Central corneal thickness in European (white) individuals, especially children and the elderly, and assessment of its possible importance in clinical measures of intra-ocular pressure

Abstract

Purpose: To ascertain the impact of central corneal thickness (CCT, as assessed by pachometry) and central corneal curvature (as assessed by keratometry) on clinical measures of intra-ocular pressure (IOP, as assessed by tonometry), especially in the young and elderly.

Methods: Pachometry, keratometry and tonometry were carried out on three groups, namely children aged 5-15 years, adults aged 32-60 years, and elderly individuals aged between 61 and 82 years. For children, ultrasound pachometry was combined with non-contact tonometry (NCT), specular microscopy was used with Perkins tonometry in the adults, and ultrasound pachometry was used with Perkins tonometry for the elderly. Central corneal curvature was assessed by keratometry.

Results: The average CCT in children was 0.529+/-0.034 mm (n = 104, +/-S.D.), averaged 0.533+/-0.033 in adults (n=75) and 0.527+/-0.034 mm (n=91) in the elderly. Tonometry values averaged 16.7+/-2.9 mm in children, 13.0+/-3.5 mmHg in adults and 13.6+/-2.5 mm in the elderly group. Central corneal thickness values were not predictably different in relation to central corneal curvature values. Regression analyses indicated that the tonometry values were higher in both children and the elderly who had thicker corneas (and vice versa) (p < 0.003), with the measures increasing by 1.3+/-0.4 and 2.6+/-0.4 mmHg for a 10% difference in CCT in children and the elderly, respectively. For adults, no statistically significant difference in tonometry values could be demonstrated with respect to CCT (<1 mmHg for a 10% difference in CCT), and for no group were the CCT or tonometry values predictably different in relation to central comeal curvature values.

Conclusions: The results of these studies, albeit relatively small scale, indicate that in young or elderly individuals with essentially normal IOP and CCT measures, the tonometry values show only small differences with respect to CCT. The slope in the observed relationship was not that different from an average of 1.5 mmHg for a 10% different in CCT, as obtained from a literature analysis over a 30-year period. The magnitude of the effect does not provide evidence that pachometry needs to be routinely performed in glaucoma screening protocols based on tonometry. Notwithstanding, the finding of higher than expected tonometry values should be further investigated, by pachometry, especially in very young children and in the elderly.