|Year : 2019 | Volume
| Issue : 10 | Page : 1645-1649
Evaluation of the vitreous chamber depth: An assessment of correlation with ocular biometrics
Brijesh Takkar1, Nripen Gaur2, Gunjan Saluja2, Anubha Rathi2, Bhavana Sharma1, Pradeep Venkatesh2, Atul Kumar2
1 Department of Ophthalmology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
2 Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
|Date of Submission||08-Jan-2019|
|Date of Acceptance||01-May-2019|
|Date of Web Publication||23-Sep-2019|
Dr. Brijesh Takkar
Department of Ophthalmology, All India Institute of Medical Sciences, Saket Nagar, Bhopal - 462 020, Madhya Pradesh
Source of Support: None, Conflict of Interest: None
Purpose: The mechanism of ocular growth eludes us and research on vitreous chamber depth (VCD) is lacking. The purpose of this study was to evaluate the role of VCD and its ratio to axial length (AL) in relation to ocular biometry. Methods: This retrospective study of patients planned for cataract surgery was performed at a tertiary center. Data regarding AL, anterior chamber depth (ACD), lens thickness (LT), and central corneal thickness (CCT) of 640 eyes was noted. Anterior segment (AS) was measured as sum of CCT, ACD, and LT, while VCD was calculated as the difference between AL and AS. Correlation of VCD and VCD: AL with ocular biometry was the primary outcome measure. Three groups were formed on the basis of AL and Pearson correlation coefficient (R) was applied. Results: Mean VCD was 15.38+/−1.14 mm. Mean VCD: AL was 0.66+/−0.02. VCD had a very strong relation with AL (R = 0.9, P < 0.001) only, whereas VCD: AL had a good--strong relation with AL (R = 0.5, P < 0.001), AS (R = 0.7, P < 0.001), ACD (R = 0.3, P < 0.001), and LT (R = 0.5, P < 0.001). The relation of VCD: AL with AS was very strong across all groups (R ≤ -0.8, P < 0.001 in all groups). 85% of eyes in group with AL <22 mm had VCD: AL <0.67, conversely 85% of eyes with AL >24.5 mm had VCD: AL >0.67. Conclusion: We found VCD to have the strongest relation with AL. VCD: AL was more consistent and showed a strong relation to ocular biometry across all ALs. This suggests the possible utility of the ratio VCD: AL while evaluating ocular growth, refractive status, and myopia-related complications.
Keywords: Axial length, growth of eye ball, Myopia, ocular growth, vitreous chamber
|How to cite this article:|
Takkar B, Gaur N, Saluja G, Rathi A, Sharma B, Venkatesh P, Kumar A. Evaluation of the vitreous chamber depth: An assessment of correlation with ocular biometrics. Indian J Ophthalmol 2019;67:1645-9
|How to cite this URL:|
Takkar B, Gaur N, Saluja G, Rathi A, Sharma B, Venkatesh P, Kumar A. Evaluation of the vitreous chamber depth: An assessment of correlation with ocular biometrics. Indian J Ophthalmol [serial online] 2019 [cited 2019 Oct 18];67:1645-9. Available from: http://www.ijo.in/text.asp?2019/67/10/1645/267453
Growth of the eye ball has fascinated ophthalmologists for a long time. Most of the research pertaining to it revolves around myopia and its management. The size of the eye is known to depend on visual sensation. As the outer coats are the obvious end point of mechanism of ocular growth, it is very likely that the retina and the posterior segment have a very important role in determining the final biometry.,, Choroidal changes responsible for ocular growth, including those of its ultra-structure and thickness, have been shown to depend on intense molecular signalling and vascular changes reliant on visual focus in experimental models.,, This concept is behind formulation of multiple hypotheses for managing progressive myopia, including that of utilizing low dose topical atropine.,,
The anterior structures may compensate for the optical effect of a longer eye ball by negating its component refractive error. A study of ocular component growth curves shows that myopia is more likely to be due to an alteration of growth, whereas emmetropia and hyperopia are a product of the initial size of the eye. Since the anterior and the posterior segments of the eye have contrasting embryonic origins, their growth may depend on different mechanisms. Yet, studies show the anterior segment to balance the posterior to nullify refractive error. Hence, it is logical to ascertain a common factor which may influence the overall growth of the eye ball and its segments.
Current literature is lacking in terms of relationship between vitreous chamber depth (VCD) and rest of the ocular biometry. In a recent study of myopic eyes undergoing refractive surgery, we showed that there is a major discord between anterior biometry and the axial length (AL) of the eye ball. We found the growth of the eye ball to be highly disproportionate, thus accounting for certain difficult scenarios surrounding refractive procedures. However, in that study we had noted an important limitation in our inability to evaluate VCD as a correlate of AL due to our sampling method. In this study, we evaluate the relationship between VCD and other biometric parameters. We also introduce VCD: AL as a parameter that may influence overall ocular biometry, and thus provide clues to the refractive status or ocular growth.
| Methods|| |
This is a retrospective observational study evaluating records of patients planned for cataract surgery at a tertiary eye care centre of northern India. Part of this data has already been published regarding planning of a new intraocular lens library.
Patients of age more than 40 years were included, while those with history of prior ocular procedures, congenital diseases, and trauma were excluded from the study. Cases where data was incomplete were also excluded. Biometric data inclusive of axial length (AL) in mm, anterior chamber depth (ACD) in mm, lens thickness (LT) in mm, and central corneal thickness (CCT) in mm was noted. These parameters were measured using a single optical biometer (Lens Star, Haag-Streit, USA). All measurements were done by a single technician. AL was measured as the distance from the anterior corneal vertex to the internal limiting membrane (ILM) along the line of fixation. ACD was measured as the distance from the endothelial surface of cornea to anterior capsule of lens. CCT and LT were obtained by optical low coherence reflectometry. The anterior segment (AS) was measured as the sum of CCT, ACD, and LT; and the VCD was obtained as the difference between AL and AS. The VCD to AL ratio (VCD: AL) was measured using Microsoft excel sheets (Microsoft office 2007).
The primary outcome measures were correlation of ocular biometry with VCD and VCD: AL. Three groups were formed on the basis of AL, group 1 included eyes with AL <22 mm, group 2 included eyes with AL 22--24.5 mm, and group 3 included eyes with AL >24.5 mm. Variations between these 2 groups and correlation between rest of the variables were studied secondarily.
Data analysis was done using Stata statistical software version 12.0 (Stata Corp, College Station, TX, USA). Mean, range, and standard deviations were assessed for nonparametric variables and frequencies were calculated for parametric ones. Pearson correlation coefficient was applied to assess the primary outcome measures as both the variables were non-ordinal. A strong correlation was defined as R > 0.5 or R < −0.5, while very strong relation was defined as R > 0.8 or R<−0.8. Chi-square test was used to compare distribution of the 3 groups as a function of VCD: AL, while one way analysis of variance (ANOVA) test was used to compare group means as applicable. Only 2-tailed P values <0.05 were taken to be statistically significant.
| Results|| |
Records of 850 eyes were initially screened. 640 eyes were found to meet the selection criteria. The mean age of patients was 60.3+/−8.9 years and 70% were male. Right and left eyes were nearly equal in number (50% each). Mean AL, CCT, LT, ACD, AS, VCD, and VCD: AL were found to be23.23+/− 1.14 mm, 0.52+/−0.04 mm, 4.30+/− 0.41 mm, 3.04+/− 0.44, 7.85+/− 0.45 mm, 15.38+/− 1.14 mm, and 0.66+/− 0.02, respectively. Nearly 10% of eyes were distributed in groups 1 and 3, while 80% were in group 2. This data and distribution of variables has been summarized in [Table 1].
Correlation analysis was performed between biometric variables and has been summarized in [Table 2]. VCD: AL was found to have a good--strong relation with all the variables, apart from CCT. VCD showed a very strong correlation with AL (R = 0.921, P < 0.001), but not with any other variable. Among the anterior parameters, a strong relation was observed only between AS and ACD (R = 0.575, P < 0.001). CCT correlated poorly with all variables. No other anterior parameter showed a strong correlation. Thus, although VCD correlated best with AL, VCD: AL had the most consistent correlation with ocular biometry.
Groups 1, 2, and 3 were compared for variation of VCD: AL [Table 3]. The mean value of VCD: AL (0.66) was chosen to divide VCD: AL in 2 groups. Although nearly 85% of the group 1 eyes had VCD: AL <0.67, nearly 85% of the group 3 eyes had VCD: AL > 0.67. This difference was found to have very high statistical significance (P < 0.001). Hence, VCD was seen to occupy a greater part of the eye length as the AL increased.
The 3 groups formed on the basis of AL were then evaluated individually for correlation between AS, VCD, VCD: AL, and AL. VCD: AL was again found to be the most consistent variable. It exhibited very strong correlation with AS in all the groups, in comparison to VCD which showed moderate to strong correlations [Table 4]. However, VCD individually showed a stronger correlation with AL than VCD: AL in all the 3 groups. This was consolidated by the finding of VCD having the highest F statistic on application of ANOVA to determine differences in AS, VCD, and VCD: AL between the 3 groups [Table 5]. AL showed a very weak relation with AS in all the groups [Table 4].
AS: VCD was analyzed for its correlation with ocular biometry, just like VCD: AL. Surprisingly, the pattern of correlation exhibited by AS: VCD was completely identical to that of VCD: AL [Table 6]. Furthermore, there was an excellent correlation between AS: VCD and VCD: AL (R = −0.988, P < 0.001).
| Discussion|| |
The literature lacks in respect to VCD, and our study provides several new insights in this regard, apart from setting a normative Indian database. We have provided an extensive analysis for variation of VCD with ocular biometry, and have evaluated VCD: AL as its correlate. We found that VCD is a better correlate of AL than AS, or any sub-parameter of AS. Furthermore, we showed that VCD: AL has the most consistent relationship with ocular biometrics. As a secondary analysis, we also proved that VCD occupies greater parts of the eye with increasing AL and that VCD: AL correlates best with AS, even better than ACD or LT. However, the most intriguing result is the similarity between VCD: AL and AS: VCD.
Ocular biometry has been studied comprehensively in all areas of the world. However, VCD has been scarcely studied. [Table 7] presents the summary of the available studies.,,,,,,,,, The mean VCD detected by our study falls well within the range measured by these studies. It can be easily noted that most of these studies are population based, rather than the current study which is hospital based. While in general hospital-based studies have inherent biases, they may have better exclusion criteria as hospital-based ocular examination is better focussed in ruling out ocular morbidities. Some work has also been done in the context of progressively increasing VCD in myopia as presented in [Table 7].
It is known that patterns of development or regression of embryonic primary vitreous can influence the size of the eye and its AL. This is one of the reasons due to which eyes with persistent fetal vasculature have a high chance of having microphthalmia.,, Hence, a very strong relation between VCD and AL is expected. The second reason for the same is the biomechanical nature of the vitreous that allows it to stretch as compared with the AS which is relatively stiff. A longer eye ball thus is expected to have a higher proportion of VCD which can be appreciated by a higher VCD: AL in group 3 in our study.
The consistent relation of VCD: AL with ocular biometry is intriguing [Table 2], as is its similarity with AS: VCD [Table 6]. In fact, VCD: AL proved to have a stronger relation with AS than ACD or LT [Table 2]. We had noted a similar lack of correlation between anterior parameters in myopic patients in a previous study. One may speculate these findings to have a simple mathematical explanation, that is, both AS and VCD contribute to AL. Hence, ratio of either of them to AL may have good relation to both. However, in such a situation, the individual correlation coefficient of AS and VCD to AL should also have been similar, which is not the case [Table 2]. The reasons for our findings are not clear at the moment, but the authors are of the view that VCD: AL may be a useful marker of ocular growth or refractive status, and should be studied further. Although relation between corneal curvature and AL has been studied prior, VCD: AL has not been studied before. Future studies can evaluate patterns of VCD: AL during early childhood, as also during progressive phase of pathological myopia. In the latter population, VCD: AL may also be a prognostic indicator of retinal complications by indicating vitreous stretch. Meng et al. concluded in a comprehensive review on AL regarding the requirement of “new creative studies” on myopia and its determinants. VCD: AL seems to be a promising answer in this context in view of its consistent nature.
Limitations:Apart from its retrospective nature, there are 2 main limitations of this study. Firstly, all patients had cataract which in effect alters LT and therefore may have an effect on the VCD too. Inclusion of patients of all ages could have nullified this limitation to some extent. Secondly, there were 63 patients in group 3. At least 11 of them had posterior staphyloma clinically and/or on ultrasound. Due to retrospective nature of this study, we cannot ascertain the exact number or provide a subgroup analysis. It is theoretically possible that this fallacy may have affected measurement of VCD in these patients., However, the consistent nature of all parameters across all groups indicates otherwise [Table 4].
| Conclusion|| |
VCD has a very good correlation with AL of the eye, while VCD: AL has a very consistent and strong relation with ocular biometry inclusive of the anterior segment parameters. In comparison to a normal or a shorter eye, larger proportion of a myopic eye ball is occupied by the vireous chamber. VCD: AL should be studied further in prospective models for its relation with ocular growth and retinal complications in myopia.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rymer J, Wildsoet CF. The role of the retinal pigment epithelium in eye growth regulation and myopia: A review. Vis Neurosci 2005;22:251-61.
Troilo D. Neonatal eye growth and emmetropisation—A literature review. Eye 1992;6:154.
Goss DA, Wickham MG. Retinal-image mediated ocular growth as a mechanism for juvenile onset myopia and for emmetropization. Doc Ophthalmol 1995;90:341-75.
Liang H, Crewther SG, Crewther DP, Junghans BM. Structural and elemental evidence for edema in the retina, retinal pigment epithelium, and choroid during recovery from experimentally induced myopia. Invest Ophthalmol Vis Sci 2004;45:2463-74.
Wallman J, Wildsoet C, Xu A, Gottlieb MD, Nickla DL, Marran L, et al.
Moving the retina: Choroidal modulation of refractive state. Vis Res 1995;35:37-50.
Chia A, Lu QS, Tan D. Five-year clinical trial on atropine for the treatment of myopia 2: Myopia control with atropine 0.01% eyedrops. Ophthalmology 2016;123:391-9.
Sivak J. The cause(s) of myopia and the efforts that have been made to prevent it. Clin Exp Optom 2012;95:572-82.
Venkatesh P, Takkar B. Suprachoroidal injection of biological agents may have a potential role in the prevention of progression and complications in high myopia. Med Hypotheses 2017;107:90-1.
Jones LA, Mitchell GL, Mutti DO, Hayes JR, Moeschberger ML, Zadnik K. Comparison of ocular component growth curves among refractive error groups in children. Invest Ophthalmol Vis Sci 2005;46:2317-27.
Bron AJ, Tripathi RC, Tripathi BJ. Development of the human eye. In: Wolff's Anatomy of the Eye and Orbit, Chapter 17. Chapman and Hall, 1997. p. 620-64.
Zeng J, Cui Y, Li J, Xie W, Li Z, Zhang L, et al.
Correlation of axial length and corneal curvature with diopter in eyes of adults with anisometropia. Int J Clin Exp Med 2015;8:13639-43
Khokhar S, Takkar B, Agarwal E, Gaur N, Ravani R, Venkatesh P. Biometric evaluation of myopic eyes without posterior staphyloma: Disproportionate ocular growth. Int Ophthalmol 2018;38:2427-34.
Saluja G, Takkar B, Agarwal E, Sharma B, Khokhar S. Planning a new intraocular lens library in the Indian scenario. Indian J Ophthalmol 2018;66:1227.
] [Full text]
Roy A, Kar M, Mandal D, Ray RS, Kar C. Variation of axial ocular dimensions with age, sex, height, BMI-and their relation to refractive status. J Clin Diagn Res 2015;9:AC01.
Hashemi H, Khabazkhoob M, Miraftab M, Emamian MH, Shariati M, Abdolahinia T, et al.
The distribution of axial length, anterior chamber depth, lens thickness, and vitreous chamber depth in an adult population of Shahroud, Iran. BMC Ophthalmol 2012;12:50.
Wickremasinghe S, Foster PJ, Uranchimeg D, Lee PS, Devereux JG, Alsbirk PH, et al.
Ocular biometry and refraction in Mongolian adults. Invest Ophthalmol Vis Sci 2004;45:776-83.
Wong TY, Foster PJ, Ng TP, Tielsch JM, Johnson GJ, Seah SK. Variations in ocular biometry in an adult Chinese population in Singapore: The Tanjong Pagar Survey. Invest Ophthalmol Vis Sci 2001;42:73-80.
Warrier SK, Wu HM, Newland HS, Muecke JS, Selva D, Aung T, et al.
Ocular biometry and determinants of refractive error in rural Myanmar: The Meiktila Eye Study. Br J Ophthalmol 2008;92:1591-4.
Mallen EA, Gammoh Y, Al-Bdour M, Sayegh FN. Refractive error and ocular biometry in Jordanian adults. Ophthalmic Physiol Opt 2005;25:302-9.
Shufelt C, Fraser-Bell S, Ying-Lai M, Torres M, Varma R. Refractive error, ocular biometry, and lens opalescence in an adult population: The Los Angeles Latino Eye Study. Invest Ophthalmol Vis Sci 2005;46:4450-60.
Jivrajka R, Shammas MC, Boenzi T, Swearingen M, Shammas HJ. Variability of axial length, anterior chamber depth, and lens thickness in the cataractous eye. J Cataract Refract Surg 2008;34:289-94.
Niu Z, Li J, Zhong H, Yuan Z, Zhou H, Zhang Y, et al.
Large variations in ocular dimensions in a multiethnic population with similar genetic background. Sci Rep 2016;6:22931.
Saka N, Ohno-Matsui K, Shimada N, Sueyoshi SI, Nagaoka N, Hayashi W, et al.
Long-term changes in axial length in adult eyes with pathologic myopia. Am J Ophthalmol 2010;150:562-8.
Duke-Elder S. Congenital and developmental anomalies. In: Duke-Elder, editor. Text book of Ophthalmology, Chapter 30. Henry Kimpton; 1946. p. 1237-416.
Takkar B, Chandra P, Kumar V, Agrawal R. A case of iridofundal coloboma with persistent fetal vasculature and lens subluxation. J AAPOS 2016;20:180-2.
Khokhar S, Takkar B, Pillay G, Venkatesh P. Three cases of associated persistent fetal vasculature and ocular coloboma: Posterior segment dysgenesis. J Pediatr Ophthalmol Strabismus 2017;54:e77-80.
Meng W, Butterworth J, Malecaze F, Calvas P. Axial length of myopia: A review of current research. Ophthalmologica 2011;225:127-34.
Rathi A, Takkar B, Venkatesh P, Gaur N, Kumar A. Ultrasonographic evaluation of transition from normal to ectatic area: A comparison between myopic staphylomata and coloboma. Indian J Ophthalmol 2017;65:1030.
] [Full text]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]