Ciliary Muscle Thickness Changes Are Associated with Age THESIS
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Ciliary Muscle Thickness Changes Are Associated With Age THESIS Presented in Partial Fulfillment of the Requirements for the Degree Master of Science in the Graduate School of The Ohio State University By Alyssa Mary Willig, B.S. Graduate Program in Vision Science The Ohio State University 2015 Master’s Examination Committee: Melissa Bailey, OD, PhD, Advisor Donald Mutti, OD, PhD Jeffrey Walline, OD, PhD Copyright by Alyssa Mary Willig 2015 ii Abstract Purpose: To model the cross-sectional relationship of ciliary muscle thickness (CMT) and age throughout the decades of life. Methods: Subjects (N = 784) were ages 3 to 91 years. Measurements included distance autorefraction and Zeiss OCT imaging of the ciliary muscle in the right eye. Four ciliary muscle thickness (CMT) measurements were made at the thickest region (CMTMAX) and at 1, 2, and 3 mm from the scleral spur (CMT1, CMT2, CMT3). General linear regression models were used. Results: Mean ± standard deviation (SD) subject age (years) was 23.4 ± 18.4 (range: 3.4 to 91). Mean ± SD spherical equivalent (D) was −0.53 ± 1.88 (range: −10.87 to +6.00). The relationship between all CMT measures and age was significant [CMTMAX: Intercept = 805.75, Age (β = 1.04, p < 0.000001)]; CMT1: Intercept = 746.6, Age (β = 2.3, p = 0.0003), Spherical Equivalent, M (β = −5.8, p = 0.005), Age2 (β = −0.02, p = 0.01), M2 (β = −0.9, p = 0.02); CMT2: Intercept = 483.5, Age (β = 2.4, p = 0.0007), M (β = −17.7, p < 0.000001), Age2 (β = −0.03, p = 0.001), M2 (β = −1.9, p = 0.00005); CMT3: Intercept = 254.6, Age (β = 2.8, p < 0.000001), M (β = −13.4, p < 0.000001), Age2 (β = −0.04, p = 0.00002), M2 (β = −1.2, p = 0.001). The relationship between the location of ii the point of maximum thickness relative to the scleral spur (SStoMAX) and age was also significant (Intercept = 666.55, Age (β = 4.5, p = 0.08), M (β = −33.75, p < 0.000001), Age2 (β = −0.07, p = 0.007), M2 (β = −2.2, p = 0.06). Discussion: These data show that the relationship between cross-sectional ciliary muscle thickness and age is positive in childhood (increasing ciliary muscle thickness with increasing age) but negative in older age (decreasing ciliary muscle thickness with older age). The point of maximum thickness increased across all decades of life and also moves posteriorly in childhood and then anteriorly in older adults. A similar relationship showing an increase in thickness in younger ages also has been found in previous studies. To the best of our knowledge, our study is the first to describe the cross-sectional relationship between ciliary muscle thickness and age as a quadratic function. iii Dedication This document is dedicated to my family and fiancé, Justin, for their love and support. iv Acknowledgments I would like to acknowledge all those who contributed to the success of this project including Loraine Sinnott, PhD, and Chiu-Yen Kao, PhD, for their advice on statistical and image analysis, and OSU undergraduates who helped me collect my data at the Center of Science and Industry. I would especially like to thank Melissa Bailey, OD, PhD, for her constant guidance, enthusiasm, and inspiration as my mentor. This project and its presentation were supported by grants from the National Eye Institute (NEI T35 EY007151) and the Elmer H. Eger Memorial Student Travel Fellowship Grant from The American Academy of Optometry. v Vita October 7, 1990………………………………….….Born - Pittsburgh, Pennsylvania April 2008…………………………………………..Seton LaSalle Catholic High School April 2012………………………………………….. Bachelor of Science Biological Sciences University of Pittsburgh December 2015…………………………………….. Master of Science Vision Science The Ohio State University May 2016…………………………………………....Doctor of Optometry The Ohio State University Publications ● Lee, Bruce Y., Sarah M. Bartsch, and Alyssa M. Willig. "The Economic Value of a Quadrivalent versus Trivalent Influenza Vaccine." Vaccine 30.52 (2012): 7443- 446 ● Lee, Bruce Y., Kristina M. Bacon, Diana L. Connor, Alyssa M. Willig, and Rachel R. Bailey. "The Potential Economic Value of a Trypanosoma Cruzi (Chagas Disease) Vaccine in Latin America." PLoS Negl Trop Dis PLoS Neglected Tropical Diseases 4.12 (2010) Fields of Study Major Field: Vision Science vi Table of Contents Abstract.………...…………………………………………………………………………ii Dedication……..………………………………………………………………………….iv Acknowledgments….……………………………………………………………………...v Vita………………………………………………………………………………………..vi List of Tables……………………………………………………………………………viii List of Figures…………………………………………………………………………….ix Chapter 1: Introduction……………………………………………………………..…….1 Chapter 2: Methods………………………………………………………………………14 Chapter 3: Results……….……………………………………………………………….18 Chapter 4: Discussion…...………………………………………………………….....…20 References………………………………………………………………………………..41 vii List of Tables Table 1. Age, Spherical Equivalent Refractive Error, and Ciliary Muscle Thickness….28 Table 2. Regression models of age and ciliary muscle relationships……………………29 Table 3. Regression models of the relationship between age and ciliary muscle dimension for all subjects age 30 years and older…………………………………………………...30 viii List of Figures Figure 1. Mean spherical equivalent frequency in the subject population………………31 Figure 2. Example ciliary muscle image…………………………………………..……..32 Figure 3. Ciliary muscle configuration variety across the sample…………………….....33 Figure 4. Ciliary muscle thickness of a 10, 20, and 30 year old example patient based on model estimates…………………………………………………………………………..34 Figure 5. Ciliary muscle thickness of a 30, 40, 50, 60, and 70 year old example patient based on model estimates………………………………………………………………...35 Figure 6. CMTMAX as a function of mean spherical equivalent refractive error for the entire sample……………………………………………………………………………..36 Figure 7. CMT1 as a function of mean spherical equivalent refractive error for the entire sample……………………………………………………………………………………37 Figure 8. CMT2 as a function of mean spherical equivalent refractive error for the entire sample……………………………………………………………………………………38 Figure 9. CMT3 as a function of mean spherical equivalent refractive error for the entire sample……………………………………………………………………………………39 ix Figure 10. Relationship between gender, refractive error, and ciliary muscle dimensions for all subjects age 30 years and older…………………………………………………...40 x Chapter 1: Introduction Eye growth and development have been widely studied areas of vision science. We know how the majority of ocular structures, such as the crystalline lens, grow, function, and change with age and time. What we do not know is how the ciliary muscle is affected by time or the role it plays in eye growth. The ciliary muscle has, up until recently, only been studied in-depth through histological analyses, as it was difficult to view in vivo because it was obscured by the iris. Many studies have assessed ciliary muscles in animal embryos, but human ciliary muscle studies, in general, are lacking. Because only the histological make-up has been known, the ciliary muscle has largely been ignored in other studies of human eye development and how it changes throughout life. This thesis serves to discover how the ciliary muscle is related to general eye growth during childhood, refractive error development, and adulthood, including advanced age. A large portion of what we do know about eye growth after birth comes from the Orinda Longitudinal Study of Myopia (OLSM) and the Collaborative Longitudinal Evaluation of Ethnicity and Refractive Error (CLEERE) Study. Longitudinal studies such as the OLSM extensively studied the eyes of growing children by measuring anterior chamber depth, lens thickness, vitreous chamber depth, refractive error, corneal power, axial length, anterior lens radius of curvature, posterior lens radius of curvature, and lens 1 power.1 They discovered that eye growth is coordinated among these structures in all directions and that having myopic parents can impact eye growth and subsequently refractive error in a child somewhat proportionately to whether one or both parents are myopic.1,2 Data from the OLSM suggest that emmetropic subjects exhibited a stable refractive error, whereas the majority of ametropic subjects progressed towards a less positive refractive error between the ages of 6 and 12 years. Crystalline lens thickness declines until the age of 9.5 years, then begins to thicken with time.2 It is thought that although lens fibers are continuously added to the crystalline lens over time, an overall thinning is caused by an equatorial pulling on the lens as the eye grows and anterior and posterior radii of curvature flatten in children.1 As this occurs, increases in anterior chamber are found between the ages of 6-12 years to be 0.22 mm, but these changes differ between refractive error groups and whether or not refractive error is stable or progressive.1,2 Within the same age group, vitreous chamber depth increases by about 0.52 mm and axial length increases by about 0.50 mm.1 Subjects who began the study with higher amounts of hyperopia tended to be arrested in that state while low hyperopes were more likely to reach emmetropia through changes in axial length and anterior chamber depth.2 Corneal power was determined to be the main initial difference between myopic and emmetropic eyes; corneal power remained stable in myopes while gradually decreasing in emmetropes.2 Data from the CLEERE study showed that the difference in corneal power between emmetropes and 2 those who became myopes was only 0.25D.3 This suggests that there are significant changes being made in emmetropic