Corneal densitometry and associated factors in an elderly population

Clinical Relevance: Knowing normative corneal optical density (COD) values is important for identifying pathologic corneal changes. Background: The aim of this work is to determine the distribution and associated factors of COD in the elderly population. Methods: This report is a part of a cross-sectional population-based study conducted on the elderly population (>= 60 years) of Tehran, Iran from Jan 2019 to Jan 2020. Using a multi-stage stratified random cluster sampling method, a total of 160 clusters were randomly selected from 22 districts of Tehran city. Study participants underwent a complete ocular examination including measurement of visual acuity, refraction, and slit-lamp biomicroscopy. Corneal densitometry was evaluated using the Pentacam HR. Generalized estimating equation (GEE) models were used to investigate associations of COD with study variables. Results: A total of 3633 eyes from 2068 individuals were analysed. Of these, 1256 (60.7%) were female, and the mean age of the individuals was 66.42 +/- 5.28 (60 to 95) years. The mean entire COD was 21.96 +/- 4.45 greyscale unit (GSU) (95% CI: 21.57-22.34). There was a statistically significant difference in the mean COD between the anterior, central, and posterior layers (p < 0.001); the highest and lowest average COD was related to the anterior and posterior corneal layers, respectively. The lowest and highest mean COD were observed in the 0-2 mm [17.21GSU (95% CI:16.87-17.55)], and 10-12 mm annular zones [31.4 GSU (95% CI: 30.89-31.91)], respectively (p < 0.001). According to the multiple GEE model, the COD had a statistically significant direct relationship with age, central corneal thickness, and mean keratometry, while it was significantly inversely associated with female sex, anterior chamber depth, white-to-white distance, and corneal volume. Conclusion: These normal values of COD in the present study could be used as reference data in older adults. The associated factors of COD should be taken into account to avoid misinterpretation of physiologic changes as pathologic processes.