Retinal nerve fibre layer thickness in association with gamma zone width and disc‐fovea distance

Previous studies have shown that the retinal nerve fibre layer (RNFL) thickness as surrogate of the optic nerve decreases with longer axial length. We explored which explanatory parameters might explain that association.Participants of the population-based Beijing Eye Study 2011 without any retinal or optic nerve disease were selected based on a refractive error-based stratified randomization.The study included of 632 participants (age: 59.1 ± 7.3 years; axial length: 23.5 ± 1.2 mm; range: 20.88-28.68 mm). Thicker RNFL (mean: 101.0 ± 10.0 μm) was associated (multivariable analysis) with smaller parapapillary gamma zone (defined as Bruch's membrane-free parapapillary region) (standardized regression coefficient beta: -0.13; non-stadardized regression coefficient B: -0.008; 95% confidence interval (CI): -0.014, -0.003; p = 0.005) and shorter disc-fovea distance (beta: -0.15; B: -3.91; 95% CI: -6.60; -1.22; p = 0.004), after adjusting for age (beta: -0.22; B: -030; 95% CI: -0.41, -0.19; p < 0.001), gender (beta: 0.12; B: 2.37; 95% CI 0.77, 3.97; p = 0.004) and larger optic disc area (beta: 0.12; B: 0.12; 95% CI: 2.14; 95% CI: 0.54, 3.73; p = 0.009). RNFL thickness decreased by 8 μm (95% CI: 3, 14) for each mm increase in gamma zone width, and by 3.91 μm (95% CI: 1.22, 6.60) for each mm elongation of the disc-fovea distance. If disc-fovea distance and gamma zone width were replaced by axial length, the latter was correlated with RNFL thickness (beta: -0.37; B: -3.12; 95% CI: -3.88, -2.35; p < 0.001). Longer disc-fovea distance was directly associated with larger gamma zone (beta: 0.50; B: p < 0.001).The RNFL thickness decrease with longer axial length is associated with a longer optic disc-fovea distance and larger parapapillary gamma zone. Longer disc-fovea distance and larger gamma zone lead to an elongation and stretching of the retinal nerve fibres, potentially causing a thinning or loss of the nerve fibres. It may explain the occurrence of visual field defects in some non-glaucomatous highly myopic eyes without macular correlates of the perimetric defects.