Determining Gender-Based Differences in Retinal and Choroidal Thickness in Underweight Individuals via Swept-Source Optical Coherence Tomography

Published: December 01, 2023

doi:

Jin Wang*¹, Qianlin Ji*², Sijie Lin*³, Yang Zhang, Jing Jiang, Yu Zhang, Yiwen Qian, Xin Che, Yan Liu, Zhiliang Wang, Qingjian Li

¹Department of Cardiology, Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine, ²Department of Ophthalmology, Huashan Hospital,Fudan University, ³Eye Institute of Xiamen University,Xiamen University School of Medicine

Summary

Here, swept-source optical coherence tomography (SS-OCT) is used to compare retinal and choroidal thickness in adults with and without malnutrition, contributing to a better understanding of the pathogenesis of ocular diseases in malnourished individuals.

Abstract

Despite improvements in reducing hunger in recent years, undernutrition remains a global public health problem. This study utilizes the swept-source optical coherence tomography (SS-OCT) technique to assess changes in retinal and choroidal thickness in underweight subjects. Ophthalmic examinations were conducted on all adults participating in this cross-sectional research. Depending on their body mass index (BMI), the participants were divided into two groups: the underweight group and the normal group. The study included the right eyes of the underweight adults and an equal number of age- and gender-matched normal-weight subjects. The retinal thickness showed no significant difference between the underweight and normal groups (P > 0.05 for all). In males, the retina of the center and inner ring in the underweight group was significantly thinner than that in the normal group, while no such results were found in females. The choroid in the underweight group was significantly thinner compared to that in the normal group (all P < 0.05). Being underweight may affect choroidal thickness in both males and females. In comparison with underweight females, underweight males may experience more retinal damage. These findings contribute to a better understanding of the pathogenesis underlying specific ocular diseases in malnourished individuals.

Introduction

Despite the Health Organization's successful efforts to combat hunger in recent years, undernutrition remains a significant global public health concern. Globally, it was estimated that 9.8% of the population was undernourished in 2022¹. The incidence of undernutrition varies across regions, with higher prevalence among individuals with lower socioeconomic status²^,³^,⁴. Additionally, some individuals, especially young people, lose weight excessively in pursuit of a perfect body shape. Malnutrition, in all its various forms, affects every country in the world⁵.

Being underweight is associated with negative clinical outcomes, including infections, immune dysfunction, delayed wound healing, and growth and developmental retardation⁶^,⁷^,⁸^,⁹. A malnourished state is one of the leading risk factors for premature death and the loss of disability-adjusted life years¹⁰^,¹¹^,¹². Studies have shown that the lowest body mass index (BMI) is associated with the poorest binocular ability¹³. Furthermore, research has demonstrated that undernutrition is linked to various ocular issues, such as macular degeneration, decreased dark adaptation, optic atrophy, keratitis, dry eye, and retinoblastoma¹⁴^,¹⁵^,¹⁶^,¹⁷^,¹⁸.

The retina, with its multiple layers and cell types, is a complex tissue, while the choroid is a highly vascularized structure that provides nutrients to the outer layer of the retina and removes metabolic waste¹⁹. The retina and choroid, as critical structures of the eyeball, can be affected by systemic pathologies or physiological conditions²⁰^,²¹. They have been found to play a significant role in the pathogenesis of specific ocular diseases, including macular degeneration, polypoidal choroidal vasculopathy, uveitis, glaucoma, and myopia-related chorioretinal atrophy²²^,²³^,²⁴^,²⁵^,²⁶. Therefore, ocular function depends on both anatomically and functionally normal retinas and choroids.

While undernutrition has various effects on the eye, there is limited information available on the relationships between malnutrition and retinal or choroidal thickness in different genders. This study aims to assess potential changes in retinal or choroidal thickness in malnourished adults using the swept-source optical coherence tomography (SS-OCT) technique, which represents a significant advancement in retinal and choroidal imaging²⁷. This technology is particularly effective in accurately identifying the choroidal scleral interface (CSI) in eyes with thicker choroids, thanks to its high penetration capabilities through the retinal pigment epithelium (RPE).

In this study, participants were categorized into two groups based on their BMI: the underweight group (BMI < 18.50 kg/m²) and the normal group (18.50 ≤ BMI < 25.00 kg/m²). The study included 996 right eyes of 996 underweight adults and an equal number of age- and gender-matched normal-weight subjects. The average BMI was 17.48 ± 0.75 kg/m² in the underweight group and 21.30 ± 1.75 kg/m² in the normal group.

Protocol

This research was conducted at Huashan Hospital of Fudan University from January 2020 to October 2020. The study was approved by the Institutional Review Board of Huashan Hospital (No. KY2016-274), and all participating adults provided written informed consent. 1. Selection of participants Record all participants' demographic characteristics, such as age, gender, and a history of systemic diseases. Consider the following as the exclusion criteria: (1) age <…

Representative Results

A total of 996 right eyes from 996 underweight adults were evaluated in this study, with 1:1 age- and gender-matched normal-weight subjects. The demographic characteristics of both groups are summarized in Table 1. The underweight group had an average BMI of 17.48 ± 0.75 kg/m2 (range: 14.60-18.40 kg/m2), while the normal-weight group had an average BMI of 21.30 ± 1.75 kg/m2 (range: 18.50-24.90 kg/m2). Table 2</stron…

Discussion

In this study, SS-OCT was employed to compare retinal and choroidal thickness in adults with and without malnutrition. The outcomes of the study showed that, among males, individuals in the underweight group had significantly thinner retinas in the central and inner ring regions compared to those in the normal group. However, no such differences were observed among females. Additionally, the choroid was found to be significantly thinner in the underweight group compared to the normal group in both males and females. Thes…

Divulgazioni

The authors have nothing to disclose.

Acknowledgements

This study was funded by grants from the National Natural Science Foundation of China (No. 81900879) and the Science and Technology Commission of Shanghai Municipality (No. 20Y11910800).

Materials

Height and weight meter	DKi, Beijing, China	HC01000209
Ophthalmoscope	66 Vision-Tech, Suzhou, China	V259204
Slit-lamp microscope	Topcon, Tokyo, Japan	6822
SPSS software	IBM, Chicago, USA	ECS000143
Swept-source optical coherence tomography	Topcon, Tokyo, Japan	185261
Visual chart	Yuejin, Shanghai, China	H24104

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