Thinning rates were classified according to SE into three groups: nonmyopic (NM; >0 D), mild-to-moderately myopic (MM; >–6 D and ≤0 D), and highly myopic (HM; ≤–6 D). Results. The overall slopes of change in RNFL thickness over time in the NM, MM, and HM groups were −0.305 ± 0.128, −0.294 ± 0.068, and −0.208 ± 0.097 μm/yr, respectively. Slopes of RNFL thickness changes in these groups were −0.514 ± 0.248, −0.520 ± 0.133, and −0.528 ± 0.188 μm/yr, in the superior quadrant; −0.084 ± 0.145, 0.107 ± 0.082, and −0.161 ± 0.112 μm/yr, in the temporal quadrant; −0.807 ± 0.242, −0.794 ± 0.130, and −0.727 ± 0.183 μm/yr, in the inferior quadrant; and 0.160 ± 0.157, 0.118 ± 0.084, and 0.429 ± 0.119 μm/yr, in the nasal quadrant. Overall and in all four quadrants, there was no significant difference in the rate of RNFL thickness change among the three groups. Conclusions. Refractive error did not affect the physiologic thinning rate of RNFL when assessed by SD OCT.
Similarly, thickening of the RNFL in this quadrant by +0.308 μm/yr has been reported [2], further suggesting that the nasal sector did not experience age-related loss in RNFL thickness. This may have been due to the proportion of nonneuronal tissue, such as glial tissue, in the RNFL, which has been reported to increase with age [27, 28]. OCT assesses the thickness between the internal limiting membrane and the ganglion cell layer in the retina; thus, OCT cannot measure the RNFL separately from other layers. Axonal fibers in the RNFL decrease with age, indicating an inverse relationship between thickness and the proportion of nonneuronal tissue. Thus, changes in RNFL, as measured by OCT, result from a combination of a decreased width of neuronal tissue and an increased width of nonneuronal tissue. This would apply not only to the nasal quadrant but also to all quadrants. However, consistent results showing that RNFL thickness in the nasal sector increases or remains stable suggest an effect of nonneuronal tissue and its possible increase over time.
In contrast to our results, RNFL thinning rate has been reported to be faster in highly myopic than in nonmyopic eyes in subjects aged 40–59 years who were followed-up for more than 3 years [29]. Because our subjects were relatively younger (mean age, 40 ± 12 years), direct comparison between these studies may be inappropriate. Furthermore, the previous study also reported that RNFL thinning rates were similar in highly myopic and nonmyopic eyes of younger subjects, in agreement with our results [29]. Furthermore, the shorter follow-up period in the previous study (3 years) than in ours (6 years) may have resulted in different outcomes. Highly myopic eyes with injured and thinner RNFL in younger subjects due to a sudden increase in axial length may experience a faster deterioration of the RNFL as the subject becomes 40–59 years old. Further studies are needed, however, to test this hypothesis. Our participants showed faster thinning in men compared with women. This may be due to thinner baseline RNFL in men than in women (83.4 vs. 87.7 μm).