Elsevier

Ophthalmology

Volume 126, Issue 11, November 2019, Pages 1500-1510
Ophthalmology

Original Article
Associations with Corneal Hysteresis in a Population Cohort: Results from 96 010 UK Biobank Participants

https://doi.org/10.1016/j.ophtha.2019.06.029Get rights and content

Purpose

To describe the distribution of corneal hysteresis (CH) in a large cohort and explore its associated factors and possible clinical applications.

Design

Cross-sectional study within the UK Biobank, a large cohort study in the United Kingdom.

Participants

We analyzed CH data from 93 345 eligible participants in the UK Biobank cohort, aged 40 to 69 years.

Methods

All analyses were performed using left eye data. Linear regression models were used to evaluate associations between CH and demographic, lifestyle, ocular, and systemic variables. Piecewise logistic regression models were used to explore the relationship between self-reported glaucoma and CH.

Main Outcome Measures

Corneal hysteresis (mmHg).

Results

The mean CH was 10.6 mmHg (10.4 mmHg in male and 10.8 mmHg in female participants). After adjusting for covariables, CH was significantly negatively associated with male sex, age, black ethnicity, self-reported glaucoma, diastolic blood pressure, and height. Corneal hysteresis was significantly positively associated with smoking, hyperopia, diabetes, systemic lupus erythematosus (SLE), greater deprivation (Townsend index), and Goldmann-correlated intraocular pressure (IOPg). Self-reported glaucoma and CH were significantly associated when CH was less than 10.1 mmHg (odds ratio, 0.86; 95% confidence interval, 0.79–0.94 per mmHg CH increase) after adjusting for covariables. When CH exceeded 10.1 mmHg, there was no significant association between CH and self-reported glaucoma.

Conclusions

In our analyses, CH was significantly associated with factors including age, sex, and ethnicity, which should be taken into account when interpreting CH values. In our cohort, lower CH was significantly associated with a higher prevalence of self-reported glaucoma when CH was less than 10.1 mmHg. Corneal hysteresis may serve as a biomarker aiding glaucoma case detection.

Section snippets

Study Population

The UK Biobank is a multisite community-based cohort study with 502 544 participants. All UK residents aged 40 to 69 years who registered with the National Health Service and lived within 25 miles of any of the 22 assessment centers were invited to join the study. The initial visit assessments took place between 2006 and 2010. Eye assessments were carried out from 2009 in 6 recruitment centers (5 in England and 1 in Wales) that enrolled 133 953 participants. The UK Biobank study was approved by

Results

All analyses were performed using left eye data in this study. A total of 111 942 UK Biobank participants had available CH values for left eyes. After data cleaning as shown in Figure 1, the mean CH was 10.60±1.88 mmHg (95% confidence interval [CI], 10.59–10.62 mmHg) in the 92 137 eyes without self-reported glaucoma. The distribution of mean CH stratified by age, sex, and ethnicity is summarized in Table 1. A significant difference in CH was found between participants with different ethnicities

Discussion

In this large UK cohort, we have described mean CH stratified by age, sex, and ethnicity (Table 1). We found that CH was significantly lower in black participants and in older age groups, which is consistent with previously published findings.15, 23 Past studies indicate that CH and CCT are positively associated,24, 25, 26 and CCT is negatively associated with darker skin pigmentation.27 One explanation for the variation in CH by ethnicity may be differences mediated by changes in CCT.

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  • Cited by (25)

    • Corneal Hysteresis and Rates of Neuroretinal Rim Change in Glaucoma

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      In contrast to CCT, which presents relative stability during adulthood, CH is a dynamic metric that may change over time. Older subjects have been shown to have lower values of CH.6,37 However, a recent longitudinal study showed that for a clinical follow-up period of up to 4.5 years, CH seems to remain stable.9

    • Corneal biomechanical properties following corneal cross-linking: Does age have an effect?

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      Their results showed that the measurements of biomechanical parameters such as corneal hysteresis and corneal resistance factor are lower in older groups compared to younger groups. Similar findings have also been reported in more recent clinical studies (Momeni-Moghaddam et al., 2019; Zhang et al., 2019). This clinical data indicates that older eyes have lower deformability compared to younger eyes, which suggests an increase in corneal stiffness with age.

    • Corneal Stiffness Parameters Are Predictive of Structural and Functional Progression in Glaucoma Suspect Eyes

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      In addition to corneal thickness, other corneal biomechanical properties also have been studied in glaucoma. Corneal hysteresis measures the viscoelastic damping of corneal tissues in response to an air puff and is found to be lower in eyes with glaucoma.44 Lower corneal hysteresis also is a risk factor for the development and progression of glaucoma.15,45

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    Supplemental material available at www.aaojournal.org.

    Financial Disclosure(s): The author(s) have made the following disclosure(s): P.J.F.: Personal fees – Allergan, Carl Zeiss, Google/DeepMind, Santen; Grant – Alcon, outside the submitted work; Support – Richard Desmond Charitable Trust, via Fight for Sight, London.

    A.P.K.: Supported – Moorfields Eye Charity Career Development Fellowship.

    P.J.F. and A.P.K.: Salary support – National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital.

    These authors acknowledge a proportion of our financial support from the UK Department of Health through an award made by the National Institute for Health Research to Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology for a Biomedical Research Centre for Ophthalmology.

    This analysis was funded by the Medical Research Council, UK (MRC), through a grant to Dementia Platforms UK (DPUK) - MRC grant ref MR/ L023784/2 (to B.Z.). Data from UK Biobank were accessed under application number 15008 (to B.Z.) on the DPUK Data Portal. The UK Biobank Eye and Vision Consortium is supported by grants from The National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital NHS Foundation Trust and UCL Institute of Ophthalmology, the Alcon Research Institute, Moorfields Eye Charity, and the International Glaucoma Association. No funders had a direct role in the collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or in the decision to submit the manuscript for publication.

    HUMAN SUBJECTS: Human subjects were included in this study. The North West Multi-centre Research Ethics Committee approved the study (Reference No., 06/MRE08/65), in accordance with the tenets of the Declaration of Helsinki. Detailed information about the study is available at the UK Biobank web site (www.ukbiobank.ac.uk). All participants provided informed consent.

    No animal subjects were used in this study.

    Author Contributions:

    Conception and design: Zhang, Khawaja, Gallacher, Foster

    Data collection: Zhang, Shweikh, Khawaja, Gallacher, Foster, UK Biobank Eye & Vision Consortium

    Analysis and interpretation: Zhang, Shweikh, Khawaja, Gallacher, Bauermeister, Foster

    Obtained funding: N/A

    Overall responsibility: Zhang, Shweikh, Khawaja, Gallacher, Bauermeister, Foster

    Appendix 1. UK Biobank Eye and Vision Consortium Membership. UK Biobank Eye & Vision Consortium: The UK Biobank Eye & Vision Consortium members are Tariq Aslam, PhD, Manchester University, Sarah A. Barman, PhD, Kingston University, Jenny H. Barrett, PhD, University of Leeds, Paul Bishop, PhD, Manchester University, Peter Blows, BSc, NIHR Biomedical Research Centre, Catey Bunce, DSc, King’s College London, Roxana O. Carare, PhD, University of Southampton, Usha Chakravarthy, FRCOphth, Queens University Belfast, Michelle Chan, FRCOphth, NIHR Biomedical Research Centre, Sharon Y.L. Chua, PhD, NIHR Biomedical Research Centre, David P. Crabb, PhD, UCL, Philippa M. Cumberland, MSc, UCL Great Ormond Street Institute of Child Health, Alexander Day, PhD, NIHR Biomedical Research Centre, Parul Desai, PhD, NIHR Biomedical Research Centre, Bal Dhillon, FRCOphth, University of Edinburgh, Andrew D. Dick, FRCOphth, University of Bristol, Cathy Egan, FRCOphth, NIHR Biomedical Research Centre, Sarah Ennis, PhD, University of Southampton, Paul Foster, PhD, NIHR Biomedical Research Centre, Marcus Fruttiger, PhD, NIHR Biomedical Research Centre, John E.J. Gallacher, PhD, University of Oxford, David F. GARWAY-HEATH FRCOphth- NIHR Biomedical Research Centre, Jane Gibson, PhD, University of Southampton, Dan Gore, FRCOphth, NIHR Biomedical Research Centre, Jeremy A. Guggenheim, PhD, Cardiff University, Chris J. Hammond, FRCOphth, King’s College London, Alison Hardcastle, PhD, NIHR Biomedical Research Centre, Simon P. Harding, MD, University of Liverpool, Ruth E. Hogg, PhD, Queens University Belfast, Pirro Hysi, PhD, King’s College London, Pearse A. Keane, MD, NIHR Biomedical Research Centre, Sir Peng T. Khaw, PhD, NIHR Biomedical Research Centre, Anthony P. Khawaja, DPhil, NIHR Biomedical Research Centre, Gerassim dos Lascaratos, PhD, NIHR Biomedical Research Centre, Andrew J. Lotery, MD, University of Southampton, Tom Macgillivray, PhD, University of Edinburgh, Sarah Mackie, PhD, University of Leeds, Keith Martin, FRCOphth, University of Cambridge, Michelle McGaughey, Queen’s University Belfast, Bernadette McGuinness, PhD, Queen’s University Belfast, Gareth J. McKay, PhD, Queen’s University Belfast, Martin McKibbin, FRCOphth, Leeds Teaching Hospitals NHS Trust, Danny Mitry, PhD, NIHR Biomedical Research Centre, Tony Moore, FRCOphth, NIHR Biomedical Research Centre, James E. Morgan, DPhil, Cardiff University, Zaynah A. Muthy, BSc, NIHR Biomedical Research Centre, Eoin O’Sullivan, MD, King’s College Hospital NHS Foundation Trust, Chris G. Owen, PhD, University of London, Praveen Patel, FRCOphth, NIHR Biomedical Research Centre, Euan Paterson, BSc, Queens University Belfast, Tunde Peto, PhD, Queen’s University Belfast, Axel Petzold, PhD, UCL, Jugnoo S. Rahi, PhD, UCL Great Ormond Street Institute of Child Health, Alicja R. Rudnikca, PhD, University of London, Jay Self, PhD, University of Southampton, Sobha Sivaprasad, FRCOphth, NIHR Biomedical Research Centre, David Steel, FRCOphth, Newcastle University, Irene Stratton, MSc, Gloucestershire Hospitals NHS Foundation Trust, Nicholas Strouthidis, PhD, NIHR Biomedical Research Centre, Cathie Sudlow, DPhil, University of Edinburgh, Dhanes Thomas, FRCOphth, NIHR Biomedical Research Centre, Emanuele Trucco, PhD, University of Dundee, Adnan Tufail, FRCOphth, NIHR Biomedical Research Centre, Veronique Vitart, PhD, University of Edinburgh, Stephen A. Vernon, DM, Nottingham University HospitalsNHS Trust, Ananth C. Viswanathan, FRCOphth, NIHR Biomedical Research Centre, Cathy Williams, PhD, University of Bristol, Katie Williams, PhD, King’s College London, Jayne V. Woodside, MRCOphth, PhD, Queen’s University Belfast, Max M. Yates, PhD, University of East Anglia, Jennifer Yip, PhD, University of Cambridge, and Yalin Zheng, PhD, University of Liverpool.

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