Peripapillary retinal nerve fiber layer thickness and central macular thickness in children with anisometropia
Medical hypothesis, discovery & innovation in optometry,
Vol. 6 No. 4 (2025),
30 January 2026
,
Page 144-149
https://doi.org/10.51329/mehdioptometry233
Abstract
Background: Anisometropia is associated with asymmetric ocular growth and may influence retinal structure, yet its impact on retinal nerve fiber layer thickness (RNFLT) remains incompletely understood. This study aimed to evaluate RNFLT and central macular thickness (CMT) in children with anisometropia and to examine their relationships with refractive error and ocular biometric parameters.Methods: This cross-sectional study included children aged 5–16 years with anisometropia. Comprehensive ophthalmic evaluation included cycloplegic refraction, ocular biometry, and spectral-domain optical coherence tomography. Peripapillary RNFLT and CMT were measured and compared between worse and fellow eyes, as well as between amblyopic and non-amblyopic eyes. Correlations between spherical equivalent refraction (SER) and ocular parameters, including axial length, intraocular pressure, CMT, and RNFLT, were assessed.
Results: Among 46 children (median age 14 years), 45.7% (n = 21) had anisometropic amblyopia. Nasal RNFLT was significantly greater in worse eyes compared with fellow eyes (P < 0.05), while other quadrants and CMT showed no significant interocular differences. Amblyopic eyes showed higher RNFLT values than non-amblyopic eyes, reaching significance only in the nasal quadrant. SER showed a strong negative correlation with axial length (r = -0.91, P < 0.001) and moderate or weak positive correlations with quadrant-specific RNFLT, including inferior (r = +0.56, P = 0.001), superior (r = +0.67, P < 0.001), temporal (r = +0.59, P < 0.001), and nasal (r = +0.37, P = 0.012) quadrants, but not with CMT (r = -0.22, P > 0.05) or IOP (r = +0.19, P > 0.05).
Conclusions: Children with anisometropia exhibit selective regional RNFLT alterations, particularly involving the nasal quadrant, while macular thickness remains largely preserved. The observed associations between refractive error, AL, and RNFLT suggest that anisometropia may influence retinal structural development in a region-specific manner. Longitudinal studies are warranted to clarify the temporal relationship between refractive asymmetry and retinal structural remodeling.
Keywords:
- anisometropia
- anisometropic amblyopia
- optical coherence tomography
- peripapillary retinal nerve fiber layer thickness
- macula luteas
- eye axial length
- ocular tonometry
- intraocular pressures
References
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11. Zhang L, Zhao Y, Shi X, Wu F, Shen Y. Understanding amblyopia from the perspective of neurovascular units: changes in the retina and brain. Front Cell Dev Biol. 2025 Jun 27;13:1590009. doi: 10.3389/fcell.2025.1590009. PMID: 40655949; PMCID: PMC12245887.
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17. O'Donoghue L, McClelland JF, Logan NS, Rudnicka AR, Owen CG, Saunders KJ. Profile of anisometropia and aniso-astigmatism in children: prevalence and association with age, ocular biometric measures, and refractive status. Invest Ophthalmol Vis Sci. 2013 Jan 21;54(1):602-8. doi: 10.1167/iovs.12-11066. PMID: 23233258.
18. Huynh SC, Wang XY, Ip J, Robaei D, Kifley A, Rose KA, Mitchell P. Prevalence and associations of anisometropia and aniso-astigmatism in a population based sample of 6 year old children. Br J Ophthalmol. 2006 May;90(5):597-601. doi: 10.1136/bjo.2005.083154. PMID: 16622090; PMCID: PMC1857062.
19. Kim SY, Cho SY, Yang JW, Kim CS, Lee YC. The correlation of differences in the ocular component values with the degree of myopic anisometropia. Korean J Ophthalmol. 2013 Feb;27(1):44-7. doi: 10.3341/kjo.2013.27.1.44. Epub 2013 Jan 9. PMID: 23372379; PMCID: PMC3550311.
20. Al-Haddad CE, Mollayess GM, Cherfan CG, Jaafar DF, Bashshur ZF. Retinal nerve fibre layer and macular thickness in amblyopia as measured by spectral-domain optical coherence tomography. Br J Ophthalmol. 2011 Dec;95(12):1696-9. doi: 10.1136/bjo.2010.195081. Epub 2011 Mar 11. PMID: 21398410.
21. Yen MY, Cheng CY, Wang AG. Retinal nerve fiber layer thickness in unilateral amblyopia. Invest Ophthalmol Vis Sci. 2004 Jul;45(7):2224-30. doi: 10.1167/iovs.03-0297. PMID: 15223799.
22. Yoon SW, Park WH, Baek SH, Kong SM. Thicknesses of macular retinal layer and peripapillary retinal nerve fiber layer in patients with hyperopic anisometropic amblyopia. Korean J Ophthalmol. 2005 Mar;19(1):62-7. doi: 10.3341/kjo.2005.19.1.62. PMID: 15929489.
23. Choi SW, Lee SJ. Thickness changes in the fovea and peripapillary retinal nerve fiber layer depend on the degree of myopia. Korean J Ophthalmol. 2006 Dec;20(4):215-9. doi: 10.3341/kjo.2006.20.4.215. PMID: 17302206; PMCID: PMC2908854.
24. Altintas O, Yüksel N, Ozkan B, Caglar Y. Thickness of the retinal nerve fiber layer, macular thickness, and macular volume in patients with strabismic amblyopia. J Pediatr Ophthalmol Strabismus. 2005 Jul-Aug;42(4):216-21. doi: 10.3928/01913913-20050701-03. PMID: 16121551.
25. Kee SY, Lee SY, Lee YC. Thicknesses of the fovea and retinal nerve fiber layer in amblyopic and normal eyes in children. Korean J Ophthalmol. 2006 Sep;20(3):177-81. doi: 10.3341/kjo.2006.20.3.177. PMID: 17004633; PMCID: PMC2908843.
26. Yalcin E, Balci O. Peripapillary retinal nerve fiber layer and foveal thickness in hypermetropic anisometropic amblyopia. Clin Ophthalmol. 2014 Apr 12;8:749-53. doi: 10.2147/OPTH.S58541. PMID: 24748770; PMCID: PMC3990465.
27. Jiang Z, Shen M, Xie R, Qu J, Xue A, Lu F. Interocular evaluation of axial length and retinal thickness in people with myopic anisometropia. Eye Contact Lens. 2013 Jul;39(4):277-82. doi: 10.1097/ICL.0b013e318296790b. PMID: 23771009.
28. Dickmann A, Petroni S, Salerni A, Dell'Omo R, Balestrazzi E. Unilateral amblyopia: An optical coherence tomography study. J AAPOS. 2009 Apr;13(2):148-50. doi: 10.1016/j.jaapos.2008.10.009. Epub 2009 Jan 20. PMID: 19157939.
2. Gong W, Zhu Z, Bulloch G, Wang J, Chen J, Du L, Yang J, Zhang B, He X, Zou H, Xu X, Deng J, Huang J. Anisometropia and its association with refraction development in highly myopic children. Clin Exp Optom. 2024 Jan;107(1):58-65. doi: 10.1080/08164622.2023.2198635. Epub 2023 Apr 20. PMID: 37078165.
3. Majdanik E, Czepita D, Safranow K. Badania nad czesto?cia wystepowania anizometropii osiowej i refrakcyjnej [Investigations on the prevalence of axial and refractive anisometropia]. Klin Oczna. 2012;114(3):184-6. Polish. PMID: 23373398.
4. Weale RA. On the age-related prevalence of anisometropia. Ophthalmic Res. 2002 Nov-Dec;34(6):389-92. doi: 10.1159/000067040. PMID: 12483028.
5. Gabai A, Zeppieri M. Anisometropia. 2023 May 11. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 35881751.
6. Multi-ethnic Pediatric Eye Disease Study Group. Prevalence of amblyopia and strabismus in African American and Hispanic children ages 6 to 72 months the multi-ethnic pediatric eye disease study. Ophthalmology. 2008 Jul;115(7):1229-1236.e1. doi: 10.1016/j.ophtha.2007.08.001. Epub 2007 Oct 22. PMID: 17953989; PMCID: PMC4839485.
7. Kang SH, Hong SW, Im SK, Lee SH, Ahn MD. Effect of myopia on the thickness of the retinal nerve fiber layer measured by Cirrus HD optical coherence tomography. Invest Ophthalmol Vis Sci. 2010 Aug;51(8):4075-83. doi: 10.1167/iovs.09-4737. Epub 2010 Mar 17. PMID: 20237247.
8. Budenz DL, Anderson DR, Varma R, Schuman J, Cantor L, Savell J, Greenfield DS, Patella VM, Quigley HA, Tielsch J. Determinants of normal retinal nerve fiber layer thickness measured by Stratus OCT. Ophthalmology. 2007 Jun;114(6):1046-52. doi: 10.1016/j.ophtha.2006.08.046. Epub 2007 Jan 8. Erratum in: Ophthalmology. 2008 Mar;115(3):472. PMID: 17210181; PMCID: PMC2916163.
9. Mashige KP, Oduntan OA. Retinal nerve fibre layer thickness values and their associations with ocular and systemic parameters in Black South Africans. Afr Health Sci. 2016 Dec;16(4):1188-1194. doi: 10.4314/ahs.v16i4.39. PMID: 28479914; PMCID: PMC5398468.
10. Barrett BT, Bradley A, Candy TR. The relationship between anisometropia and amblyopia. Prog Retin Eye Res. 2013 Sep;36:120-58. doi: 10.1016/j.preteyeres.2013.05.001. Epub 2013 Jun 15. PMID: 23773832; PMCID: PMC3773531.
11. Zhang L, Zhao Y, Shi X, Wu F, Shen Y. Understanding amblyopia from the perspective of neurovascular units: changes in the retina and brain. Front Cell Dev Biol. 2025 Jun 27;13:1590009. doi: 10.3389/fcell.2025.1590009. PMID: 40655949; PMCID: PMC12245887.
12. Wu SQ, Zhu LW, Xu QB, Xu JL, Zhang Y. Macular and peripapillary retinal nerve fiber layer thickness in children with hyperopic anisometropic amblyopia. Int J Ophthalmol. 2013;6(1):85-9. doi: 10.3980/j.issn.2222-3959.2013.01.18. Epub 2013 Feb 18. PMID: 23550031; PMCID: PMC3580257.
13. Wu YY, Luo H, Li J. Thickness of macular area and peripapillary retinal nerve fiber layer in monocular anisometropic amblyopia measured by optical coherence tomography: a Meta-analysis. International Eye Science. 2020; 20(9):1560-6. doi:10.3980/j.issn.1672-5123.2020.9.19.
14. Culha D, Arici MC. Evaluation of retinal nerve fiber layer thickness and macular thickness in amblyopic children. Cumhuriyet Medical Journal. 2021 Sep 30;43(3):232-40. doi: 10.7197/cmj.821209.
15. Kim HY. Statistical notes for clinical researchers: Sample size calculation 1. comparison of two independent sample means. Restor Dent Endod. 2016 Feb;41(1):74-8. doi: 10.5395/rde.2016.41.1.74. Epub 2015 Dec 30. PMID: 26877994; PMCID: PMC4751211.
16. Weakley DR Jr. The association between nonstrabismic anisometropia, amblyopia, and subnormal binocularity. Ophthalmology. 2001 Jan;108(1):163-71. doi: 10.1016/s0161-6420(00)00425-5. PMID: 11150283.
17. O'Donoghue L, McClelland JF, Logan NS, Rudnicka AR, Owen CG, Saunders KJ. Profile of anisometropia and aniso-astigmatism in children: prevalence and association with age, ocular biometric measures, and refractive status. Invest Ophthalmol Vis Sci. 2013 Jan 21;54(1):602-8. doi: 10.1167/iovs.12-11066. PMID: 23233258.
18. Huynh SC, Wang XY, Ip J, Robaei D, Kifley A, Rose KA, Mitchell P. Prevalence and associations of anisometropia and aniso-astigmatism in a population based sample of 6 year old children. Br J Ophthalmol. 2006 May;90(5):597-601. doi: 10.1136/bjo.2005.083154. PMID: 16622090; PMCID: PMC1857062.
19. Kim SY, Cho SY, Yang JW, Kim CS, Lee YC. The correlation of differences in the ocular component values with the degree of myopic anisometropia. Korean J Ophthalmol. 2013 Feb;27(1):44-7. doi: 10.3341/kjo.2013.27.1.44. Epub 2013 Jan 9. PMID: 23372379; PMCID: PMC3550311.
20. Al-Haddad CE, Mollayess GM, Cherfan CG, Jaafar DF, Bashshur ZF. Retinal nerve fibre layer and macular thickness in amblyopia as measured by spectral-domain optical coherence tomography. Br J Ophthalmol. 2011 Dec;95(12):1696-9. doi: 10.1136/bjo.2010.195081. Epub 2011 Mar 11. PMID: 21398410.
21. Yen MY, Cheng CY, Wang AG. Retinal nerve fiber layer thickness in unilateral amblyopia. Invest Ophthalmol Vis Sci. 2004 Jul;45(7):2224-30. doi: 10.1167/iovs.03-0297. PMID: 15223799.
22. Yoon SW, Park WH, Baek SH, Kong SM. Thicknesses of macular retinal layer and peripapillary retinal nerve fiber layer in patients with hyperopic anisometropic amblyopia. Korean J Ophthalmol. 2005 Mar;19(1):62-7. doi: 10.3341/kjo.2005.19.1.62. PMID: 15929489.
23. Choi SW, Lee SJ. Thickness changes in the fovea and peripapillary retinal nerve fiber layer depend on the degree of myopia. Korean J Ophthalmol. 2006 Dec;20(4):215-9. doi: 10.3341/kjo.2006.20.4.215. PMID: 17302206; PMCID: PMC2908854.
24. Altintas O, Yüksel N, Ozkan B, Caglar Y. Thickness of the retinal nerve fiber layer, macular thickness, and macular volume in patients with strabismic amblyopia. J Pediatr Ophthalmol Strabismus. 2005 Jul-Aug;42(4):216-21. doi: 10.3928/01913913-20050701-03. PMID: 16121551.
25. Kee SY, Lee SY, Lee YC. Thicknesses of the fovea and retinal nerve fiber layer in amblyopic and normal eyes in children. Korean J Ophthalmol. 2006 Sep;20(3):177-81. doi: 10.3341/kjo.2006.20.3.177. PMID: 17004633; PMCID: PMC2908843.
26. Yalcin E, Balci O. Peripapillary retinal nerve fiber layer and foveal thickness in hypermetropic anisometropic amblyopia. Clin Ophthalmol. 2014 Apr 12;8:749-53. doi: 10.2147/OPTH.S58541. PMID: 24748770; PMCID: PMC3990465.
27. Jiang Z, Shen M, Xie R, Qu J, Xue A, Lu F. Interocular evaluation of axial length and retinal thickness in people with myopic anisometropia. Eye Contact Lens. 2013 Jul;39(4):277-82. doi: 10.1097/ICL.0b013e318296790b. PMID: 23771009.
28. Dickmann A, Petroni S, Salerni A, Dell'Omo R, Balestrazzi E. Unilateral amblyopia: An optical coherence tomography study. J AAPOS. 2009 Apr;13(2):148-50. doi: 10.1016/j.jaapos.2008.10.009. Epub 2009 Jan 20. PMID: 19157939.
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