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Zhou X, Ye C, Wang X, Zhou W, Reinach P, Qu J. Choroidal blood perfusion as a potential "rapid predictive index" for myopia development and progression. EYE AND VISION (LONDON, ENGLAND) 2021; 8:1. [PMID: 33397473 PMCID: PMC7780679 DOI: 10.1186/s40662-020-00224-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 12/10/2020] [Indexed: 12/13/2022]
Abstract
Myopia is the leading cause of visual impairment worldwide. The lack of a "rapid predictive index" for myopia development and progression hinders the clinic management and prevention of myopia. This article reviews the studies describing changes that occur in the choroid during myopia development and proposes that it is possible to detect myopia development at an earlier stage than is currently possible in a clinical setting using choroidal blood perfusion as a "rapid predictive index" of myopia.
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Affiliation(s)
- Xiangtian Zhou
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang China
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences (2019RU025), Wenzhou, Zhejiang China
| | - Cong Ye
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang China
| | - Xiaoyan Wang
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang China
| | - Weihe Zhou
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang China
| | - Peter Reinach
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang China
| | - Jia Qu
- Eye Hospital and School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, Zhejiang China
- National Clinical Research Center for Ocular Diseases, Wenzhou, Zhejiang China
- State Key Laboratory of Optometry, Ophthalmology and Vision Science, Wenzhou, Zhejiang China
- Research Unit of Myopia Basic Research and Clinical Prevention and Control, Chinese Academy of Medical Sciences (2019RU025), Wenzhou, Zhejiang China
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Read SA, Cox RA, Alonso-Caneiro D, Hopkins S, Wood JM. Choroidal Thickness in Indigenous Australian Children. Transl Vis Sci Technol 2020; 9:28. [PMID: 33244448 PMCID: PMC7683852 DOI: 10.1167/tvst.9.12.28] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 10/11/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose This study aimed to examine the choroidal thickness profiles in visually normal Australian Indigenous children, given the important role of the choroid in refractive error and a range of ocular diseases. Methods Choroidal thickness was assessed across the central 5 mm macular region using enhanced depth imaging spectral domain optical coherence tomography, in 250 children enrolled in an elementary school and a secondary school in rural Queensland, Australia. One hundred (40%) of these children identified as Indigenous Australians. Results The subfoveal choroid was significantly thicker in Indigenous children (mean 369 ± 75 µm), compared to non-Indigenous children (355 ± 73 µm; P = 0.03). Subfoveal choroidal thickness was also significantly associated with age (β = +7.6, r2 = 0.105, P = 0.003), and axial length (β = −19.9, r2 = 0.030, P < 0.001). A significantly thicker choroid in Indigenous children was also found in analyses across the central 5 mm macular region (P = 0.008). A significant interaction between Indigenous status and meridian was observed (P = 0.007) with the largest differences between Indigenous and non-Indigenous children being in the nasal and inferonasal meridians. Conclusions This study establishes the normative characteristics of macular choroidal thickness in Indigenous Australian children and demonstrates a significantly thicker choroid compared to non-Indigenous children from the same geographic region. These results may have implications for our understanding of factors predisposing or protecting Australian Indigenous people from a range of conditions associated with choroidal thickness. Translational Relevance The significantly thicker choroid in Australian Indigenous children should be considered in clinical diagnoses and management of conditions associated with choroidal changes.
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Affiliation(s)
- Scott A Read
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Kelvin Grove, Queensland, Australia
| | - Rebecca A Cox
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Kelvin Grove, Queensland, Australia
| | - David Alonso-Caneiro
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Kelvin Grove, Queensland, Australia
| | - Shelley Hopkins
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Kelvin Grove, Queensland, Australia
| | - Joanne M Wood
- Queensland University of Technology (QUT), Centre for Vision and Eye Research, School of Optometry and Vision Science, Kelvin Grove, Queensland, Australia
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Ayyildiz D, Ayyildiz T. Central choroidal thickness in children and adolescents with anxiety disorders: enhanced depth imaging optical coherence tomography findings. Int J Ophthalmol 2020; 13:1580-1585. [PMID: 33078108 PMCID: PMC7511390 DOI: 10.18240/ijo.2020.10.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/22/2020] [Indexed: 12/22/2022] Open
Abstract
AIM To measure the central choroidal thickness (ChT) in children and adolescents with anxiety disorders. METHODS Totally 41 anxiety patients (8-16y) and 35 healthy controls (age-matched) were evaluated. Complete ophthalmic examination was performed. Inclusion criteria were best corrected visual acuity ≥20/20, normal intraocular pressure (IOP; 10-21 mm Hg), and no systemic or ocular diseases according to history. The diagnosis of psychiatric disorders was determined using Schedule for Affective Disorders and Schizophrenia for School Aged Children Present-Lifetime Version (K-SADS-PL). Enhanced depth imaging optical coherence tomography (EDI-OCT) was used to measure the central ChT. RESULTS The mean age was 12.18±3.24y in the patient group and 12.86±3.15y in the control group. Age and gender distribution of the two groups was similar. Central ChT mean value was 353.26±31.9 µm in anxiety patients while 318.75±60.9 µm in the control group. Mean central ChT was statistically significantly higher in the children and adolescents with anxiety disorders than healthy controls (P=0.002). CONCLUSION The children and adolescents with anxiety disorders have significantly thicker central ChT than controls. In the larger sample, longitudinal studies will contribute to the use of choroidal differences as a clinical marker for monitoring anxiety disorders.
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Affiliation(s)
- Didem Ayyildiz
- Child and Adolescent Psychiatry Department, Bursa Dörtçelik Child Hospital, Bursa 16120, Turkey
| | - Taha Ayyildiz
- Ophthalmology Department, Bursa City Hospital, Bursa 16110, Turkey
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Hoogmartens C, Stanzel BV. [Acute macular neuroretinopathy in a 13-year-old female patient with focal choroidal excavation and pachychoroid disease]. Ophthalmologe 2020; 117:791-797. [PMID: 31562562 DOI: 10.1007/s00347-019-00974-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Acute macular neuroretinopathy (AMN) is a rare disease that causes sudden onset of paracentral scotomas. The current case report describes a 13-year-old girl with AMN adjacent to a focal choroidal excavation (FCE) with pachychoroidal features. The patient was followed for 20 months and examined with multimodal imaging. During follow-up the AMN area showed an incomplete atrophy of the outer nuclear layer, while the FCE changed along with decreasing choroidal thickness from a non-conforming into a conforming type. This case provides an interesting association of AMN, FCE and pachychoroid disease.
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Affiliation(s)
- Caroline Hoogmartens
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland.
| | - Boris V Stanzel
- Augenklinik Sulzbach, Knappschaftsklinikum Saar GmbH, An der Klinik 10, 66280, Sulzbach/Saar, Deutschland. .,Makulazentrum Saar, Knappschaftsklinikum Saar GmbH, Sulzbach/Saar, Deutschland.
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Abstract
The review summarizes experimental and clinical data attesting to the important role the choroid plays in the development of refraction through optically oriented thickness changes and the release of growth factors. Because of its unique anatomical position, the choroid can influence the transmission of a cascade of chemical signals from the retina to the sclera and thereby affect the growth of the eye. Understanding the relationship between the optical defocus and the response of the choroid to it will help uncover the fundamental mechanisms for controlling eye growth and develop new strategies for preventing the progression of myopia.
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Affiliation(s)
- E P Tarutta
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - S V Milash
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - G A Markosyan
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
| | - N A Tarasova
- Helmholtz National Medical Research Center of Eye Diseases, Moscow, Russia
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Lee JH, Hong IH, Lee TY, Han JR, Jeon GS. Choroidal Thickness Changes after Orthokeratology Lens Wearing in Young Adults with Myopia. Ophthalmic Res 2020; 64:121-127. [PMID: 32759609 DOI: 10.1159/000510715] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/05/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Recently in South Korea, there are increasing number of young adults undergoing orthokeratology treatment for myopia control. They prefer orthokeratology treatment more than wearing spectacles or having a refractive surgery for several reasons. However, there is little research on the effect of orthokeratology treatment on choroids. OBJECTIVE The aim of this study was to analyze the change in choroidal thickness (CT) in the horizontal axis in young myopic adults after orthokeratology treatment. METHODS This was a retrospective research among young myopic patients (-1.0 to -5.0 diopters) aged 19-29 years (n = 36; 23.6 ± 2.5 years). We selected patients who were treated with orthokeratology for 12 months. CT values of the horizontal axis near the fovea before and after orthokeratology treatment were analyzed using optical coherence tomography. The value was measured at the beginning of treatment and at 3, 6, and 12 months after orthokeratology treatment. Three regional areas of choroid on the horizontal plane including fovea were analyzed. RESULT AND CONCLUSIONS In the beginning of orthokeratology treatment, CT of the horizontal axis was 248.9 ± 45.7 μm in the temporal region, 259.9 ± 55.3 μm in the macular region, and 219.2 ± 46.4 μm in the nasal region. Three months after orthokeratology treatment, thickness values of choroids in the 3 divided areas increased significantly (p < 0.05). Mean CT at 6 or 12 months after orthokeratology treatment was greater than before ortho<X00_Del_TrennDivis>--</X00_Del_TrennDivis>keratology treatment. CT increased after 3 months of orthokeratology treatment in each regional area. In young myopic adults, CT in nasal area was thinner than that in foveal or temporal area before treatment. CT recovered to near baseline when it was observed for more than 6 months after orthokeratology treatment.
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Affiliation(s)
- Jang Hun Lee
- Department of Ophthalmology, Dasan Samsung Bright Eye Clinic, Gyeonggi-do, Republic of Korea
| | - In Hwan Hong
- Department of Ophthalmology, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Gyeonggi-do, Republic of Korea
| | - Tae Yeem Lee
- Galmae Samsung Bright Clinic, Gyeonggi-do, Republic of Korea
| | - Jae Ryong Han
- Department of Ophthalmology, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Gyeonggi-do, Republic of Korea
| | - Gang Seok Jeon
- Department of Ophthalmology, Dasan Samsung Bright Eye Clinic, Gyeonggi-do, Republic of Korea,
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Abstract
PURPOSE To elucidate the development of the choroid and retina in children, and to explore changes in these during myopic shift. METHODS A total of 118 children aged 7 to 12 years participated in this 1-year longitudinal study. Children underwent several examinations at baseline and follow-up, including cycloplegic refraction, axial length measurement, and swept-source optical coherence tomography. Thickness changes in the choroid and retina were compared among children with or without myopic shift. RESULTS Eighty-eight children (74.6%) developed a myopic shift after 1 year, and their central foveal choroid was significantly attenuated (P < 0.01). No significant change was observed in choroids of children without myopic shift (P = 0.83). Choroidal thickness decreased in all subfields during myopic shift, whereas the thickness of the retinal layers increased or were unchanged in most subfields. Axial length increase and central foveal choroidal thinning were associated with myopic shift (R = 0.157, P < 0.01), but axial length increase was not significantly related to choroidal thinning (P > 0.05). CONCLUSION Choroidal thinning occurs early in myopic progression. Axial length increase and choroidal thinning are independently associated with myopic shift.
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Abstract
PURPOSE To report optical coherence tomography angiography (OCTA) values in healthy pediatric eyes and to identify factors that may modify these values. METHODS In this prospective observational cross-sectional study, macular OCTA images were acquired from healthy pediatric patients. Main outcome measures were 1) foveal avascular zone (FAZ) area at the level of the superficial retinal capillary plexus (SCP); 2) SCP and deep retinal capillary plexus (DCP) perfusion density (based on the area of vessels); 3) SCP and DCP vessel density (based on a map with vessels of 1-pixel width); and 4) CC perfusion density. Multiple regression analysis was performed to assess the effect of age, sex, ethnicity, refraction, and foveal macular thickness (FMT) on OCTA parameters. RESULTS Seventy-seven eyes from 52 subjects (23 male and 29 female) were included in analysis. Mean age was 11.1 ± 3.3 years (range = 5.0-17.0 years). Twenty-nine (55.8%) subjects were white, 14 (27.0%) Hispanic, 8 (15.4%) Asian, and 1 (1.8%) African-American. Mean refraction was -0.1 ± 2.4 diopters (D) (range = -5.75 to +9.0 D). Mean FMT was 248.6 ± 18.6 μm. Larger FAZ area was significantly associated with older age (P = 0.014). Furthermore, larger FAZ area was associated with reduced FMT (P < 0.0001). Male sex was associated only with increased SCP perfusion density (P = 0.042). Increased CC perfusion density was associated with younger age (P = 0.022). CONCLUSION We report data for pediatric OCTA parameters in healthy subjects. Several variables influence the density of macular microvascular networks, and these factors should be considered in the OCTA study of pediatric eye disorders.
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Prousali E, Dastiridou A, Ziakas N, Androudi S, Mataftsi A. Choroidal thickness and ocular growth in childhood. Surv Ophthalmol 2020; 66:261-275. [PMID: 32634443 DOI: 10.1016/j.survophthal.2020.06.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 12/22/2022]
Abstract
The involvement of the choroid in ocular growth regulation has been postulated in studies showing that refractive errors correlate with alterations in choroidal thickness (ChT). The advent of optical coherence tomography imaging has enabled qualitative and quantitative assessment of the choroid. In children, ChT changes correlate with a number of ocular pathologies, including myopia, retinopathy of prematurity, and amblyopia. We synthesize mechanisms and evidence regarding choroidal thickness variation during childhood. Subfoveal ChT is influenced by a number of factors including age, ethnicity, gender, axial length, and intraocular pressure. Myopic eyes have thinner choroids compared to emmetropic and hyperopic eyes. ChT may in fact serve as a marker of myopic progression, as ChT thinning occurs early during myopic development, but this association has not been established quantitatively. In addition, subfoveal ChT appears thicker in amblyopic eyes, while prematurity and retinopathy of prematurity may be associated with thinner ChT. Overall, both animal models and clinical research indicate that ChT induces or reflects physiological changes in the eye pertaining to ocular growth or maturation.
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Affiliation(s)
- Efthymia Prousali
- 2(nd) Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna Dastiridou
- 2(nd) Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Ziakas
- 2(nd) Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sofia Androudi
- Department of Ophthalmology, University of Thessaly, Larissa, Greece
| | - Asimina Mataftsi
- 2(nd) Department of Ophthalmology, Aristotle University of Thessaloniki, Thessaloniki, Greece.
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Lee SSY, Lingham G, Alonso-Caneiro D, Chen FK, Yazar S, Hewitt AW, Mackey DA. Choroidal Thickness in Young Adults and its Association with Visual Acuity. Am J Ophthalmol 2020; 214:40-51. [PMID: 32112771 DOI: 10.1016/j.ajo.2020.02.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/11/2020] [Accepted: 02/13/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To describe the choroidal thickness (ChT) in a large sample of young adults with the aim of establishing a normative ChT profile reference in this demographic cohort and explore its association with best-corrected visual acuity (BCVA). DESIGN Cross-sectional study. METHODS From a single center, 741 young adults (19-30 years of age, 49% male) were recruited to undergo a comprehensive ophthalmic examination, including BCVA measurement, post-cycloplegic autorefraction, ocular biometry, tonometry, and spectral-domain optical coherence tomography (SD-OCT) imaging. The enhanced depth imaging mode on the SD-OCT was used. The main outcome measure was the central macular ChT (0.5-mm radius around the fovea). The ChTs at the inner (between 0.5-mm and 1.5-mm radius) and outer macular rings (between 1.5-mm and 2.5-mm radius) were also measured. RESULTS The median central macular ChT was 370 μm (interquartile range 312-406 μm). The choroid was thickest at the superior-inner, inferior-inner, and central macular regions (370-373 μm) and thinnest nasally at the outer macular region (median 256 μm). Decreased central macular ChT was associated with younger age, female sex, nonwhite ethnicities, and myopia (P ≤ .013). There was a significant association between better BCVA and increased central macular ChT (P < .001), after adjusting for age, sex, ethnicity, and ocular measures. His relationship was only apparent in eyes with central macular ChTs <300 μm (P = .019) and absent in eyes with ChTs >300 μm. CONCLUSIONS The central ChT of young adults was 370 μm. There was a significant association between worse BCVA and thinner choroids below a threshold of 300 μm, raising the possibility that ChT could be predictive of visual function.
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Affiliation(s)
- Samantha S Y Lee
- Centre for Ophthalmology and Visual Sciences, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia.
| | - Gareth Lingham
- Centre for Ophthalmology and Visual Sciences, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia
| | - David Alonso-Caneiro
- Contact Lens and Visual Optic Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Sciences, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia; Department of Ophthalmology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Seyhan Yazar
- Centre for Ophthalmology and Visual Sciences, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia; Single Cell and Computational Genomics Lab, Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Alex W Hewitt
- Centre for Ophthalmology and Visual Sciences, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia; Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; School of Medicine, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - David A Mackey
- Centre for Ophthalmology and Visual Sciences, Lions Eye Institute, University of Western Australia, Perth, Western Australia, Australia; Centre for Eye Research Australia, University of Melbourne, Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia; School of Medicine, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
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Subfoveal Choroidal Thickness in Myopia: An OCT-Based Study in Young Chinese Patients. J Ophthalmol 2020; 2020:5896016. [PMID: 32454989 PMCID: PMC7222498 DOI: 10.1155/2020/5896016] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/25/2020] [Accepted: 04/06/2020] [Indexed: 12/29/2022] Open
Abstract
Myopia is a common cause of visual impairment worldwide. Choroidal thickness (ChT) reflects the characteristic changes in myopic children and may be used as an important index of myopia. The purpose of this study was to investigate ChT and its distribution across the posterior pole in young myopic Chinese patients using enhanced depth imaging optical coherence tomography (EDI-OCT) and to explore the factors associated with it. A total of 402 myopic Chinese patients aged 6–16 years who underwent complete ophthalmic examinations, including those for axial length, cycloplegic refraction, and intraocular pressure, were examined with EDI-OCT. The mean subfoveal ChT was 303.08 ± 76.87 μm and displayed large variations at different positions (p < 0.05). The thickest sector was located 3 mm temporally from the fovea. Multivariate regression analysis showed a significant negative correlation of the subfoveal ChT values with axial length (AL), whereas the ChT was moderately influenced by the patient's sex. AL accounted for 7.9% of the ChT variance, whereas sex explained 9.6% of the ChT variance. In the population aged 11 years and older, AL accounted for 13.1% of the ChT variance. However, in those younger than 11 years, age was the only significant explanatory factor accounting for 5.2% of the ChT variance. In conclusion, we found a significant decrease in ChT with age in myopic children younger than 11 years. The negative association between age and ChT in children aged 11 years and older may be offset by the choroidal thickening mediated by pubertal growth spurts. The positive correlation between ChT and spherical equivalent in myopic adolescents aged 11 years and older suggests that the protective effect of lens thinning against rapid axial elongation disappears with age. Axial elongation becomes the dominant determinant of ChT in this age group.
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Xiong S, He X, Zhang B, Deng J, Wang J, Lv M, Zhu J, Zou H, Xu X. Changes in Choroidal Thickness Varied by Age and Refraction in Children and Adolescents: A 1-Year Longitudinal Study. Am J Ophthalmol 2020; 213:46-56. [PMID: 31945330 DOI: 10.1016/j.ajo.2020.01.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/26/2019] [Accepted: 01/03/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To clarify the changing characteristics of choroidal thickness over time within different age ranges and among different refractive statuses of children aged 6 to 18 years. DESIGN Prospective cohort study. METHODS Data of axial length, cycloplegic refraction, and choroidal thickness (using swept-source optical coherence tomography) were collected at baseline and at a 1-year follow-up for 756 participants. One-year change in choroidal thickness and its association with age and refraction were analyzed. RESULTS Significantly greater attenuation of choroidal thickness was observed in younger children aged 6-9 years for all participants (-9 ± 25 μm) and for those with a myopic shift (-12 ± 25 μm), whereas there was a larger increase in adolescents aged 10-13 years for those without a myopic shift (9 ± 23 μm). There was a marked decrease in the choroidal thickness for newly developed myopic patients compared with persistent-nonmyopic patients and persistent-myopic patients (P < .01). The association between changes in axial length and choroidal thickness was less strong in persistent-myopic patients (β = -15.4, P = .022) than that in persistent-nonmyopic patients (β = -30.4, P < .001) and newly developed myopic patients (β = -33.7, P = .001), whereas among the persistent-myopic patients, the association was less strong in the baseline mild-myopic patients (β = -10.4, P = .193) than that in the baseline moderate-to high-myopic patients (β = -31.4, P = .026). CONCLUSIONS Changes in choroidal thickness varied by age. There was an increased rapid thinning of the choroid among newly developed myopic patients, and a nonsignificant association between changes in choroidal thickness and axial length in the early stages of myopia.
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Nishi T, Ueda T, Mizusawa Y, Semba K, Shinomiya K, Mitamura Y, Sonoda S, Uchino E, Sakamoto T, Ogata N. Effect of optical correction on choroidal structure in children with anisohypermetropic amblyopia. PLoS One 2020; 15:e0231903. [PMID: 32324782 PMCID: PMC7179822 DOI: 10.1371/journal.pone.0231903] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/02/2020] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to assess the effect of wearing optical correction on the choroidal structure in eyes of children with anisohypermetropic amblyopia. This study was conducted at the Nara Medical University Hospital and at the Tokushima University Hospital. Twenty-nine anisohypermetropic amblyopic eyes and their fellow eyes of 29 amblyopic patients (mean age, 5.7 ± 1.7 years, range 3- to 8-years) and twenty eyes of 20 age-similar control children (4.9 ± 0.8 years, range 4- to 6-years) were studied. All patients wore optical correction and 15 patients had both optical correction and patching. The values at the baseline were compared to that at one year later. The binarization method was used to determine the total, luminal, and stromal areas of the choroid in the enhanced depth imaging optical coherence tomographic images. The best-corrected visual acuity (BCVA) of the amblyopic eyes was significantly improved after the one-year period. A large luminal area was characteristic of the amblyopic eye at the baseline, and it was significantly reduced after the optical treatment. The stromal area widened significantly in the amblyopic and fellow eyes after one year whereas there were no significant changes in the choroid of the control eyes after one year. After one-year of optical correction, the luminal/stromal ratios in the amblyopic and fellow eyes were decreased and were then not significantly different from that of the normal control eyes. There was a significant and positive correlation between the improvement of the BCVA and the stromal area at the baseline (r = 0.64, P = 0.001). Wearing corrective lenses on the amblyopic eyes improves the BCVA, and the choroidal structure of the amblyopic eye becomes closer to that of the control eyes. The narrowed luminal area is a specific response of the amblyopic eye associated with the correction of the refractive error. The larger stromal area in the amblyopic eyes at the baseline is a predictive factor for improvements of the BCVA.
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Affiliation(s)
- Tomo Nishi
- Department of Ophthalmology, Nara Medical University, Nara, Japan
- * E-mail:
| | - Tetsuo Ueda
- Department of Ophthalmology, Nara Medical University, Nara, Japan
| | - Yuutaro Mizusawa
- Department of Ophthalmology, Nara Medical University, Nara, Japan
| | - Kentaro Semba
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kayo Shinomiya
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yoshinori Mitamura
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Shozo Sonoda
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Eisuke Uchino
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Nahoko Ogata
- Department of Ophthalmology, Nara Medical University, Nara, Japan
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Heirani M, Shandiz JH, Shojaei A, Narooie-Noori F. Choroidal Thickness Profile in Normal Iranian Eyes with Different Refractive Status by Spectral-Domain Optical Coherence Tomography. J Curr Ophthalmol 2020; 32:58-68. [PMID: 32510015 PMCID: PMC7265263 DOI: 10.1016/j.joco.2019.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 08/10/2019] [Accepted: 08/20/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose To investigate the choroidal thickness and its association with age, gender, spherical equivalent (SE), and axial length (AL) in a sample of Iranian population with different refractive status using spectral-domain optical coherence tomography (SD-OCT). Methods In a cross-sectional study, a total of 469 right eyes of 469 healthy subjects comprising 194 (41.4%) males and 275 (58.6%) females were examined. The mean age was 32.76 ± 15.77 years (range, 4-60 years). All subjects were divided into different groups according to their refractive status, age, and AL. The choroidal thickness was evaluated through enhanced-depth imaging (EDI) modality at subfoveal (Sf), 1, and 3 mm nasal (N1 and N3, respectively), temporal (T1 and T3, respectively), superior (S1 and S3, respectively), and inferior (I1 and I3, respectively) to the foveal center. Results In the whole population, the mean subfoveal choroidal thickness (SfChT) was 329.83 ± 70.33 μm, and the choroid was thickest at S1 (342.04 ± 71.28 μm) and thinnest at N3 (209.00 ± 66.0 μm). Our data indicated a significant difference in the mean choroidal thickness across all points in different age groups (P < 0.0001). For emmetropic, myopic, and hyperopic subjects, mean SfChT values were 346.64 ± 59.63, 319.66 ± 73.17, and 364.00 ± 74.54 μm, respectively. Linear regression estimated that SfChT decreased about 12.8 and 8.71 μm for every 10 years of aging and each diopter increasing in myopia, respectively. Additionally, the SfChT decreased as 13.48 μm per mm increase in AL. Conclusions The mean SfChT of a sample of Iranian emmetropic subjects was 346.64 ± 59.63 μm. The choroidal thickness has a decreasing trend with increasing age, and the choroid is thinner in myopes and thicker in hyperopes compared with emmetropic subjects. In the whole participants, the thickest and thinnest points were S1 and N3, respectively.
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Affiliation(s)
- Mohsen Heirani
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Javad Heravian Shandiz
- Refractive Errors Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Optometry, School of Paramedical Sciences, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Foroozan Narooie-Noori
- Department of Optometry, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Biyik KZ, Tideman JWL, Polling JR, Buitendijk GHS, Jaddoe VVW, Larsen M, Klaver CCW. Subfoveal choroidal thickness at age 9 years in relation to clinical and perinatal characteristics in the population-based Generation R Study. Acta Ophthalmol 2020; 98:172-176. [PMID: 31386803 DOI: 10.1111/aos.14178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 06/07/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess the association between clinical and perinatal characteristics and subfoveal choroidal thickness in 9-year-old children. METHODS The study included data from the population-based Generation R cohort, whose participants underwent cycloplegic refractometry, ocular biometry, height, weight and subfoveal choroidal thickness measurements using a swept-source optical coherence tomography (SS-OCT) instrument. Birth parameters were obtained using medical records. Statistical analyses were performed using multivariate regression models adjusted for age, ethnicity and sex. RESULTS A total of 1018 children (52.5% girls, 47.5% boys) with a mean age of 9.9 ± 0.3 years and a mean cycloplegic spherical equivalent refraction of 0.80 ± 1.1 D in boys and 0.81 ± 1.4 in girls were eligible for analysis. The subfoveal choroid was 17 μm thicker in girls (298 ± 60.6 μm) than in boys (281 ± 55.0 μm; p < 0.001), a difference of 9.1 μm persisting after adjustment for age, ethnicity and axial length (p = 0.017). Subfoveal choroidal thickness decreased with increasing ocular axial length (-16.2 μm/mm, 95% CI -21.2 to -12.4, p < 0.001) and with increasing myopic refraction (-10.0 μm/D, 95% CI 6.8-13.1; p < 0.001, adjusted for age, ethnicity, axial length and sex) while it increased with increasing body height (1.3 μm/cm, 95% CI 0.8 to 1.9, p < 0.001). Additionally, choroidal thickness increased with increasing birthweight (13.0 μm/kg; 95% CI 0.006-0.020; p < 0.001) and increasing size for gestational age (8.2 μm/kg; 95% CI 4.6-11.8; p < 0.001). Smoking up until the time that pregnancy became known was associated with a thinner choroid (p = 0.016). There was no detectable effect of alcohol consumption. The distributions of axial length, refraction and choroidal thickness were narrower than in older populations. CONCLUSION The subfoveal choroid was thicker in girls than in boys, and higher body height, higher birthweight and larger size for gestational age were associated with a thicker subfoveal choroid. The implications of these findings for myopia development need further evaluation in longitudinal studies.
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Affiliation(s)
- Kevser Zehra Biyik
- Department of Ophthalmology and Department of Epidemiology Erasmus Medical Center Rotterdam The Netherlands
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
- Faculty of Health Sciences University of Copenhagen Copenhagen Denmark
| | - Jan Willem L. Tideman
- Department of Ophthalmology and Department of Epidemiology Erasmus Medical Center Rotterdam The Netherlands
| | - Jan Roelof Polling
- Department of Ophthalmology and Department of Epidemiology Erasmus Medical Center Rotterdam The Netherlands
- Department of Orthoptics School of Applied Science Utrecht Utrecht The Netherlands
| | - Gabriëlle H. S. Buitendijk
- Department of Ophthalmology and Department of Epidemiology Erasmus Medical Center Rotterdam The Netherlands
| | | | - Michael Larsen
- Department of Ophthalmology Rigshospitalet Glostrup Denmark
| | - Caroline C. W. Klaver
- Department of Ophthalmology and Department of Epidemiology Erasmus Medical Center Rotterdam The Netherlands
- Department of Ophthalmology Radboud UMC Nijmegen The Netherlands
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Comparison of Choroidal Thickness Measurements Using Semiautomated and Manual Segmentation Methods. Optom Vis Sci 2020; 97:121-127. [PMID: 32011585 DOI: 10.1097/opx.0000000000001473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE This study demonstrated that a semiautomated segmentation method could help inexperienced practitioners to obtain choroidal thickness as good as experienced practitioners. PURPOSE The purpose of this study was to compare choroidal thickness measurements obtained by semiautomated and manual segmentation methods. METHODS Optical coherence tomography images of 37 eyes from 37 healthy young subjects acquired by a spectral-domain optical coherence tomography device were reviewed retrospectively. Two naive examiners measured choroidal thickness using manual and semiautomated methods, whereas two experienced examiners used only the semiautomated method. The semiautomated method referred to a fully automated segmentation program customized based on MATLAB and followed manual verification. After highlighting the inner and outer choroidal boundaries through automated segmentation, examiners reviewed these boundaries in each B-scan and conducted manual revisions if segmentation errors occurred. After selecting points where correct boundary was located, the software used a spline fit to blend the corrected region with the rest of the boundary. All measurements were summarized in a 6-mm Early Treatment Diabetic Retinopathy Study grid. Operation time spent to complete retinal and choroidal segmentation on each eye was recorded. Between-examiner agreements, that is, intraclass correlation coefficient and coefficient of reproducibility (CoR), were calculated among four sets of semiautomated measurements, and within-examiner agreements were comparisons between manual and semiautomated results from the same naive examiners. Eyes with thin or thick choroids were also analyzed separately. RESULTS The between-examiner and within-examiner agreements were excellent with intraclass correlation coefficient of 0.976 or greater. Pairwise within-examiner CoRs ranged from 17.4 to 47.1 μm. Pairwise between-examiner CoRs were between 13.0 and 38.9 μm. Eyes with thin choroid had better agreements than those with thick choroids. On average, naive examiners saved 3 to 5 minutes per eye using the semiautomated method. CONCLUSIONS With the help of a dedicated software, inexperienced practitioners could obtain choroidal thickness measurements with accuracy similar to experienced practitioners. Processing time with the semiautomated method was also reduced.
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Abstract
SIGNIFICANCE The Bifocal & Atropine in Myopia (BAM) study aims to determine whether combining 0.01% atropine and +2.50-diopter add center-distance soft bifocal contact lenses (SBCL) slows myopia progression more than SBCL alone. The results could provide significant information on the myopia control effect of combining optical and pharmacological treatments. PURPOSE This article describes the subject characteristics at baseline, the study methods, and the short-term effects of this combination treatment on visual acuity (VA) and vision-related outcomes. METHODS Subjects from the BAM study who met the baseline eligibility criteria were dispensed the combination treatment for 2 weeks to determine final eligibility. Outcome measures included VA at near and distance (Bailey-Lovie logMAR charts), near phoria (modified Thorington), accommodative lag (Grand Seiko WAM-5500), and pupil size (NeurOptics VIP-200 Pupillometer). Compliance was monitored using surveys. Two subgroups in the Bifocal Lenses In Nearsighted Kids study, single-vision contact lens wearers and those who wore +2.50-diopter add SBCL, will serve as the age-matched historical controls for BAM study. RESULTS Forty-nine BAM subjects (9.6 ± 1.4 years) were enrolled; mean spherical equivalent cycloplegic autorefraction was -2.33 ± 1.03 diopters. After 2 weeks of treatment, the best-corrected low-contrast (10% Michelson) distance VA was reduced (pre-treatment, +0.09 ± 0.07; post-treatment, +0.16 ± 0.08; P < .0001), but the high-contrast VA at near or distance was unaffected. Near phoria increased by approximately 2 in the exo direction (P = .01), but the accommodative lag was unchanged. The pupil size was not significantly different between pre-treatment and post-treatment of either the photopic or mesopic condition. Surveys indicated that the subjects wore SBCL 77 ± 22% of waking hours and used atropine 6.4 ± 0.7 days per week. CONCLUSIONS Two weeks of combination treatment reduced low-contrast distance VA and increased near exophoria slightly, but the subjects were compliant and tolerated the treatment well.
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Hansen MH, Li XQ, Larsen M, Olsen EM, Skovgaard AM, Kessel L, Munch IC. Five-Year Change in Choroidal Thickness in Relation to Body Development and Axial Eye Elongation: The CCC2000 Eye Study. Invest Ophthalmol Vis Sci 2020; 60:3930-3936. [PMID: 31546258 DOI: 10.1167/iovs.19-26807] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose We describe changes in choroidal thickness from age 11 to 16 years and its association with ocular biometrics and body development. Method In this longitudinal, population-based observational study, choroidal thickness was measured subfoveally and 1- and 3-mm temporal thereof using enhanced depth imaging spectral domain optical coherence tomography. Analyses were stratified by sex and adjusted for age and the time of day that the scan was performed. Results The study included 687 participants (304 boys). Median (interquartile range [IQR]) age was 11.5 (0.6) years at baseline and 16.6 (0.3) years at follow-up. Mean increase in choroidal thickness was 33, 27, and 11 μm at the three respective locations. The subfoveal choroid thickened less in eyes whose axial length increased more (boys, β = -85 μm/mm; 95% confidence interval [CI], -104 to -66, P < 0.0001; girls, β = -105 μm/mm; 95% CI, -121 to -89, P < 0.0001) and in eyes with a more negative refractive development (boys, 11 μm/diopters [D]; 95% CI, 4.0 to 18, P = 0.0022; girls, 22 μm/D; 95% CI, 16 to 27, P < 0.0001). Subfoveal choroidal thickness increased less in girls who underwent early puberty (Tanner stage 4 vs. 1; -39 μm' 95% CI, -72 to -5.9, P = 0.021) and who had a longer baseline axial length (β = -8.6 μm/mm; 95% CI, -15 to -2.7, P = 0.0043), and more in girls who grew taller (β = 0.9 μm/cm; 95% CI, 0.1 to 1.7, P = 0.026). Conclusions The choroid increased in thickness from age 11 to 16 years. The increase was greater in girls with later sexual maturation and smaller in eyes that added more axial length and had a relatively negative refractive development.
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Affiliation(s)
- Mathias Hvidtfelt Hansen
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Xiao Qiang Li
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark
| | - Michael Larsen
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Else Marie Olsen
- Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Center for Clinical Research and Disease Prevention, Capital Region, Copenhagen, Denmark
| | - Anne Mette Skovgaard
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Line Kessel
- Department of Ophthalmology, Rigshospitalet-Glostrup, Copenhagen, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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He XG, Deng JJ, Yin Y, Zhang B, Xiong SY, Zhu JF, Zou HD, Xu X, Wang L. Macular choroidal thickness in Chinese preschool children: decrease with axial length but no evident change with age. Int J Ophthalmol 2019; 12:1465-1473. [PMID: 31544044 DOI: 10.18240/ijo.2019.09.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/07/2019] [Indexed: 12/27/2022] Open
Abstract
AIM To explore the distribution pattern of macular choroidal thickness (ChT) and its association with age as well as refractive status in Chinese preschoolers. METHODS School-based, cross-sectional study. A total of 550 healthy preschool children aged 3 to 6 years old from 6 kindergartens were enrolled. Comprehensive ocular examinations, including measurement of visual acuity, axial length, intraocular pressure and slit-lamp examination before cycloplegia, as well as refraction measurement and swept-source optical coherence tomography (SS-OCT) examination after cycloplegia, were performed. The macular ChT in each sector of the ETDRS grid was measured by the built-in software of SS-OCT. RESULTS The mean central ChT of the participants was 312±59 µm. The mean axial length and spherical equivalent refraction were 22.36±0.72 mm and 1.51±0.83 D, respectively. Axial length increased with age (P<0.001), while the spherical equivalent refraction was similar among different age groups. Similarly, no significant difference was observed in ChT in all sectors among different age groups (all P>0.05). The central ChT of 3-4, 5 and 6 years old children was 314±59 µm, 312±60 µm and 312±59 µm, respectively (P=0.920). No difference was observed in ChT in most of the sectors between genders. No statistical significant difference was observed among different refractive groups (all P>0.05), though the ChT of each sector seemed to be smaller in myopic children. Axial length and weight were the independent factors of central ChT. Children with longer axial length (β=-21.184, P<0.001) and smaller weight (β=1.502, P=0.041) tended to have thinner choroid. CONCLUSION In preschool children, the ChT remains relatively stable with age, while a negative association between ChT and axial length existed. This will be helpful to elucidate the characteristics of ChT during the early refractive development.
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Affiliation(s)
- Xian-Gui He
- Department of Maternal and Child Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China.,Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai 200080, China
| | - Jun-Jie Deng
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai 200080, China
| | - Yao Yin
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China
| | - Bo Zhang
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China
| | - Shu-Yu Xiong
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai 200080, China
| | - Jian-Feng Zhu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China
| | - Hai-Dong Zou
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai 200080, China
| | - Xun Xu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Ocular Fundus Diseases, Shanghai Engineering Center for Visual Science and Photomedicine, Shanghai 200080, China
| | - Ling Wang
- Department of Maternal and Child Health, School of Public Health, Key Laboratory of Public Health Safety, Ministry of Education, Fudan University, Shanghai 200032, China
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Kugelman J, Alonso-Caneiro D, Read SA, Hamwood J, Vincent SJ, Chen FK, Collins MJ. Automatic choroidal segmentation in OCT images using supervised deep learning methods. Sci Rep 2019; 9:13298. [PMID: 31527630 PMCID: PMC6746702 DOI: 10.1038/s41598-019-49816-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 09/02/2019] [Indexed: 11/08/2022] Open
Abstract
The analysis of the choroid in the eye is crucial for our understanding of a range of ocular diseases and physiological processes. Optical coherence tomography (OCT) imaging provides the ability to capture highly detailed cross-sectional images of the choroid yet only a very limited number of commercial OCT instruments provide methods for automatic segmentation of choroidal tissue. Manual annotation of the choroidal boundaries is often performed but this is impractical due to the lengthy time taken to analyse large volumes of images. Therefore, there is a pressing need for reliable and accurate methods to automatically segment choroidal tissue boundaries in OCT images. In this work, a variety of patch-based and fully-convolutional deep learning methods are proposed to accurately determine the location of the choroidal boundaries of interest. The effect of network architecture, patch-size and contrast enhancement methods was tested to better understand the optimal architecture and approach to maximize performance. The results are compared with manual boundary segmentation used as a ground-truth, as well as with a standard image analysis technique. Results of total retinal layer segmentation are also presented for comparison purposes. The findings presented here demonstrate the benefit of deep learning methods for segmentation of the chorio-retinal boundary analysis in OCT images.
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Affiliation(s)
- Jason Kugelman
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Alonso-Caneiro
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia.
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia.
| | - Scott A Read
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Jared Hamwood
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Fred K Chen
- Centre for Ophthalmology and Visual Science, The University of Western Australia, Perth, Australia
- Ocular Tissue Engineering Laboratory, Lions Eye Institute, Perth, Australia
- Department of Ophthalmology, Royal Perth Hospital, Perth, Australia
| | - Michael J Collins
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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Jiang L, Garcia MB, Hammond D, Dahanayake D, Wildsoet CF. Strain-Dependent Differences in Sensitivity to Myopia-Inducing Stimuli in Guinea Pigs and Role of Choroid. Invest Ophthalmol Vis Sci 2019; 60:1226-1233. [PMID: 30913566 PMCID: PMC6438103 DOI: 10.1167/iovs.18-25365] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Purpose To investigate differences in sensitivity to myopia-inducing stimuli of two strains of pigmented guinea pigs. Methods Eleven-day-old animals (New Zealand [NZ], n = 24 and Elm Hill strains [EH], n = 26) wore either a +2 or -2 diopter (D) lens over one eye and a plano lens over the fellow eye for 5 days; other 10-day-old EH (n = 9) and 7-day-old NZ (n = 9) animals were monocularly form-deprived (FD) for 28 days. Choroidal thickness and axial length were measured using A-scan ultrasonography at baseline and after 1 and 5 days for optical defocus treatments, and at baseline and after 28 days for the FD treatment. Refractive errors were measured by retinoscopy. Choroids of untreated animals were also evaluated using spectral-domain optical coherence tomography. Results One day of optical defocus induced bidirectional (optical sign-dependent) choroidal responses in EH animals only (P < 0.01). Similar responses were detected in NZ animals after 5 days (P < 0.01), with concordant spherical equivalent refraction changes (P < 0.01). Compared with NZ animals, EH animals developed minimal myopia with FD after 28 days (-4.58 ± 0.97 vs. -0.69 ± 0.75 D for NZ versus EH, P < 0.001). Yet, EH animals showed paradoxical choroidal thickening, 20 ± 9 vs. -8 ± 8 μm for EH versus NZ, P < 0.001. Untreated EH animals also had significantly thicker choroids than NZ animals (147 ± 19 vs. 132 ± 16 μm, P < 0.05), with well-defined layering. Conclusions As previously reported in chicks, guinea pigs show strain-related differences in response to myopia-inducing stimuli. The finding of a thicker, multilayered choroid in the strain showing decreased sensitivity to FD is provocative, suggesting a possible protective role of the choroid.
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Affiliation(s)
- Liqin Jiang
- Berkeley Myopia Research Group, Vision Science Program and School of Optometry, University of California, Berkeley, California, United States.,Singapore Eye Research Institute, Singapore
| | | | - David Hammond
- Faculty of Health, School of Medicine-Optometry, Deakin University, Victoria, Australia
| | - Dinasha Dahanayake
- Berkeley Myopia Research Group, Vision Science Program and School of Optometry, University of California, Berkeley, California, United States
| | - Christine F Wildsoet
- Berkeley Myopia Research Group, Vision Science Program and School of Optometry, University of California, Berkeley, California, United States
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Statistical framework for validation without ground truth of choroidal thickness changes detection. PLoS One 2019; 14:e0218776. [PMID: 31251762 PMCID: PMC6599222 DOI: 10.1371/journal.pone.0218776] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 06/11/2019] [Indexed: 11/19/2022] Open
Abstract
Monitoring subtle choroidal thickness changes in the human eye delivers insight into the pathogenesis of various ocular diseases such as myopia and helps planning their treatment. However, a thorough evaluation of detection-performance is challenging as a ground truth for comparison is not available. Alternatively, an artificial ground truth can be generated by averaging the manual expert segmentations. This makes the ground truth very sensitive to ambiguities due to different interpretations by the experts. In order to circumvent this limitation, we present a novel validation approach that operates independently from a ground truth and is uniquely based on the common agreement between algorithm and experts. Utilizing an appropriate index, we compare the joint agreement of several raters with the algorithm and validate it against manual expert segmentation. To illustrate this, we conduct an observational study and evaluate the results obtained using our previously published registration-based method. In addition, we present an adapted state-of-the-art evaluation method, where a paired t-test is carried out after leaving out the results of one expert at the time. Automated and manual detection were performed on a dataset of 90 OCT 3D-volume stack pairs of healthy subjects between 8 and 18 years of age from Asian urban regions with a high prevalence of myopia.
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73
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Hoseini-Yazdi H, Vincent SJ, Collins MJ, Read SA, Alonso-Caneiro D. Wide-field choroidal thickness in myopes and emmetropes. Sci Rep 2019; 9:3474. [PMID: 30837507 PMCID: PMC6401121 DOI: 10.1038/s41598-019-39653-w] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 01/23/2019] [Indexed: 12/19/2022] Open
Abstract
There is a paucity of knowledge regarding the normal in-vivo thickness of the choroid beyond the macula (~17°). In this study, the choroidal thickness of 27 healthy young adults was examined across the macular (the central 5 mm including the fovea, parafovea, and perifovea) and extra-macular (a 5-14 mm annulus including the near-periphery and periphery) regions using wide-field optical coherence tomography, and compared between emmetropes (n = 14) and myopes (n = 13). The choroid progressively thinned beyond the parafovea (350 ± 86 µm) towards the periphery (264 ± 44 µm), and was thickest superiorly (355 ± 76 µm) and thinnest nasally (290 ± 79 µm). Choroidal thickness also varied with refractive error; myopes exhibited a thinner choroid than emmetropes in the macular region (311 ± 88 vs. 383 ± 66 µm), however, this difference diminished towards the periphery (251 ± 48 vs. 277 ± 37 µm). Meridional variations in choroidal thickness were not different between myopes and emmetropes. In conclusion, the choroid was thickest within the perifovea; thinned substantially towards the periphery, and exhibited the minimum and maximum peripheral thinning superiorly and nasally across a 55° region respectively. Choroidal thinning associated with myopia was more pronounced in the macular than extra-macular regions.
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Affiliation(s)
- Hosein Hoseini-Yazdi
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia.
| | - Stephen J Vincent
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Michael J Collins
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - Scott A Read
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
| | - David Alonso-Caneiro
- Contact Lens and Visual Optics Laboratory, School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Australia
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Taha A, Mevlut Y, Didem A. The effect of allergic conjuctivitis on choroidal thickness. SANAMED 2019. [DOI: 10.24125/sanamed.v14i3.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: To examine the effects of allergic conjunctivitis and its treatment upon choroidal thickness (ChT) using topical antihistaminic agents. Methods: 60 eyes of 30 children and adolescents with allergic conjunctivitis and 60 eyes of 30 healthy controls participated in the study. Inclusion criteria for patient groups were best-corrected visual acuity 20/20 or better, normal intraocular pressure (IOP) and no systemic or ocular diseases other than allergic conjunctivitis. Healthy controls recruited from children and adolescents who had no ocular or chronic systemic disorders and had best-corrected visual acuity 20/20 or better and normal IOP. ChT was measuredby using Enhanced Depth Imaging Optical Coherence Tomography (EDI-OCT) before and after treatment by antihistamine agents. Results: Subfoveal choroidal thicknes mean value was 364.1 ± 63.8 m in the allergic conjunctivitis group and the first-month values after the treatment were 333.5 ± 52.1 m. Subfoveal choroidal thickness means value in the control group was 320.6 ± 80.9 m. There was a statistically significant decrease in ChT after treatment of allergic conjunctivitis patients and there was a significant difference in terms of baseline ChT values between the allergic conjunctivitis group and the control group. There was no significant difference between one month after treatment values and the mean values of the control group. Conclusions: Our results demonstrate that ChT can increase in allergic conjunctivitis patients and can become normal again with topical antihistamine treatment. In order to support choroidal thickness to be a marker for the diagnosis and follow-up of allergic conjunctivitis, further studies with larger samples and longitudinal studies are needed.
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Read SA, Fuss JA, Vincent SJ, Collins MJ, Alonso-Caneiro D. Choroidal changes in human myopia: insights from optical coherence tomography imaging. Clin Exp Optom 2018; 102:270-285. [PMID: 30565333 DOI: 10.1111/cxo.12862] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 10/23/2018] [Accepted: 11/12/2018] [Indexed: 01/05/2023] Open
Abstract
The choroid is a vascular tissue which plays a range of critical roles in the normal physiology of the eye, such as supplying the outer retina with oxygen and nutrients and the regulation of intraocular pressure. There is also substantial evidence, particularly from animal studies, that the choroid plays an important role in the regulation of eye growth and the development of common refractive errors like myopia. In recent years, advances in optical coherence tomography technology have improved our ability to image and measure the choroid in the human eye. Research using this technology over the past decade has dramatically improved our knowledge of the normal choroid, and its potential role in the regulation of eye growth and refractive error development. This review aims to provide an overview of recent work examining the normal human choroid, its changes with myopia and the possible role of the choroid in the mechanism regulating eye growth. Studies have demonstrated that choroidal thinning accompanies the development and progression of myopia, and have established a close link between eye growth and choroidal thickness changes. Dramatic thinning of the choroid is seen with high myopia, and associations are also observed between choroidal thinning and reduced vision, and the development of retinal pathology associated with high myopia. In the short-term, environmental factors known to be associated with myopia development and more rapid eye growth typically lead to a thinning of the choroid, whereas factors linked to a slowing of eye growth are typically associated with short-term choroidal thickening. Collectively, these findings suggest that the choroid is an important biomarker of eye growth in the human eye, and additional research to better understand the human choroid is likely to further our knowledge of the signals and pathways regulating eye growth, myopia development and progression.
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Affiliation(s)
- Scott A Read
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - James A Fuss
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Stephen J Vincent
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Michael J Collins
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
| | - David Alonso-Caneiro
- School of Optometry and Vision Science, Queensland University of Technology, Brisbane, Queensland, Australia
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Abstract
PURPOSE To determine the relationship of subfoveal choroidal thickness (ChT), refraction, and axial length in children, and evaluate the evolution of subfoveal ChT with time in myopic versus nonmyopic eyes. METHODS A total of 229 eyes of 115 children aged 2 to 16 years were included in the study. Refraction under cycloplegia, axial length, and subfoveal ChT were measured at baseline with comparative investigations at 15 months follow-up. RESULTS The probability for the subfoveal ChT to be thinner in myopic children compared to nonmyopic children was 0.9999. We found a relation between subfoveal ChT and axial length. At 15 months follow-up, subfoveal ChT was found to have increased in the nonmyopic eyes, but decreased in myopic patients. CONCLUSIONS A number of studies have already shown the choroid to play an important role in the process of emmetropization. We found that ChT had a different evolution in myopic children compared to nonmyopic children. A thinner choroid may predict the onset, or progression, of myopia. Further studies, with longer follow-up, are necessary to confirm this hypothesis.
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Macular Thickness, Foveal Volume, and Choroidal Thickness in Amblyopic Eyes and Their Relationships to the Treatment Outcome. J Ophthalmol 2018; 2018:1967621. [PMID: 30159164 PMCID: PMC6109533 DOI: 10.1155/2018/1967621] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Accepted: 07/05/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose To assess the correlations between the retinal/choroidal structure and the treatment outcomes of amblyopic children. Methods This study enrolled eyes with amblyopia resulting from strabismus, anisometropia, or ametropia. All patients underwent detailed eye examinations, including spectral domain optical coherence tomography (SD-OCT) scan. All of the subjects received amblyopic treatment and were divided into 2 groups after 6 months of follow-up: the recovered amblyopic group with a best-corrected visual acuity (BCVA) ≥0.8 and the persistent amblyopic group with a BCVA <0.8 on the Landolt C chart. Results Forty-four amblyopic children were included, of which 26 were in the recovered amblyopic group after 6 months of follow-up. The patients with strabismic anisometropic amblyopia and severe amblyopia (initial VA ≤ 0.3) were significantly predisposed to developing persistent amblyopia (P=0.049 and P < 0.001, respectively). After correcting with Littmann's formula, the thickness and volume of the parafoveal and perifoveal retinal regions in the persistent amblyopia group did not show significant differences with the recovered amblyopia group. Conclusions The initial severity of amblyopia and the type of amblyopia were the risk factors related to the poor outcome of amblyopic treatment. The foveal thickness, foveal volume, and choroidal thickness were not associated with the treatment outcome.
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Ohsugi E, Mitamura Y, Shinomiya K, Niki M, Sano H, Nagasawa T, Shimizu Y, Nagasato D, Tabuchi H. Changes in choroidal thickness in healthy pediatric individuals: a longitudinal study. Int J Ophthalmol 2018; 11:1179-1184. [PMID: 30046536 DOI: 10.18240/ijo.2018.07.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 02/05/2018] [Indexed: 11/23/2022] Open
Abstract
AIM To investigate the changes in the choroidal thickness in healthy pediatric children in a longitudinal study, and to determine the ocular and systemic parameters that were significantly correlated with the changes in the choroidal thickness. METHODS This study included 64 eyes of 34 healthy Japanese children with a mean age (±SD) of 4.4 (±0.4)y (range, 3.6-5.8y) at baseline. Swept-source optical coherence tomography (SS-OCT) was used to record images of the retina and choroid at the baseline and after a mean follow-up period of about 1.5y. The 3D raster scan protocol was used to construct the choroidal thickness map. Mean choroidal thickness was calculated for each of the nine sectors of the Early Treatment Diabetic Retinopathy Study grid. Best-corrected visual acuity, axial length, body height, and weight were also measured. Changes in measurements were defined as the baseline values subtracted from the values at the final visit. A generalized estimating equation was used to eliminate the effect of within-subject intereye correlations. RESULTS The mean central choroidal thickness was significantly reduced during the follow-up period (baseline, 301.8±8.6 µm; final visit, 286.6±8.0 µm, P<0.001). The decrease in the choroidal thickness was greatest in the central sector, followed by the sectors of the inner and outer rings. The inner and outer rings had diameters of 1 to 3 mm and 3 to 6 mm, respectively. The changes in the choroidal thickness in the central, inner ring, and outer ring sectors were significantly and negatively correlated with the age, baseline body height, baseline body weight, and elongation of the axial length. CONCLUSION These results indicate that the choroidal thickness among preschool-aged Japanese children decreased significantly during the follow-up period. The choroidal thinning is significantly associated with the elongation of axial length. These characteristics should be considered in the evaluation of choroidal thickness in younger children with retinochoroidal disorders.
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Affiliation(s)
- Eiko Ohsugi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan.,Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan
| | - Yoshinori Mitamura
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan
| | - Kayo Shinomiya
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan
| | - Masanori Niki
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan
| | - Hiroki Sano
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan
| | - Toshihiko Nagasawa
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan.,Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan
| | - Yukiko Shimizu
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan
| | - Daisuke Nagasato
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan.,Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan
| | - Hitoshi Tabuchi
- Department of Ophthalmology, Saneikai Tsukazaki Hospital, Himeji 671-1227, Japan.,Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima 770-8503, Japan
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Jin WQ, Huang SH, Jiang J, Mao XJ, Shen MX, Lian Y. Short term effect of choroid thickness in the horizontal meridian detected by spectral domain optical coherence tomography in myopic children after orthokeratology. Int J Ophthalmol 2018; 11:991-996. [PMID: 29977813 DOI: 10.18240/ijo.2018.06.16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 04/03/2018] [Indexed: 12/18/2022] Open
Abstract
AIM To investigate choroidal thickness changes in the horizontal meridian after orthokeratology. METHODS This is a prospective cross-sectional observed study. Subjects (n=30; 11.3±1.7y) with low-to-moderate myopia (-1.0 to -6.0 diopters), wore orthokeratology (Ortho-K) lenses for 3mo. Before and after Ortho-K, OCT scans were made through the fovea in the horizontal meridian. Choroid thickness around the fovea was acquired by custom software. The analyzed regions along the horizontal meridian were divided into 7 equal zones. Ocular parameters were measured by Lenstar LS 900 non-contact biometry. RESULTS Only the right eye ocular parameters were analyzed in this study. Before Ortho-K, choroidal thickness along the horizontal meridian was 273.7±31.8 µm in the temporal zone, 253.1±38.6 µm in the macula zone, and 194.8±52.2 µm in the nasal zone. After Ortho-K, the choroid was thicker in each horizontal zone (P<0.05). The increased thickness was greatest in the temporal zone (13.5±22.5 µm) and least in the nasal zone (8.4±14.2 µm). The axial length (AL) increased 0.02 mm (P>0.05). The choroid thickness change in each horizontal zone was negatively correlated with AL (r, -0.3 to -0.4; P<0.05) except one of the nasal zones. CONCLUSION In myopic children, the thickness of the choroid is greatest in the temporal zone and thinnest in the nasal zone. After nightly Ortho-K for 3mo, the thickness increase along the horizontal meridian. The choroid thickness changes are negatively correlated with the change of AL.
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Affiliation(s)
- Wan-Qing Jin
- Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,Optometry Academy of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Sheng-Hai Huang
- Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,Optometry Academy of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Jun Jiang
- Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,Optometry Academy of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Xin-Jie Mao
- Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,Optometry Academy of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Mei-Xiao Shen
- Optometry Academy of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Yan Lian
- Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.,Optometry Academy of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
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Choroidal Thickness in Chinese Children Aged 8 to 11 Years with Mild and Moderate Myopia. J Ophthalmol 2018; 2018:7270127. [PMID: 29955394 PMCID: PMC6000853 DOI: 10.1155/2018/7270127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Revised: 04/19/2018] [Accepted: 05/10/2018] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate macular choroidal thickness (CT), topographical variation, and associations between subfoveal choroidal thickness (SFCT) and age, gender, spherical equivalent (SE), and axial length (AL) in Chinese healthy mild and moderate myopia children aged 8 to 11 years. Methods One hundred twenty eyes from 120 healthy children were studied. Children were divided into mild and moderate myopia groups. AL and CT were evaluated. CTs were measured at the fovea, and 1 mm, 2 mm, and 3 mm nasal, temporal, superior, and inferior to the fovea. Results SFCT was 252.80 ± 46.95 µm in the whole population. AL was shorter in the mild myopia group (24.18 ± 0.69 mm) than in the moderate myopia group (24.97 ± 0.68 mm, P < 0.001), and SFCT was thicker in the mild myopia group (262.00 ± 40.57 µm) than in the moderate myopia group (236.00 ± 55.08 µm, P=0.005). The topographical variation was similar in refraction groups. CTs nasal to the fovea thinned gradually and were all significantly thinner than SFCT. CTs in the other three directions gradually thickened and peaked at locations of 2 mm to the fovea. Then, CTs thinned at 3 mm to the fovea. The thickest choroid is located temporal to the fovea. There were significant negative correlations between AL and SFCT in the mild myopia group and the whole population. No other correlations were found. Conclusions The topographical variations of choroidal thickness were similar in mild and moderate myopia groups with the thickest locations temporal to the fovea. SFCT was relatively stable in children in narrow range of age and refractive error.
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Matalia J, Anegondi NS, Veeboy L, Roy AS. Age and myopia associated optical coherence tomography of retina and choroid in pediatric eyes. Indian J Ophthalmol 2018; 66:77-82. [PMID: 29283128 PMCID: PMC5778588 DOI: 10.4103/ijo.ijo_652_17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose: To evaluate the association between retinal and choroidal thickness and volume along with choroidal vessel volume in children using optical coherence tomography (OCT) images. Methods: 113 normal eyes of children ranging from 5-17 years of age were imaged with a clinical OCT scanner (Optovue Inc., Fremont, USA). The retina, choroid and choroidal vessels were automatically segmented with algorithms. Parameters evaluated were thickness and volume. Location specific analyses of thickness were also performed at a distance of 2.5 mm from foveal center. Multivariate analyses of variance were used to analyze the effect of age and myopia. Manual segmentation of the fovea and subfoveal choroid thickness was also performed to compare with the algorithm segmentation. Results: There was excellent agreement between manual and automatic segmentation (intra-class correlation of 0.95). Within the same eye, total retinal and choroid thickness of nasal and temporal location were significantly lower than the superior and inferior thickness (P < 0.0001). With age (P = 0.026) and myopia (P < 0.001), foveal thickness increased. Choroid volume, vessel volume and temporal choroid thickness increased with increasing myopia (P < 0.05). There was significant positive correlation between choroid volume and retinal volume (r = 0.62, P < 0.0001), choroid volume and vessel volume (r = 0.48, P < 0.0001), and with foveal thickness (r = 0.31, P = 0.009). Choroid vessel volume also showed significant positive correlations with the other metrics (P < 0.05). Conclusion: Retinal and choroidal structural features were quantified simultaneously from OCT images. Magnitude of myopia had a greater effect on retino-choroid features than age in children.
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Affiliation(s)
- Jyoti Matalia
- Department of Pediatric Ophthalmology, Narayana Nethralaya, Bangalore, India
| | | | - Leio Veeboy
- School of Biosciences and Technology, VIT University, Vellore, India
| | - Abhijit Sinha Roy
- Imaging, Biomechanics and Mathematical Modelling Solutions, Narayana Nethralaya Foundation, Bangalore, India
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Swept-source and optical coherence tomography angiography in patients with X-linked retinoschisis. Eye (Lond) 2018; 32:707-715. [PMID: 29303151 DOI: 10.1038/eye.2017.281] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2017] [Accepted: 10/02/2017] [Indexed: 11/09/2022] Open
Abstract
PurposeTo explore the structural features of juvenile X-linked retinoschisis (XLRS) using swept-source-optical coherence tomography (SS-OCT) and optical coherence tomography angiography (OCT-A).DesignRetrospective, observational cross-sectional study.Patients and methodsNine patients (18 eyes) diagnosed with juvenile XLRS were included. SS-OCT and OCT-A were used to evaluate the characteristics of the inner/outer retina and the choroid.ResultsSS-OCT showed that the inner nuclear layer (INL) was the most commonly affected area (16/18 eyes; 89%). No significant differences in central macular thickness (CMT) or subfield choroidal thickness (SFCT) were evidenced between eyes (CMT: 364 μm in the right eye vs 320 μm in the left eye; SFCT: 305 vs 307 μm; P=0.895). Best-corrected visual acuity (BCVA) did not correlate with CMT (rs= -0.19; P=0.445) or SFCT (rs=0.06; P=0.795). BCVA was significantly correlated with the following defects: outer plexiform layer (OPL; rs=0.50; P=0.036); external limiting membrane (ELM; rs=0.65; P=0.003); ellipsoid portion of inner segment (EPIS; rs=0.67; P=0.002); and the cone outer segment tips (COST; rs=0.69; P=0.001). Schisis at the INL revealed a spoke-like pattern in the foveal region and a reticular pattern in the parafoveal region on en-face imaging. In cases in which the schisis affected the OPL, multiple polygonal hyporeflective cavities were observed in the foveal region.ConclusionsThe hyporeflective spaces on SS-OCT were primarily located at the INL and OPL. BCVA did not correlate with CMT or SFCT; however, ELM, EPIS, and COST defects were significantly correlated with worse BCVA. There was a positive correlation between age and SFCT.
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Nishi T, Ueda T, Mizusawa Y, Semba K, Shinomiya K, Mitamura Y, Sakamoto T, Ogata N. Effect of optical correction on subfoveal choroidal thickness in children with anisohypermetropic amblyopia. PLoS One 2017; 12:e0189735. [PMID: 29261750 PMCID: PMC5736200 DOI: 10.1371/journal.pone.0189735] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/30/2017] [Indexed: 11/19/2022] Open
Abstract
The purpose of this study was to determine the effect of optical correction on the best-corrected visual acuity (BCVA) and subfoveal choroidal thickness (CT) in the eyes of children with anisohypermetropic amblyopia. Twenty-four anisohypermetropic amblyopic eyes and their fellow eyes of 24 patients and twenty-three eyes of 23 age-matched control children were studied. After one year of optical correction, the BCVA in the anisohypermetropic amblyopic eyes was significantly improved. Before the treatment, the mean subfoveal CT in the amblyopic eyes was 351.9 ± 59.4 μm which was significantly thicker than that of control eyes at 302.4 ± 63.2 μm. After the treatment, the amount of change in the subfoveal CT in the amblyopic and fellow eyes was greater than that in the control eyes. The amblyopic and fellow eyes with thicker choroids had a greater thinning of the choroid whereas eyes with thinner choroids had a greater thickening of the choroid. We conclude that wearing corrective lenses improves the visual acuity, and induces changes of the subfoveal CT in eyes with anisohypermetropic amblyopia.
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Affiliation(s)
- Tomo Nishi
- Department of Ophthalmology, Nara Medical University, Nara, Japan
- * E-mail:
| | - Tetsuo Ueda
- Department of Ophthalmology, Nara Medical University, Nara, Japan
| | - Yuutaro Mizusawa
- Department of Ophthalmology, Nara Medical University, Nara, Japan
| | - Kentaro Semba
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kayo Shinomiya
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yoshinori Mitamura
- Department of Ophthalmology, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Nahoko Ogata
- Department of Ophthalmology, Nara Medical University, Nara, Japan
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Li Z, Cui D, Hu Y, Ao S, Zeng J, Yang X. Choroidal thickness and axial length changes in myopic children treated with orthokeratology. Cont Lens Anterior Eye 2017; 40:417-423. [PMID: 28935528 DOI: 10.1016/j.clae.2017.09.010] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 09/01/2017] [Accepted: 09/11/2017] [Indexed: 12/22/2022]
Abstract
PURPOSE To analyze the change in subfoveal choroidal thickness (SFChT) and its relationship with changes in axial length (AL) in myopic children treated with Orthokeratology (Ortho-k). METHODS Fifty myopic children participated in this study: 29 subjects were treated with Ortho-k lenses and 21 with single vision distance spectacles. The SFChT and ocular biometrics, including AL, were measured at baseline, one month, and six months after lens wear in both groups. RESULTS AL significantly increased in both groups over time. In the Ortho-k group, SFChT also increased; however, there was no significant change in SFChT in the control group over time. At the six-month visit, the magnitude of eye growth was significantly reduced in the Ortho-k group compared to the control group (0.06±0.10mm vs. 0.17±0.10mm, P<0.001). SFChT was significantly thicker in the Ortho-k group compared to the control group at the one-month and six-month visits (15.78±11.37μm vs. -2.98±8.96μm, P<0.001 (one-month visit); 21.03±12.74μm vs. -2.50±14.43μm, P<0.001 (six-month visit)), although there was no significant difference between the two follow-up visits (P=0.102 for the Ortho-k group; P=0.898 for the control group). Changes in the large choroidal vascular layer (LCVL) accounted for the majority of subfoveal choroidal thickening (approximately 77% and 80% at one-month and six-month visits, respectively). CONCLUSION Ortho-k treatment induced significant choroidal thickening and a slowing of eye growth. LCVL thickening accounted for the majority of SFChT thickening. However, its potential mechanism in myopia control requires further investigation.
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Affiliation(s)
- Zhouyue Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Dongmei Cui
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Yin Hu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Sichun Ao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Junwen Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Xiao Yang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China.
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86
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Choroidal thickness measurements in children with isolated growth hormone deficiency. Eye (Lond) 2017; 32:364-369. [PMID: 28912516 DOI: 10.1038/eye.2017.194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 07/11/2017] [Indexed: 11/08/2022] Open
Abstract
PurposeThe aim of this study was to determine the choroidal thickness measurement values in cases with isolated growth hormone deficiency (IGHD), to compare them with the healthy control group by using enhanced depth imaging optical coherence tomography (EDI-OCT), and to evaluate the effect of growth hormone (GH) treatment on choroid.Patients and methodsIn this study, 23 cases who were diagnosed with IGHD as a study group and 46 healthy subjects as a control group were included. All patients and controls underwent a complete ophthalmologic examination, including an examination with EDI-OCT. Choroidal thickness (CT) was measured at the fovea and at 1000 μm intervals from the foveal center in both temporal and nasal directions.ResultsThe mean subfoveal choroidal thickness (SFCT) was 329.04±88.49 μm in the cases with IGHD and 365.35±50.48 μm in the control group (P=0.033). The mean CT at temporal 1 and 2 mm were thinner in the IGHD group than that of control group (P=0.033 and P=0.043, respectively). Nasal quadrant measurements were also found to be thinner in the IGHD cases than that of control group, but the difference was not statistically significant. We found a significant positive correlation between pubertal staging and SFCT (rs=0.607, P=0.006). There was no statistically significant difference in CT values of the study group between before and 12 months after GH treatment (P>0.05).ConclusionThis study shows patients with IGHD has a thinner CT when compared with healthy pediatric cases. GH treatment seems to be not associated with the choroidal development.
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Abstract
PURPOSE To investigate the effect of orthokeratology (ortho-k) treatment on choroidal thickness and its relationship with axial length change. METHODS Seventy-seven myopic subjects aged between 7 and 17 years were treated with ortho-k lenses (n = 39) or single-vision spectacle lenses (SVL, n = 38). Choroidal thickness and axial length measurements were taken at baseline and repeated 1 week and 3 weeks after lens wear for the ortho-k group and at 3 weeks for the SVL group. Parafoveal choroidal thickness was assessed using optical coherence tomography and segmented into nine regions according to the Early Treatment Diabetic Retinopathy Study (ETDRS) within a 6 × 6 mm circular zone centered on the fovea. Axial length was measured using partial coherence interferometry. The changes in subfoveal choroidal thickness were compared to the changes in axial length in both study groups. RESULTS The change in axial length was significantly correlated with the change in choroidal thickness in both groups at 3 weeks (ortho-k, r = -0.351, p = 0.028 vs. SVL, r = -0.408, p = 0.011). Parafoveal choroidal thickness increased after 3 weeks of lens wear in the ortho-k group (mean, 21.8 ± 25.2 μm) but did not change in the SVL group (mean, 0.1 ± 19.7 μm). Choroidal thickness significantly varied across the posterior retinal regions (F = 82.14, p < 0.001), with the temporal regions being thickest and nasal regions being thinnest. After 3 weeks of ortho-k treatment, the magnitude of change (range, 14.1-27.6 μm) in choroidal thickness of the nine ETDRS regions was proportional to the baseline choroidal thickness in those regions (r = 0.88, p = 0.002). Axial length did not significantly change over time (F = 0.001, p = 0.975) and did not differ between the two treatment modalities (F = 0.305, p = 0.582). CONCLUSIONS Choroidal thickness increases after short-term ortho-k treatment. Regional choroidal thickening after ortho-k treatment may be attributable to the altered retinal defocus profile associated with ortho-k lens wear.
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Abstract
PURPOSE To explore the characteristics of choroidal thickness (ChT) in Chinese children. METHODS A total of 144 healthy children, aged 6 years to 12 years old, were enrolled in the study. The ChT of subfovea and peripheral locations 0.5, 1.5, and 2.5 mm away from the fovea were evaluated by enhanced depth imaging optical coherence tomography. The association between subfoveal ChT and systemic, as well as ocular factors, including age, sex, height, weight, body mass index, axial length, refractive error, intraocular pressure, preterm history, and the refractive status of parents were studied. RESULTS The mean subfoveal ChT was 302 ± 63 μm. In the nasal, superior, and inferior areas, the ChT of locations closer to the fovea was thicker than those farther away from the fovea (all P < 0.05); however, ChT was not significantly different among different locations in the temporal area (P = 0.16). The ChT of the nasal quadrant was significantly thinner than that of other areas (P < 0.01). Subfoveal ChT decreased with age, axial length, preterm history, and increased with height. Sex was not statistically associated with subfoveal ChT. CONCLUSION In Chinese children, the ChT is thinnest in the nasal quadrant and thicker in central regions than in peripheral areas. The subfoveal ChT independently decreases with age, axial length, preterm history, and increases with height.
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Choroidal thickness in school children: The Gobi Desert Children Eye Study. PLoS One 2017; 12:e0179579. [PMID: 28617854 PMCID: PMC5472304 DOI: 10.1371/journal.pone.0179579] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 05/31/2017] [Indexed: 12/26/2022] Open
Abstract
Purpose To investigate choroidal thickness (CT) and its associations in children in a school-based study. Methods The cross-sectional school-based Gobi Desert Children Eye Study included 1565 out of 1911 (81.9%) eligible children from all schools in the oasis region of Ejina in the Gobi Desert. A detailed ophthalmic examination was performed, including spectral-domain optical coherence tomography with enhanced depth imaging for CT measurement. Results CT measurements were available for 1463 (93.5%) students (mean age: 11.8±3.5 years; range:7–21 years). Mean subfoveal choroidal thickness (SFCT) was 282±49μm. CT was thickest at 1000μm temporal to the fovea (286±49μm), followed by the subfoveal region (282±49 μm; P<0.001), the region at 2500μm temporal to the fovea (278±49μm), the region at 1000μm nasal to the fovea (254±49μm;P<0.001), and the region at 2500μm nasal to the fovea (197±50μm;P<0.001). In cross-sectional analysis, the mean SFCT increased with age from 288μm at 7 years of age to 304μm at 11 years, and then decreased to 258 μm at 18 years. In multivariate analysis, thicker SFCT was associated (regression coefficient r:0.38) with higher hyperopic refractive error (P<0.001;standardized regression coefficient beta:0.31;non-standardized regression coefficient B:7.61;95% confidence intervals (CI):6.29,8.93), younger age (P<0.001;beta:-0.10;B:-1.39;95%CI:-2.14,-0.64), male gender (P = 0.03;beta:-0.05;B:-5.33;95%CI:-10.1,-0.53), higher corneal refractive power (P<0.001;beta:0.12;B:3.68;95%CI:2.12,5.24), and non-Han Chinese ethnicity (P = 0.03;beta:0.05;B:6.16;95%CI:0.50,11.8). Ratio of CT(1000μm nasal to fovea)/SFCT (0.90±0.06;range:0.66,1.23) and ratio of CT(2500μm nasal to fovea)/SFCT (0.70±0.13;range:0.28,1.23) decreased with older age (P = 0.01;and P = 0.001, respectively), while ratio of CT(1000μm temporal to fovea)/SFCT (1.02±0.06;range:0.56,1.37) and ratio of CT(2500μm temporal to fovea)/SFCT (0.99±0.11;range:0.54,1.84) increased with older age (both P<0.001). Time spent outdoors or indoors was not significantly associated with CT-related parameter in multivariate analysis. Conclusions In contrast to SFCT in adults and despite elongating axial length, SFCT in children increased in cross-sectional analysis with older age (up to 11 years of age) and then started to decrease with further ageing. It suggests an increase in choroidal volume up to the age of 11 years. In children, the choroid was thickest at 1000μm temporal to the fovea, followed by the subfoveal region, and this difference significantly increased with older age. In contrast, CT nasal to the fovea in relationship to SFCT decreased with older age. CT was independent of lifestyle-associated parameters.
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Xiong S, He X, Deng J, Lv M, Jin J, Sun S, Yao C, Zhu J, Zou H, Xu X. Choroidal Thickness in 3001 Chinese Children Aged 6 to 19 Years Using Swept-Source OCT. Sci Rep 2017; 7:45059. [PMID: 28327553 PMCID: PMC5361145 DOI: 10.1038/srep45059] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 02/17/2017] [Indexed: 11/17/2022] Open
Abstract
The purpose of the cross-sectional study is to describe the values and distribution of choroidal thickness and to explore its related factors, especially age, in Chinese children. A total of 3001 Chinese school children aged 6 to 19 years underwent comprehensive ophthalmic examinations, including axial length and cycloplegic refraction. Choroidal thickness was measured by swept-source optical coherence tomography (SS-OCT). There was a greater difference in the more central regions between the myopes and emmetropes. Multiple regression analysis was performed to determine the associated factors of choroidal thickness. The results demonstrated that age was independently positively related to choroidal thickness for emmetropes (β = 3.859, p < 0.001), and mild myopes with spherical equivalent greater than −2.00 D (−1.25 D < spherical equivalent ≤ −0.50 D: β = 3.476, p = 0.006; −2.00 D < spherical equivalent ≤ −1.25 D: β = 3.232, p = 0.020). However, no significant relationship between age and choroidal thickness was found in children with spherical equivalent ≤ −2.00 D, suggesting that the protective effect of physiologic choroidal growth with age against rapid axial elongation disappeared while axial elongation becomes the dominant determinant of choroidal thickness among children with myopia worse than −2.00 D.
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Affiliation(s)
- Shuyu Xiong
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Xiangui He
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China.,School of Public Health, Fudan University, Shanghai 200032, China
| | - Junjie Deng
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Minzhi Lv
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China
| | - Jiali Jin
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China
| | - Sifei Sun
- Jiading Center for Disease Prevention and Control, Shanghai 201901, China
| | - Chunxia Yao
- Songjiang Center for Disease Prevention and Control, Shanghai 201620, China
| | - Jianfeng Zhu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China
| | - Haidong Zou
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Xun Xu
- Department of Preventative Ophthalmology, Shanghai Eye Disease Prevention and Treatment Center, Shanghai Eye Hospital, Shanghai 200040, China.,Department of Ophthalmology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
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91
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Lee GY, Yu S, Kang HG, Kim JS, Lee KW, Lee JH. Choroidal Thickness Variation According to Refractive Error Measured by Spectral Domain-optical Coherence Tomography in Korean Children. KOREAN JOURNAL OF OPHTHALMOLOGY 2017; 31:151-158. [PMID: 28367044 PMCID: PMC5368089 DOI: 10.3341/kjo.2017.31.2.151] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 01/14/2016] [Indexed: 11/24/2022] Open
Abstract
Purpose To assess choroidal thickness (CT) variation according to refractive errors using enhanced-depth imaging optical coherence tomography. Methods Eighty-nine eyes (in 89 children) <±6 diopter were categorized into three groups: hyperopia, emmetropia, and myopia, according to refractive error, and underwent choroidal scans using enhanced-depth imaging-optical coherence tomography. CT was measured at the fovea and at 1 mm and 3 mm nasal (N1 and N3), temporal (T1 and T3), superior (S1 and S3), and inferior (I1 and I3) from the fovea. Results Mean foveal CTs were 346.86 µm, 301.97 µm, and 267.46 µm in the hyperopia, emmetropia, and myopia groups, respectively (p < 0.05). CTs at N3 and T3 were 214.59 µm and 318.68 µm, 163.92 µm and 320.79 µm, and 153.93 µm and 295.61 µm in the hyperopia, emmetropia, and myopia groups, respectively (p < 0.05). All CTs in the hyperopia group were thicker than those of other groups (p < 0.05). Fovea was thickest and was significantly thicker than at N3 and I3 in hyperopia (p < 0.05). T3 thickness in the emmetropia and myopia groups was greater than thickness at other areas, particularly the nasal and inferior choroids (p < 0.05). CT was positively correlated with spherical equivalent (p = 0.029). Conclusions In Korean children, CTs were greater in the hyperopia group than in the emmetropia and myopia groups. The temporal choroid was thicker than the nasal choroid, regardless of the refractive error. The thickest location in the hyperopia group was the fovea; however, the temporal choroid was thickest in the emmetropia and myopia groups.
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Affiliation(s)
| | - Sung Yu
- Cheil Eye Hospital, Daegu, Korea
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Wagner M, Scheibe P, Francke M, Zimmerling B, Frey K, Vogel M, Luckhaus S, Wiedemann P, Kiess W, Rauscher FG. Automated detection of the choroid boundary within OCT image data using quadratic measure filters. JOURNAL OF BIOMEDICAL OPTICS 2017; 22:25004. [PMID: 28301657 DOI: 10.1117/1.jbo.22.2.025004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 01/03/2017] [Indexed: 06/06/2023]
Abstract
A novel method for the automated detection of the outer choroid boundary within spectral-domain optical coherence tomography image data, based on an image model within the space of functions of bounded variation and the application of quadratic measure filters, is presented. The same method is used for the segmentation of retinal layer boundaries and proves to be suitable even for data generated without special imaging modes and moderate line averaging. Based on the segmentations, an automated determination of the central fovea region and choroidal thickness measurements for this and two adjacent 1-mm regions are provided. The quality of the method is assessed by comparison with manual delineations performed by five trained graders. The study is based on data from 50 children of the ages 8 to 13 that were obtained in the framework of the LIFE Child study at Leipzig University.
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Affiliation(s)
- Marcus Wagner
- Max Planck Institute for Mathematics in the Sciences, Leipzig, Germany
| | - Patrick Scheibe
- Leipzig University, Saxonian Incubator for Clinical Translation, Leipzig, Germany
| | - Mike Francke
- Leipzig University, Saxonian Incubator for Clinical Translation, Leipzig, GermanycLeipzig University, Paul-Flechsig-Institute of Brain Research, Leipzig, Germany
| | - Beatrice Zimmerling
- Leipzig University, Saxonian Incubator for Clinical Translation, Leipzig, GermanycLeipzig University, Paul-Flechsig-Institute of Brain Research, Leipzig, Germany
| | - Katharina Frey
- Ernst-Abbe-Hochschule Jena-University of Applied Sciences, Department SciTec, Jena, Germany
| | - Mandy Vogel
- Leipzig University, LIFE Leipzig Research Center for Civilization Diseases, Leipzig, Germany
| | - Stephan Luckhaus
- Leipzig University, Saxonian Incubator for Clinical Translation, Leipzig, GermanyfLeipzig University, Institute of Mathematics, Leipzig, Germany
| | - Peter Wiedemann
- Leipzig University Hospital, Department of Ophthalmology, Leipzig, Germany
| | - Wieland Kiess
- Leipzig University, LIFE Leipzig Research Center for Civilization Diseases, Leipzig, GermanyhUniversity Hospital for Children and Adolescents and Center for Pediatric Research, Department of Women and Child Health, Leipzig University, Leipzig, GermanyiLeipzig University, Integrated Research and Treatment Center Adiposity Diseases, Leipzig, Germany
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93
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Bulus AD, Can ME, Baytaroglu A, Can GD, Cakmak HB, Andiran N. Choroidal Thickness in Childhood Obesity. Ophthalmic Surg Lasers Imaging Retina 2017; 48:10-17. [DOI: 10.3928/23258160-20161219-02] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/05/2016] [Indexed: 12/30/2022]
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Chhablani JK, Deshpande R, Sachdeva V, Vidya S, Rao PS, Panigati A, Mahat B, Pappuru RR, Pehere N, Pathengay A. Choroidal thickness profile in healthy Indian children. Indian J Ophthalmol 2016; 63:474-7. [PMID: 26265634 PMCID: PMC4550976 DOI: 10.4103/0301-4738.162577] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Purpose: The purpose was to study choroidal thickness and its profile based on location in healthy Indian children using enhanced depth spectral-domain-optical coherence tomography (SD-OCT). Methods: In this cross-sectional observational study 255 eyes of 136 children with no retinal or choroidal disease were consecutively scanned using enhanced depth SD-OCT. Eyes with any ocular disease or axial length (AXL) >25 mm or < 20 mm were excluded. A single observer measured choroidal thickness from the posterior edge of the retinal pigment epithelium to the choroid/sclera junction at 500-microns intervals up to 2500 microns temporal and nasal to the fovea. Generalized estimating equations were used to evaluate the correlation between choroidal thickness at various locations and age, AXL, gender and spherical equivalent (SEq). Results: Mean age of the subjects was 11.9 ± 3.4 years (range: 5–18 years). There were 62 Females and 74 males. The mean AXL was 23.55 ± 0.74 mm. Mean subfoveal choroidal thickness was 312.1 ± 45.40 μm. Choroid was found to be thickest subfoveally, then temporally. Age, AXL and SEq showed a significant correlation with choroidal thickness, whereas gender did not affect choroidal thickness. Conclusion: Our study provides a valid normative database of choroidal thickness in healthy Indian children. This database could be useful for further studies evaluating choroidal changes in various chorioretinal disorders. Age and AXL are critical factors, which negatively correlated with choroidal thickness.
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Affiliation(s)
- Jay Kumar Chhablani
- L. V. Prasad Eye Institute, Kallam Anji Reddy Campus, L. V. Prasad Marg, Hyderabad, Telangana, India
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Nickla DL, Totonelly K. Choroidal thickness predicts ocular growth in normal chicks but not in eyes with experimentally altered growth. Clin Exp Optom 2016; 98:564-70. [PMID: 26769180 DOI: 10.1111/cxo.12317] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 05/13/2014] [Accepted: 05/15/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND In hatchling chicks, the thickness of the choroid is quite variable. It has been postulated that thickness per se or the changes occurring during early life might play a causal role in the regulation of ocular growth. We tested this notion by measuring ocular dimensions in several experimental conditions that alter ocular growth and in the fellow eyes. METHODS Chicks aged 12 to 14 days wore monocular lenses or diffusers (+10 D, n = 23; -10 D, n = 16; diffusers, n = 16) for four to five days. Fellow untreated eyes served as controls. A separate group of completely untreated birds aged eight days were also tested (n = 12). We tested two drugs known to alter ocular growth. The dopaminergic agonist quinpirole was injected daily for five days into eyes wearing negative lenses (n = 47). The muscarinic agonist oxotremorine was injected one time into normal eyes (n = 27). All eyes were measured using high-frequency A-scan ultrasonography at the start and end of the experiment. Spearman's correlation coefficient was used in all analyses. RESULTS Choroidal thickness predicted ocular growth rates in normal eyes: eyes with thinner choroids grew faster than those with thicker choroids (p = 0.0001). Furthermore, there was a negative correlation between initial thickness and the change in thickness (p = 0.0353). By contrast, eyes wearing lenses or diffusers did not show a correlation between initial thickness and growth rate. For lens-wearing eyes injected with quinpirole, which slowed growth, initial choroidal thickness predicted subsequent growth rate (p = 0.0126), similar to normal eyes. This was not so for oxotremorine, which stimulated growth. CONCLUSIONS The loss of the association between choroidal thickness and subsequent growth rate in eyes with experimentally altered growth implies an uncoupling of the choroidal response from the visual regulation of ocular growth. The negative correlation between initial thickness and ocular growth in eyes injected with quinpirole suggests potential therapeutic benefits to thicker choroids.
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Affiliation(s)
- Debora L Nickla
- The New England College of Optometry, Boston, Massachusetts, USA.
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96
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Wu XS, Shen LJ, Chen RR, Lyu Z. Peripapillary choroidal thickness in Chinese children using enhanced depth imaging optical coherence tomography. Int J Ophthalmol 2016; 9:1451-1456. [PMID: 27803863 DOI: 10.18240/ijo.2016.10.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 05/30/2016] [Indexed: 01/14/2023] Open
Abstract
AIM To evaluate the peripapillary choroidal thickness (PPCT) in Chinese children, and to analyze the influencing factors. METHODS PPCT was measured with enhanced depth imaging optical coherence tomography (EDI-OCT) in 70 children (53 myopes and 17 non-myopes) aged 7 to 18y, with spherical equivalent refractive errors between 0.50 and -5.87 diopters (D). Peripapillary choroidal imaging was performed using circular scans of a diameter of 3.4 mm around the optic disc. PPCT was measured by EDI-OCT in six sectors: nasal (N), superonasal (SN), superotemporal (ST), temporal (T), inferotemporal (IT) and inferonasal (IN), as well as global RNFL thickness (G). RESULTS The mean global PPCT was 165.49±33.76 µm. The temporal, inferonasal, inferotemporal PPCT were significantly thinner than the nasal, superonasal, superotemporal segments PPCT were significantly thinner in the myopic group at temporal, superotemporal and inferotemporal segments. The axial length was significantly associated with the average global (β=-0.419, P=0.014), superonasal (β=-2.009, P=0.049) and inferonasal (β= -2.000, P=0.049) PPCT. The other factors (gender, age, SE) were not significantly associated with PPCT. CONCLUSION PPCT was thinner in the myopic group at temporal, superotemporal and inferotemporal segments. The axial length was found to be negatively correlated to PPCT. We need more further studies about the relationship between PPCT and myopia.
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Affiliation(s)
- Xi-Shi Wu
- Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Li-Jun Shen
- Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Ru-Ru Chen
- Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
| | - Zhe Lyu
- Eye Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China
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Choroidal Structure in Children with Anisohypermetropic Amblyopia Determined by Binarization of Optical Coherence Tomographic Images. PLoS One 2016; 11:e0164672. [PMID: 27736947 PMCID: PMC5063323 DOI: 10.1371/journal.pone.0164672] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 09/28/2016] [Indexed: 12/01/2022] Open
Abstract
Purpose To compare the choroidal structure of the subfoveal area in the eyes of children with anisohypermetropic amblyopia to that of the fellow eyes and to age-matched controls using a binarization method of the images obtained by enhanced depth imaging optical coherence tomography (EDI-OCT). Methods This study was performed at Nara Medical University Hospital, Tokushima University Hospital, and Kagoshima University Hospital, Japan. Forty amblyopic eyes with anisohypermetropic amblyopia and their fellow eyes (5.9 ± 2.1 years, mean ± standard deviation), and 103 age-matched controls (6.7 ± 2.4 years) were studied. The control eyes were divided into myopic, emmetropic, and hyperopic eyes. The total choroidal area, luminal area and stromal area of the subfoveal choroid were measured by the binarization method. The luminal/stromal ratio and the axial length of the amblyopic eyes were compared to that of the control eyes. Results The total choroidal area in the amblyopic eyes was significantly larger than that of the fellow eyes (P = 0.005). The luminal/stromal ratio was significantly larger in the amblyopic eyes than that of the fellow eyes (P<0.001) and the control hyperopic eyes (P<0.001). There was a significant negative correlation between the luminal/stromal ratio and the axial length in the control eyes (r = -0.30, P = 0.001), but no significant correlation was found in the amblyopic eyes. Conclusions The choroidal structure of the amblyopic eyes was different from that of the fellow and the control hyperopic eyes. The choroidal changes are related to amblyopia.
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98
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Al-Haddad C, Fattah MA, Ismail K, Bashshur Z. Choroidal Changes in Anisometropic and Strabismic Children With Unilateral Amblyopia. Ophthalmic Surg Lasers Imaging Retina 2016; 47:900-907. [PMID: 27759855 DOI: 10.3928/23258160-20161004-02] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 08/17/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To detect changes in the choroidal layer at the macular area in amblyopic eyes. PATIENTS AND METHODS A cross-sectional study of 50 amblyopic patients (20 strabismic and 30 anisometropic) and 50 controls was done. Cross-sectional images using enhanced depth optical coherence tomography (OCT) were taken. Thicknesses were measured subfoveally and at 1,500 µm nasally, temporally, inferiorly, and superiorly. Submacular corresponding choroidal areas were also computed. Parameters were compared between amblyopic eyes, fellow eyes, and controls. RESULTS Significantly thicker choroid was detected in the subfoveal, temporal, and nasal locations (P = .007, .009, and .01, respectively) in amblyopic compared to fellow eyes; areas were also significantly greater temporally, nasally, and inferiorly. Significant differences in all choroidal measurements were found between amblyopic eyes and controls; these persisted only in the anisometropic subgroup. CONCLUSION Using enhanced depth OCT, the choroid of amblyopic eyes was observed to be thicker compared to normal fellow eyes and controls. [Ophthalmic Surg Lasers Imaging Retina. 2016;47:900-907.].
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Wang D, Chun RKM, Liu M, Lee RPK, Sun Y, Zhang T, Lam C, Liu Q, To CH. Optical Defocus Rapidly Changes Choroidal Thickness in Schoolchildren. PLoS One 2016; 11:e0161535. [PMID: 27537606 PMCID: PMC4990278 DOI: 10.1371/journal.pone.0161535] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 08/08/2016] [Indexed: 12/13/2022] Open
Abstract
The current study aimed to examine the short-term choroidal response to optical defocus in schoolchildren. Myopic schoolchildren aged 8–16 were randomly allocated to control group (CG), myopic defocus group (MDG) and hyperopic defocus group (HDG) (n = 17 per group). Children in MDG and HDG received additional +3D and -3D lenses, respectively, to their full corrections on the right eyes. Full correction was given to their left eyes, and on both eyes in the CG. Axial length (AXL) and subfoveal choroidal thickness (SFChT) were then measured by spectral domain optical coherence tomography. Children wore their group-specific correction for 2 hours after which any existing optical defocus was removed, and subjects wore full corrections for another 2 hours. Both the AXL and SFChT were recorded hourly for 4 hours. The mean refraction of all subjects was -3.41 ± 0.37D (± SEM). SFChT thinned when exposed to hyperopic defocus for 2 hours but less thinning was observed in response to myopic defocus compared to the control group (p < 0.05, two-way ANOVA). Removal of optical defocus significantly decreased SFChT in the MDG and significantly increased SFChT in the HDG after 1 and 2 hours (mean percentage change at 2-hour; control vs. hyperopic defocus vs. myopic defocus; -0.33 ± 0.59% vs. 3.04 ± 0.60% vs. -1.34 ± 0.74%, p < 0.01). Our results showed short-term exposure to myopic defocus induced relative choroidal thickening while hyperopic defocus led to choroidal thinning in children. This rapid and reversible choroidal response may be an important clinical parameter in gauging retinal response to optical defocus in human myopia.
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Affiliation(s)
- Danyang Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, PR China.,Laboratory of Experimental Optometry, Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, PR China.,Hainan Eye Hospital, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Haikou, PR China
| | - Rachel Ka Man Chun
- Laboratory of Experimental Optometry, Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, PR China
| | - Manli Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, PR China
| | - Roger Pak Kin Lee
- Laboratory of Experimental Optometry, Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, PR China
| | - Yuan Sun
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, PR China
| | - Ting Zhang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, PR China
| | - Chuen Lam
- Laboratory of Experimental Optometry, Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, PR China
| | - Quan Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, PR China.,Laboratory of Experimental Optometry, Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, PR China
| | - Chi Ho To
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, PR China.,Laboratory of Experimental Optometry, Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Hong Kong, PR China
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Li T, Zhou X, Wang Z, Zhu J, Shen W, Jiang B. Assessment of Retinal and Choroidal Measurements in Chinese School-Age Children with Cirrus-HD Optical Coherence Tomography. PLoS One 2016; 11:e0158948. [PMID: 27391015 PMCID: PMC4938617 DOI: 10.1371/journal.pone.0158948] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 06/25/2016] [Indexed: 11/30/2022] Open
Abstract
Purpose To evaluate retinal thickness (RT), retinal volume (RV) and choroidal thickness (ChT) in Chinese children using Cirrus-HD optical coherence tomography (OCT), and assess their associations with spherical equivalent (SE), age and gender. Methods This was a prospective study that recruited 193 healthy Chinese children (193 eyes) with no ophthalmic disease history between December 2012 and December 2013. RT and RV were acquired using OCT. Subfoveal ChT (SFCT) and ChT1-mm and 2-mm temporal, nasal, superior and inferior to the fovea were measured manually. Results RT in the inner temporal and nasal regionsdiffered significantly between refraction groups (both P<0.05). Significant differences were also found inSFCT andChT 1- and 2-mm inferior to the fovea (all P<0.05). RT differed significantly between males and females in the outer superior region in the emmetropia group (P<0.05). ChT differed significantly between males and females 2-mm temporal to the fovea in the emmetropia group (P<0.05), and 1-mm temporal to the fovea in the mild myopia group (P<0.05). SE correlated positively with RT in the inner temporal (r = 0.230),nasal (r = 0.252) and inferior (r = 0.149) regions (all P<0.05). Age correlated positively with foveolar (r = 0.169), total macular (r = 0.202), inner temporal (r = 0.237), inner nasal (r = 0.248), inner superior (r = 0.378) and inner inferior (r = 0.345) region thicknesses, and with RV (r = 0.207)(all P<0.05). SE correlated positively with SFCT (r = 0.195), and with ChT1-mm temporal (r = 0.167), 1- and 2-mm nasal (r = 0.144 and r = 0.162), 2-mm superior (r = 0.175), and 1- and 2-mm inferior (r = 0.207 and r = 0.238) to the fovea (all P<0.05). Age had no significant association with ChT. Conclusions SE, age and gender did not influence macular RT and ChT in most regions, and correlations of RT with age and ChT with SE were weak.
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Affiliation(s)
- Tao Li
- Department of Ophthalmology, Fudan University Jinshan Hospital and, 1508 Longhang Road, Shanghai, China
| | - Xiaodong Zhou
- Department of Ophthalmology, Fudan University Jinshan Hospital and, 1508 Longhang Road, Shanghai, China
- * E-mail:
| | - Zhi Wang
- Department of Ophthalmology, Fudan University Jinshan Hospital and, 1508 Longhang Road, Shanghai, China
| | - Jie Zhu
- Department of Ophthalmology, Fudan University Jinshan Hospital and, 1508 Longhang Road, Shanghai, China
| | - Wenli Shen
- Department of Ophthalmology, Fudan University Jinshan Hospital and, 1508 Longhang Road, Shanghai, China
| | - Bo Jiang
- Department of Ophthalmology, Fudan University Jinshan Hospital and, 1508 Longhang Road, Shanghai, China
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