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Effect of Vitamin D Deficiency on Peripapillary Retinal Nerve Fiber Layer and Choroidal Thickness: A Cross-Sectional Study

Year 2025, Volume: 22 Issue: 3, 515 - 521, 29.09.2025
https://doi.org/10.35440/hutfd.1696683

Abstract

Background: To evaluate the effect of vitamin D deficiency (VDD) on the choroidal thickness (CT) and the peripapillary retinal nerve fiber layer thickness (RNFLT).
Materials and Methods: This study involved 60 patients with VDD (Group 1) and 50 healthy controls (Group 2). Group 1 was further divided into three subgroups—severe deficiency (Group 1a), defici-ency (Group 1b), and insufficiency (Group 1c)—based on serum vitamin D levels. Optical coherence tomography (OCT) was utilized to measure the subjects’ subfoveal CT, nasal CT, temporal CT, and peripapillary RNFLT.
Results: The subfoveal, temporal, and nasal CTs were observed to be significantly thinner in Group 1 than in Group 2 (p < 0.001). However, peripapillary RNFLTs did not differ significantly between Groups 1 and 2 in all quadrants (all p > 0.05). Subfoveal, temporal, and nasal CTs were significantly thinner in Group 1a than in Groups 1b and 1c (all p < 0.001). However, peripapillary RNFLTs were comparable across subgroups in all quadrants (all p > 0.05). Vitamin D levels correlated positively with subfoveal, temporal, and nasal CTs among patients with VDD.
Conclusions: Patients with VDD exhibited decreased CTs, and those with severe deficiency showed an even more dramatic decrease. Therefore, VDD may cause choroidal pathologies.

Ethical Statement

Ethical approval of the study was obtained with the decision of Adıyaman University Clinical Research Ethics Committee dated 23.06.2022 and numbered 2022-01-02.

References

  • 1. Hilger J, Friedel A, Herr R, Rausch T, Roos F, Wahl DA, et al. A systematic review of vitamin D status in populations worldwi-de. Br J Nutr. 2014;111(1):23-45.
  • 2. Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M. Vitamin D Deficiency in Children and Its Management: Review of Current Knowledge and Recommendations. Pediatrics. 2008;122(2):398–417.
  • 3. Norman AW. Sunlight, season, skin pigmentation, vitamin D, and 25-hydroxyvitamin-D:integral components of the vitamin D endocrin system. Am J Clin Nutr 1998;67:1108–10.
  • 4. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice gu-ideline. J Clin Endocrinol Metab. 2011; 96: 1911–1930.
  • 5. Alsalem JA, Patel D, Susarla R, Coca-Prados M, Bland R, Walker EA, et al. Characterization of vitamin D production by human ocular barrier cells. Invest Ophthalmol Vis Sci. 2014;55(4):2140-7.
  • 6. Reins RY, McDermott AM. Vitamin D: Implications for ocular disease and therapeutic potential. Exp Eye Res. 2015;134:101–10.
  • 7. Seyyar SA, Tokuc EO, Tıskaoğlu NS, Karabaş VL, Güngör K. Do serum vitamin D levels correlate with macular edema or with diabetic retinopathy? Eur J Ophthalmol. 2022;32(6):3592–3598.
  • 8. Kim HT, Kim JM, Kim JH, Lee MY, Won YS, Lee JY, et al. The relationship between vita- min D and glaucoma: a Kangbuk Samsung health study. Korean J. Ophthalmol. 30 (6) (2016) 426–433.
  • 9. Goncalves A, Milea D, Gohier P, Jallet G, Leruez S, Baskaran M, et al. Serum vitamin D status is associated with the presence but not the severity of primary open angle glaucoma. Maturi-tas. 2015;81(4):470–474.
  • 10. Choi D, Appukuttan B, Binek SJ, Planck SR, Stout JT, Rosenbaum JT, et al. Prediction of cis-regulatory elements controlling ge-nes differentially expressed by retinal and choroidal vascular endothelial cells. J Ocul Biol Dis Infor 2008;1:37–45.
  • 11. Mantell DJ, Owens PE, Bundred NJ, Mawer EB, Canfield AE. 1alpha,25-dihydroxyvitamin D(3) inhibits angiogenesis in vitro and in vivo. Circ Res. 2000;87(3):214–220.
  • 12. Zittermann A, Koerfer R. Protective and toxic effects of vitamin D on vascular calcification: clinical implications. 2008;29(6):423–432
  • 13. Yang L, Ma J, Zhang X, Fan Y, Wang L. Protective role of the vitamin D receptor. Cell Immunol. 2012;279(2):160–166.
  • 14. Wang Y, Chiang YH, Su TP, Hayashi T, Morales M, Hoffer BJ, et al. Vitamin D3 attenuates cortical infarction induced by middle cerebral arterial ligation in rats. Neuropharmacology. 2000;39(5):873–880.
  • 15. Pilz S, Tomaschitz A, März W, Drechsler C, Ritz E, Zittermann A, et al. Vitamin D, cardiovascular disease and mortality. Clin En-docrinol. 2011;75:575–84.
  • 16. Tarcin O, Yavuz DG, Ozben B, Telli A, Ogunc AV, Yuksel M, et al. Effect of vitamin D deficiency and replacement on endothelial function in asymptomatic subjects. J Clin Endocrinol Metab. 2009;94:4023–30.
  • 17. Brewer LC, Michos ED, Reis JP. Vitamin D in atherosclerosis, vascular disease, and endothelial function. Curr Drug Targets 2011;12:54–60.
  • 18. Vural E, Hazar L, Çağlayan M, Şeker Ö, Çelebi ARC. Peripapillary choroidal thickness in patients with vitamin D deficiency. Eur J Ophthalmol. 2021;31(2):578-583
  • 19. Öncül H, Alakus MF, Çağlayan M, Öncül FY, Dag U, Arac E.. Chan-ges in choroidal thickness after vitamin D supplementation in patients with vitamin D deficiency. Can J Ophthalmol. 2020;55(6):486–491.
  • 20. Gürbostan Soysal G, Berhuni M, Özer Özcan Z, Tıskaoğlu NS, Kaçmaz Z. Decreased choroidal vascularity index and subfoveal choroidal thickness in vitamin D insufficiency. Photodiagnosis Photodyn Ther. 2023;44:103767.
  • 21. Kocaay F, Bilen A, Asik A, Çınar ŞŞ, Aydemir E, Aydemir GA, et al. Changes in choroidal tissue post-supplementation with vitamin D in pediatric patients who are deficient in vitamin D. Int Ophthalmol. 2023;43(10):3767-3775.
  • 22. Aydemir E, Ilhan C, Aksoy Aydemir G, Bayat AH, Bolu S, Asik A. Evaluation of Retinal Structure in Pediatric Subjects With Vita-min D Deficiency. Am J Ophthalmol. 2022;233:30-37.
  • 23. Wrzosek M, Łukaszkiewicz J, Wrzosek M, Jakubczyk A, Matsumo-to H, Piątkiewicz P, et al. Vitamin D and the central nervous system. Pharmacol Rep. 2013;65(2):271–278.
  • 24. Kalueff AV, Eremin KO, Tuohimaa P. Mechanisms of neuropro-tective action of vitamin D3. Biochemistry (Mosc). 2004;69(7):738–741.
  • 25. Ozturk E, Cankaya C. Effect of Vitamin D Deficiency on Contrast Sensitivity Function. Curr Eye Res. 2020;45(12):1619-1624.

D Vitamini Eksikliğinin Peripapiller Retina Sinir Lifi Tabakası ve Koroid Kalınlığı Üzerindeki Etkisi: Kesitsel Bir Çalışma

Year 2025, Volume: 22 Issue: 3, 515 - 521, 29.09.2025
https://doi.org/10.35440/hutfd.1696683

Abstract

Amaç: D vitamini eksikliğinin (DVE) koroid kalınlığı (KK) ve peripapiller retina sinir lifi tabakası kalınlığı (RSLTK) üzerindeki etkisini değerlendirmek.
Materyal ve Metod: Çalışma grubu, DVE'si olan 60 hastadan (Grup 1) ve 50 sağlıklı kontrolden (Grup 2) oluşuyordu. Alt gruplama için serum D vitamini düzeyleri kriter alınarak Grup 1'den şiddetli eksi-klik (Grup 1a), eksiklik (Grup 1b) ve yetersizlik (Grup 1c) olmak üzere üç alt grup oluşturuldu. Deneklerin subfoveal, nazal, temporal KK ve peripapiller RSLTK'sini ölçmek için optik koherens to-mografi (OKT) (Heidelberg Spectralis OKT) kullanıldı.
Bulgular: Grup 1'in subfoveal, temporal ve nazal KK ölçümlerinin Grup 2'ninkinden önemli ölçüde daha ince olduğu görüldü (p<0,001). Grup 1 ve Grup 2'nin tüm kadranlarda Peripapiller RSLTK'leri benzerdi (her biri için p>0,05). Subfoveal, temporal ve nazal KK ölçümleri Grup 1a'da Grup 1b ve Grup 1c'den önemli ölçüde daha inceydi (her biri için p<0,001). Alt grupların peripapiller RSLTK'leri tüm kadranlarda benzerdi (her biri için p>0,05). DVE'li hastalarda subfoveal KK, temporal KK ve nazal KK skorları ile D vitamini seviyeleri arasında pozitif korelasyonlar bulundu.
Sonuç: DVE'li hastalarda KK'de azalma izlendi ve şiddetli eksikliği olanlarda daha da belirgin bir azalma mevcuttu. DVE koroidal patolojilere neden olabilir.

Ethical Statement

Çalışmanın etik onayı Adıyaman Üniversitesi Klinik Araştırmalar Etik Kurulunun 23.06.2022 tarih ve 2022-01-02 sayılı kararı ile alındı.

References

  • 1. Hilger J, Friedel A, Herr R, Rausch T, Roos F, Wahl DA, et al. A systematic review of vitamin D status in populations worldwi-de. Br J Nutr. 2014;111(1):23-45.
  • 2. Misra M, Pacaud D, Petryk A, Collett-Solberg PF, Kappy M. Vitamin D Deficiency in Children and Its Management: Review of Current Knowledge and Recommendations. Pediatrics. 2008;122(2):398–417.
  • 3. Norman AW. Sunlight, season, skin pigmentation, vitamin D, and 25-hydroxyvitamin-D:integral components of the vitamin D endocrin system. Am J Clin Nutr 1998;67:1108–10.
  • 4. Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP, et al. Evaluation, treatment, and prevention of vitamin D deficiency: an endocrine society clinical practice gu-ideline. J Clin Endocrinol Metab. 2011; 96: 1911–1930.
  • 5. Alsalem JA, Patel D, Susarla R, Coca-Prados M, Bland R, Walker EA, et al. Characterization of vitamin D production by human ocular barrier cells. Invest Ophthalmol Vis Sci. 2014;55(4):2140-7.
  • 6. Reins RY, McDermott AM. Vitamin D: Implications for ocular disease and therapeutic potential. Exp Eye Res. 2015;134:101–10.
  • 7. Seyyar SA, Tokuc EO, Tıskaoğlu NS, Karabaş VL, Güngör K. Do serum vitamin D levels correlate with macular edema or with diabetic retinopathy? Eur J Ophthalmol. 2022;32(6):3592–3598.
  • 8. Kim HT, Kim JM, Kim JH, Lee MY, Won YS, Lee JY, et al. The relationship between vita- min D and glaucoma: a Kangbuk Samsung health study. Korean J. Ophthalmol. 30 (6) (2016) 426–433.
  • 9. Goncalves A, Milea D, Gohier P, Jallet G, Leruez S, Baskaran M, et al. Serum vitamin D status is associated with the presence but not the severity of primary open angle glaucoma. Maturi-tas. 2015;81(4):470–474.
  • 10. Choi D, Appukuttan B, Binek SJ, Planck SR, Stout JT, Rosenbaum JT, et al. Prediction of cis-regulatory elements controlling ge-nes differentially expressed by retinal and choroidal vascular endothelial cells. J Ocul Biol Dis Infor 2008;1:37–45.
  • 11. Mantell DJ, Owens PE, Bundred NJ, Mawer EB, Canfield AE. 1alpha,25-dihydroxyvitamin D(3) inhibits angiogenesis in vitro and in vivo. Circ Res. 2000;87(3):214–220.
  • 12. Zittermann A, Koerfer R. Protective and toxic effects of vitamin D on vascular calcification: clinical implications. 2008;29(6):423–432
  • 13. Yang L, Ma J, Zhang X, Fan Y, Wang L. Protective role of the vitamin D receptor. Cell Immunol. 2012;279(2):160–166.
  • 14. Wang Y, Chiang YH, Su TP, Hayashi T, Morales M, Hoffer BJ, et al. Vitamin D3 attenuates cortical infarction induced by middle cerebral arterial ligation in rats. Neuropharmacology. 2000;39(5):873–880.
  • 15. Pilz S, Tomaschitz A, März W, Drechsler C, Ritz E, Zittermann A, et al. Vitamin D, cardiovascular disease and mortality. Clin En-docrinol. 2011;75:575–84.
  • 16. Tarcin O, Yavuz DG, Ozben B, Telli A, Ogunc AV, Yuksel M, et al. Effect of vitamin D deficiency and replacement on endothelial function in asymptomatic subjects. J Clin Endocrinol Metab. 2009;94:4023–30.
  • 17. Brewer LC, Michos ED, Reis JP. Vitamin D in atherosclerosis, vascular disease, and endothelial function. Curr Drug Targets 2011;12:54–60.
  • 18. Vural E, Hazar L, Çağlayan M, Şeker Ö, Çelebi ARC. Peripapillary choroidal thickness in patients with vitamin D deficiency. Eur J Ophthalmol. 2021;31(2):578-583
  • 19. Öncül H, Alakus MF, Çağlayan M, Öncül FY, Dag U, Arac E.. Chan-ges in choroidal thickness after vitamin D supplementation in patients with vitamin D deficiency. Can J Ophthalmol. 2020;55(6):486–491.
  • 20. Gürbostan Soysal G, Berhuni M, Özer Özcan Z, Tıskaoğlu NS, Kaçmaz Z. Decreased choroidal vascularity index and subfoveal choroidal thickness in vitamin D insufficiency. Photodiagnosis Photodyn Ther. 2023;44:103767.
  • 21. Kocaay F, Bilen A, Asik A, Çınar ŞŞ, Aydemir E, Aydemir GA, et al. Changes in choroidal tissue post-supplementation with vitamin D in pediatric patients who are deficient in vitamin D. Int Ophthalmol. 2023;43(10):3767-3775.
  • 22. Aydemir E, Ilhan C, Aksoy Aydemir G, Bayat AH, Bolu S, Asik A. Evaluation of Retinal Structure in Pediatric Subjects With Vita-min D Deficiency. Am J Ophthalmol. 2022;233:30-37.
  • 23. Wrzosek M, Łukaszkiewicz J, Wrzosek M, Jakubczyk A, Matsumo-to H, Piątkiewicz P, et al. Vitamin D and the central nervous system. Pharmacol Rep. 2013;65(2):271–278.
  • 24. Kalueff AV, Eremin KO, Tuohimaa P. Mechanisms of neuropro-tective action of vitamin D3. Biochemistry (Mosc). 2004;69(7):738–741.
  • 25. Ozturk E, Cankaya C. Effect of Vitamin D Deficiency on Contrast Sensitivity Function. Curr Eye Res. 2020;45(12):1619-1624.
There are 25 citations in total.

Details

Primary Language English
Subjects Ophthalmology
Journal Section Research Article
Authors

Burak Ören 0000-0003-4933-2500

Özhan Uygun This is me 0000-0002-6317-0408

Early Pub Date September 10, 2025
Publication Date September 29, 2025
Submission Date May 10, 2025
Acceptance Date August 29, 2025
Published in Issue Year 2025 Volume: 22 Issue: 3

Cite

Vancouver Ören B, Uygun Ö. Effect of Vitamin D Deficiency on Peripapillary Retinal Nerve Fiber Layer and Choroidal Thickness: A Cross-Sectional Study. Harran Üniversitesi Tıp Fakültesi Dergisi. 2025;22(3):515-21.

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