PONE-D-25-01148Retinal Structure and Related Factors in 8-year-old Japanese Children: The Yamanashi Adjunct Study of the Japan Environment and Children's StudyPLOS ONE

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This adjunct study was supported by Japan Society for the Promotion of Science, No.23K09003.

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Zentaro Yamagata, Ryoji Shinohara, Sanae Otawa, Anna Kobayashi, Megumi Kushima, Hideki Yui, Takeshi Inukai, Kyoichiro Tsuchiya, Hirotaka Haro, Masanori Wako, Takahiko Mitsui, Kenji Kashiwagi, Daijyu Sakurai, Koichiro Ueki, Sumire Ono, Tadao Ooka, Hiroshi Yokomichi, Kunio Miyake, Sayaka Horiuchi, and Reiji Kojima.

The Japan Environment and Children’s Study was funded by the Ministry of the Environment, Japan. This adjunct study was supported by Japan Society for the Promotion of Science, No.23K09003.

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This adjunct study was supported by Japan Society for the Promotion of Science, No.23K09003.

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Reviewer #1: Partly

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #2: Yes

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Reviewer #1:  The authors reported retinal structure and related factors in 8-year-old Japanese children. Although this manuscript has some interesting observations, the manuscript needs to be improved before it can be accepted in the journal.

Introduction

Line 60: Space is needed between sentences

Figure 1

Why do the authors exclude the nerve fiber layer and inner nuclear layer from the inner retinal layer, and the outer plexiform layer from the outer retinal layer? Isn't the inner retinal layer that the authors refer to GCIPL (ganglion cell and inner plexiform layer)? The terms used in the paper and the terms used by the authors have different meanings. The term All retinal layers (ARLs) is also not used in the paper, so please change it to the term used in ordinary papers.

At 8.5 years of age, the choroid is very thick and many eyes cannot be measured, so how did the authors measure the choroid? The boundary between the sclera and choroid is not clear in Figure 1, so please provide an image that clearly shows the boundary. If there are many cases where the choroid cannot be measured, please explain the impact on the results.

Inclusion criteria

Please state the number of subjects who used their left eye.

Table 2

What does "Choroid only" mean? Does it mean that the choroid was measurable in 239 eyes?

Discussion

Line 278: This study is part of a cohort survey, but as an ophthalmology study it is a cross-sectional study, so please correct this.

Reviewer #2:  Main comments

1. justification for selecting 8-year-olds

Further clarification is needed as to why the 8-year-olds were chosen as the study subjects. Providing a clear justification for why the 8-year-olds were chosen would strengthen the methodological foundation of the study. 2.

2. possible underestimation due to exclusion bias

The manuscript states that a significant number of participants were excluded due to poor OCT image quality, lack of cooperation in examination, and suboptimal fixation. Notably, the excluded group had significantly longer axial lengths and a higher prevalence of myopia. This exclusion may have underestimated the association between axial length and retinal thickness in this study. For the sake of transparency, it would be beneficial to discuss in more detail the potential impact of this exclusion bias on the study results.

Minor comments.

1. the circled numbers in Figure 1b are not shown.

2. it is difficult to see the relationship between the columns of independent variables and dependent variables in Table 6.

3. a brief description of the specifications of the NIDEK RS-3000 Advance used for the measurements (e.g., spatial resolution, measurement accuracy, etc.) would facilitate comparison with other studies.

4. a colon is missing at the end of the sentence in line82.

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Reviewer #1: No

Reviewer #2: No

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Retinal Structure and Related Factors in 8-year-old Japanese Children: The Yamanashi Adjunct Study of the Japan Environment and Children's Study

PONE-D-25-01148R1

Dear Prof. Kahiwagi

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