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Figure 1.

Central corneal thickness CCT for white and Hispanic subjects plotted by age with superimposed 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles. Figure 2. Central corneal thickness CCT for African American subjects plotted by age with superimposed 5th, 10th, 25th, 50th, 75th, 90th, and 95th percentiles. Figure 3. Central corneal thickness CCT by spherical equivalent.

Regression was adjusted for age, race, and sex. Partial coefficient of determination R 2 for spherical equivalent is 0. Figure 4.

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Intraocular pressure by central corneal thickness CCT. Regression was adjusted for age, race, sex, and examination setting. Partial coefficient of determination R 2 for CCT is 0. Central Corneal Thickness in Children. Arch Ophthalmol. Objectives To determine the central corneal thickness CCT in healthy white, African American, and Hispanic children from birth to 17 years of age and to determine whether CCT varies by age, race, or ethnicity.

De Prospective observational multicenter study. Central corneal thickness was measured with a handheld contact pachymeter. A total of children were included in the study, with ages ranging from birth to 17 years.

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Sex addict Erie Pennsylvania 9 thick were whites, Hispanics, and African Americans, in addition to Asian, unknown race, and mixed-race individuals. Conclusions Median CCT increases with age from 1 to 11 years, with the greatest increase present in the youngest age groups.

African American children on average have thinner central corneas than white and Hispanic children, whereas white and Hispanic children demonstrate similar CCT. These data suggest that basing applanation tonometry on average CCT may be inaccurate because it does not for wide individual variation in CCT. Following the Ocular Hypertension Treatment Study publication, studies in adults confirmed racial differences in CCT between white and African American adults, but not between white and Asian or Hispanic adults. More recently, heredity 2 and refractive error 3 have been reported to influence CCT.

If differences in CCT produce substantial errors in measurement of applanation intraocular pressure IOP 4 then CCT could have a direct effect on the clinical assessment of glaucoma risk.

There are limited data for CCT among children. One study performed among European white subjects found no difference in the mean CCT of children compared with adults.

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Another study demonstrated that African American children had CCT thinner than that of white children, and both groups showed an increase in CCT after 10 years of age. This report was also limited in that most subjects were older than 5 years. Our primary objectives were to determine the CCT of a large cohort of healthy children from birth to 17 years of age and to determine whether CCT varies by age, race, or ethnicity.

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Secondarily, we sought to determine the age at which childhood CCT stabilizes and to examine associations between CCT and other clinical characteristics, such as refractive error and IOP. The protocol and Health Insurance Portability and ability Act—compliant informed consent forms were approved by the institutional review boards at each participating site, and a parent or guardian of each study subject gave written informed consent. The study adhered to the tenets of the Declaration of Helsinki.

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Major eligibility criteria included age from birth to 17 years, ability to have CCT measured in the clinic setting or under general anesthesia, cycloplegic refraction performed upon enrollment or within 6 months of enrollment, and presence of healthy corneas without ocular or systemic conditions that would influence CCT or IOP measurements. Acceptable ocular conditions included strabismus, nasolacrimal duct obstruction, and refractive error.

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A third IOP measurement with the tonometer was required if the first 2 differed by 2 mm Hg or more. A cycloplegic refraction with dilated fundus examination was performed, if not performed within the prior 6 months. Measurements could be taken in the clinic setting or under general anesthesia. The tonometer and pachymeter were calibrated for use each day prior to the initial subject testing.

The CCT average, of measurements included in the average, and SD were calculated by the instrument. Each average measurement took a few seconds to obtain. Intraocular pressure measurements were taken after instillation of proparacaine, 0. Subjects under general anesthesia had IOP measured within 2 minutes of anesthesia induction, if possible. Time in minutes from induction to IOP measurement was documented. There were no specific targets for other racial groups because it was not considered feasible to enroll the necessary s in a reasonable time frame.

The age groups were as follows: 0 to 5 months, 6 to 11 months, 12 to 23 months, 2 years, 3 years, 4 to 5 years, 6 to 7 years, 8 to 9 years, 10 to 12 years, and 13 to 17 years.

Age groups were used to define recruitment goals and to guarantee a greater of subjects in the age range at which CCT was suspected to be most rapidly changing, on the basis of of studies of CCT in children, 79 but the age groups were not used in analyses; age was analyzed as a continuous factor. Central corneal thickness measurements with an SD greater than 5.

The median of the CCT measurements for each eye was computed using the of measurements as a weighting factor, and the medians of the 2 eyes were averaged to obtain a subject-level measurement used for analysis Pearson product moment correlation for right eye vs left eye medians, 0. For subjects with data for only 1 eye, the median for that eye was used as the subject-level measurement.

The Tukey-Kramer adjustment for multiple comparisons was used for racial group comparisons.

Central corneal Sex addict Erie Pennsylvania 9 thick at different ages was compared using linear contrasts. Because the growth curve for CCT was not linear with age, models with higher-order polynomial terms for age were fit, with non—statistically ificant higher-order terms eliminated one at a time, to reach a final model that contained a linear and a quadratic term for age.

Data for infants birth to 11 months were not included in the model because of the small sample size of this age group. Models including interactions for age by race and sex also were tested to allow for the possibility that the growth curve for CCT differed by these criteria. Because of the small sample size in African Americans younger than 4 years, the reference percentile derivation for these subjects was limited to age 4 years and older. A reference range for whites 6 to 11 months of age was derived assuming normally distributed data with constant mean and SD across the age range.

It has been reported that inhalation anesthetics lower IOP within a few minutes of anesthesia induction. The model for IOP also included an adjustment for examination setting. The spherical equivalent model included averaged data from both eyes, whereas the IOP model included data from right eyes only.


Infants younger than 6 months with cycloplegic refraction performed more than 30 days before enrollment were excluded from the refractive error analysis because these measurements may not reflect their refraction at the time of CCT measurement. The study enrolled subjects; Reasons for exclusion from analysis were as follows: subject found to be ineligible after enrollment 29 subjectsprocedural deviation when obtaining measurements 11 subjectsSD greater than 5. Two subjects were enrolled on the day of birth. The East Asian subjects enrolled were insufficient for derivation of reference percentiles but were sufficient for comparison of mean CCT with other racial groups.

Measurements were made in A total of eyes The mean age of the subjects tested with topical anesthesia in the office was 8. Sex addict Erie Pennsylvania 9 thick percent of subjects were female eTable. Other than refractive error, common diagnoses included normal findings on the eye examination, strabismus, nasolacrimal duct obstruction, and amblyopia. The coefficients of determination R 2 were 0. However, there was substantial variability across the age range.

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There was no evidence that the differences observed with age in the median CCT differed by race or sex. Because of the similarity of CCT for Hispanic and white subjects, their data were pooled for derivation of reference percentiles, whereas reference percentiles for African American subjects were derived separately Tables 1 and 2.

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Similarly, data for both sexes were pooled because the small difference between them was judged to be clinically irrelevant. Intraocular pressure ranged from 5 to 29 mm Hg, with most subjects We did not enroll a sufficient of whites younger than 6 months or African American infants to derive normative percentiles for those groups. ificant changes in axial length, corneal diameter, and refractive state occur with the growth of 's eye. We demonstrated that CCT in healthy children also changes modestly with age, with most of the change occurring before age 11 years.

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Hispanic and white subjects had similar CCT at each age, whereas African American subjects had ificantly thinner corneas at all ages. The clinical ificance of this range is unknown.

Several studies of CCT among children of varying age have been reported. Hussein et al 9 studied CCT measurements in children and found mean CCT to increase with age, reaching adult thickness by 5 years of age. However, the study had only 18 patients older than 10 years. Consistent with ourHaider et al 6 found mean CCT to be thicker in both white and African American children 10 to 18 years old compared with that of younger children. Hussein et Sex addict Erie Pennsylvania 9 thick 9 reported higher CCT in children 5 to 9 years old, compared with that of children younger than 4 years.

These investigators did not have sufficient s of older children to determine whether this trend continued beyond age 9 years. Conversely, other investigators have not found CCT to increase with age. Zheng and colleagues 13 studied children 8 to 16 years of age and found no association between CCT and age.