상하기시작했다는의미로파악된다. 이러한결과는병원을상대적으로많이찾는 40대이상의남성과여성에있어서두군간의황반두께, 특히 3 mm 직경이내의황반중심부는정상안이라도측정값이서로다를수있음을임상에서유념할필요가있음을말해주며조직학적연구등과같은포괄적인연구가필요한부분이라할수있다. 여러가지황반관련질환들은황반부종혹은위축등을일으켜시력저하를일으킨다. 31,32 이에황반의두께를측정하는연구들은끊임없이지속되어왔다. 특히최근발전을거듭하고있는 OCT를이용한황반두께연구가많이이루어져왔다. 본연구는다른연구와달리황반두께의영향을미칠수있는인자중하나인굴절이상, 특히근시에의한영향을최소화하기위해정시안을가진정상인을대상으로연구를시행하였다. 이는정상한국인의황반두께를객관적으로정량화하는데도움을줄수있을것이라생각하며황반부의이상이있는환자를평가하는데좋은참고자료가될수있을것이다. 하지만본연구는어떤한시점에서연령이다른여러사람들을나열하여분석하였기때문에연속적인결과라보기에는한계가있다. 이에연령에따른좀더객관적인분석을위해서는동일연령군을지속적으로추적연구하는것이필요할것이다. 또한다른기종의 SD OCT를이용한연구와조직학적연구가동시에시행된다면정상인에서의황반두께에대한표준치를마련하는것은더이상어려운일이아닐것이다. 참고문헌 1) Puliafito CA, Hee MR, Lin CP, et al. Imaging of macular diseases with optical coherence tomography. Ophthalmology 1995;102: ) Muscat S, Parks S, Kemp E, Keating D. Repeatability and reproducibility of macular thickness measurements with the Humphrey OCT system. Invest Ophthalmol Vis Sci 2002;43: ) Chen TC, Cense B, Pierce MC, et al. Spectral domain optical coherence tomography: ultra-high speed, ultra-high resolution ophthalmic imaging. Arch Ophthalmol 2005;123: ) Yi K, Chen TC, de Boer JF. Spectral domain optical coherence tomography. Tech Ophthalmol 2006;4: ) Ahlers C, Michels S, Beckendorf A, et al. Three-dimensional imaging of pigment epithelial detachment in age-related macular degeneration using optical coherence tomography, retinal thickness analysis and topographic angiography. Graefes Arch Clin Exp Ophthalmol 2006;244: ) Kim CS, Kim SY, Park YH, Lee YC. Change in ocular dimensions with age in patients with emmetropia. J Korean Ophthalmol Soc 2008;49: ) Panda-Jonas S, Jonas JB, Jakobczyk-Zmija M. Retinal photoreceptor density decreases with age. Ophthalmology 1995;102: ) Gao H, Hollyfield JG. Aging of the human retina. Differential loss of neurons and retinal pigment epithelial cells. Invest Ophthalmol Vis Sci 1992;33: ) Repka MX, Quigley HA. The effect of age on normal human optic nerve fiber number and diameter. Ophthalmology 1989;96: ) Balazsi AG, Rootman J, Drance SM, et al. The effect of age on the nerve fiber population of the human optic nerve. Am J Ophthalmol 1984;97:

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9 - 김승훈외 : 정시안에서의황반두께변화 - =ABSTRACT= Macular Thickness Changes with Age and Gender in Emmetropia Using Spectral Domain Optical Coherence Tomography Seung Hoon Kim, MD, Kyung Seek Choi, MD, PhD, Sung Jin Lee, MD, PhD Department of Ophthalmology, College of Medicine, Soonchunhyang University, Seoul, Korea Purpose: To evaluate the changes in macular thickness with regard to age and gender in normal subjects with emmetropia using spectral domain optical coherence tomography. Methods: The present study consisted of 90 healthy subjects (162 eyes) with no ophthalmic evidence of retinopathy and who had emmetropic eyes. The data from macular measurements using spectral domain optical coherence tomography was analyzed according to the groups divided by age (Group 1: 0 to 19 years of age, Group 2: 20 to 39 years of age, Group 3: 40 to 59 years of age, Group 4: 60 to 80 years of age) and gender. Results: Macular thickness of the central circle was ± μm in all subjects. There was no significant change with age (p > 0.05). However, the measurements at the inner (3 mm) and outer circle (6 mm) showed a reduction of macular thickness with age (p < 0.05). The macular thickness at the central and inner circle was significantly lower in the female subjects (p < 0.05). In group 3 and 4, macular thickness at the central circle in males was greater than in females. In group 3, the average inner macular thickness in males was significantly greater than in females (p < 0.05). Conclusions: In normal subjects with emmetropia, there are statistically significant differences in macular thickness between subjects of different age and gender. The results from the present study can be expected to provide a reference value for evaluating macular disease. J Korean Ophthalmol Soc 2011;52(3): Key Words: Age, Emmetropia, Gender, Macular thickness, Spectral domain optical coherence tomography Address reprint requests to Sung Jin Lee, MD, PhD Department of Ophthalmology, Soonchunhyang University Hospital #22 Daesagwan-gil, Yongsan-gu, Seoul , Korea Tel: , Fax: , wismile@unitel.co.kr 307

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