Sex-Dependent Choroidal Thickness Differences in Healthy Adults: A Study Based on Original and Synthesized Data

Racial Differences in Choroidal Vascularity Index in Healthy Patients: Novel Insights

BACKGROUND AND OBJECTIVE

Choroidal vascularity index (CVI) measures the ratio of blood vessels in the choroid to the total choroidal area. We aimed to compare CVI between young Black and White patients without a history of ocular or systemic disease.

PATIENTS AND METHODS

We used a previously validated algorithm for shadow compensation and choroidal vessel binarization to measure CVI across the Early Treatment of Diabetic Retinopathy Study grid.

RESULTS

Black patients had a lower CVI (ß = -0.05, P < 0.001) compared to White patients. Choroidal volume or luminal volume did not significantly differ with respect to race, whereas there was a trend for Black patients to have a greater stromal volume (ß = 3.08, P = 0.01).

CONCLUSIONS

Black patients have a lower CVI than do White patients, likely due to a greater proportion of stromal volume. Further study of this parameter is warranted to validate the findings of this exploratory study. [Ophthalmic Surg Lasers Imaging Retina 2024;55:30-38.].

Choriocapillaris and choroidal thickness in all Leber hereditary optic neuropathy stages using swept source technology

PURPOSE

The role of the choroid in Leber hereditary optic neuropathy (LHON) remains unclear. The literature is scarce, with conflicting results and lacks axial length measurements. Therefore, we aimed to analyse the choriocapillaris (CC) vessel density (VD) and choroidal thickness (ChT) in all stages of LHON using swept source (SS) technology and considering the possible influence of axial length on choroidal parameters.

METHODS

This was a prospective cross-sectional observational study. A total of 119 eyes of 60 patients with molecularly confirmed LHON across all stages and 120 eyes of 60 control participants were included. We obtained the CC VD using optical coherence tomography angiography maps centred on the fovea. ChT was measured from the Bruch's membrane to the choroid-sclera interface in the macular and peripapillary regions.

RESULTS

The CC VD was not significantly affected in any sector or average, except for a slight change in the superior region of chronic eyes (52.08 ± 1.62% vs. 53.50 ± 2.29%, p = 0.002). ChT demonstrated a trend towards decreased values in asymptomatic eyes and increased values in the symptomatic stages that failed to reach statistical significance in sectors corresponding to the papillomacular bundle except for the macular nasal inner sector of chronic eyes (281.10 ± 67.12 μm vs. 252.08 ± 70.55 μm, p = 0.045). No significant correlations were observed between visual acuity and CC VD or ChT.

CONCLUSION

The CC VD remained stable across the LHON stages. Choroidal vasculature does not appear to play a role in LHON pathophysiology. Further research is needed on ChT as a potential biomarker of LHON.

Evaluation of Choroidal and Retinal Features in Patients with Primary Vasculitis-An Original Optical Coherence Tomography and Optical Coherence Tomography Angiography Study

Ocular manifestations have been described in the course of various types of vasculitis. However, there seems to be no routine ophthalmological examinations for patients suffering from those diseases. To ensure holistic care we aimed to investigate any retinal and choroidal abnormalities in patients suffering from primary vasculitis. The objective was to use non-invasive methods, which would not be time- and cost-consuming, yet would be helpful in routine tests. We conducted a prospective and observational study in 41 patients (78 eyes) with 5 types of primary vasculitis, including: Takayasu's arteritis; giant cell arteritis; Buerger's disease; granulomatosis with polyangiitis; and polyarteritis nodosa. A total of 44 healthy individuals were enrolled in the control group for comparison (88 eyes). With the use of optical coherence tomography, optical coherence tomography angiography, and MATLAB, the following parameters were assessed: choroidal thickness; vascularity index; area and perimeter of foveal avascular zone; and circularity index. The following parameters were lower in the study group compared to the control group: mean nasal and temporal CTs; mean central, temporal, and nasal CVI; and mean CI. In contrast, the results of mean central CT as well as the area and perimeter of FAZ were higher in the study group. The differences were statistically significant in the case of all parameters except for CI. Conducting routine ophthalmological examinations in patients diagnosed with vasculitis by assessment of the retina and choroid by measuring parameters like CT, CVI, area and perimeter of FAZ, and CI could be beneficial, as it may detect pathological changes before any ocular symptoms alarm the patients. CVI seems to be especially promising for choroidal evaluation, as it appears to be less influenced by various factors compared to CT.

The ocular anterior segment examination of perinatal newborns by wide-field digital imaging system: a cross-sectional study

PURPOSE

The aim of this study was to evaluate and summarize the developmental rules of the ocular anterior segment of neonates by means of wild-field digital imaging system.

METHODS

We used the wide-field digital imaging system to sequentially capture images of the neonates' eyes within 42 days after delivery, including the ocular surface, anterior segment, and fundus. At the same time, basic information at the time of birth and examination was collected.

RESULTS

Among 248 newborns, 51.21% were male. Abnormalities of the anterior segment such as visualization of anterior chamber angle vessels (79.03%) and iris vessels (51.21%), iris process (42.34%), persistent pupillary membranes (19.35%), albinism, congenital cataracts, corneal leucoma, and subconjunctival hemorrhage were observed in this study. There were significant differences in the appearance of iris vessels among different sex, gestational age and birth weight, postmenstrual age and weight at the time of examination and iris color groups. The iris vessels were more visualized in males relative to females (OR = 6.313, 95% CI 2.529-15.759). The greater the postmenstrual age at the time of examination, the lower the visualization of iris vessels (OR = 0.377, 95% CI 0.247-0.575). In addition, although visualization of anterior chamber angle vessels differed within the birth gestation age and weight at examination groups, there was no significant correlation by regression analysis.

CONCLUSIONS

The anterior segment of perinatal neonates can be visualized by the wide-field digital imaging system. The neonatal iris and anterior chamber angle are immature, and the visible vessels at the anterior chamber angle that vanish later than the surface of the iris are characteristic structures.

The choroid vascular index and its association with visual acuity in children and young adults with high myopia

BACKGROUND

To explore the relationship between the choroid vascular index (CVI) and best corrected visual acuity (BCVA) in a young population with high myopia (HM).

SUBJECTS/METHODS

Three hundred twenty-six patients with HM were recruited. All subjects underwent a comprehensive ophthalmic examination and enhanced depth imaging optical coherence tomography (EDI-OCT). The horizontal and vertical subfoveal choroidal areas within a 3-mm diameter centred over the fovea were selected. Choroid thickness (ChT), horizontal and vertical total choroidal area (TCAH and TCAV), luminal area (LAH and LAV) and stromal area (SAH and SAV) within the 3-mm diameter were assessed. CVI values (CVIH and CVIV), defined as the ratio of LA to TCA, were also calculated. The correlations among choroid parameters and ocular characteristics were analysed.

RESULTS

The median age, spherical equivalent (SE) and BCVA were 22.4 years, -10.1 dioptres and 0.099 logMAR, respectively. The ChT was thickest on the temporal and superior sides of the macula and thinnest in the nasal region, with a significant difference. The value of CVIH was significantly greater than that of CVIV because SCAH was smaller than SCAV. Both CVIH and CVIV were closely correlated with BCVA in all patients.

CONCLUSIONS

The CVI is significantly related to BCVA but is not affected by age, axial length or SE, suggesting that the CVI could be used as an adjunct tool for assessing the visual acuity status in patients with HM.

One-year follow-up of choroidal and macular thickness in acute non-treated central serous chorioretinopathy

CLINICAL RELEVANCE

Choroidal and macular thickness assessments are essential to understand the evolution of central serous chorioretinopathy and could help in identifying patients more prone to recurrence.

BACKGROUND

The aim of this work was to evaluate changes in the choroidal thickness and macular thickness in acute non-treated central serous chorioretinopathy during a one-year follow-up.

METHODS

A prospective longitudinal study of 38 patients with central serous chorioretinopathy and 35 healthy controls at a tertiary care facility (Fundación Alcorcón University Hospital) was conducted. Choroidal and macular thicknesses were measured using enhanced-depth-imaging optical coherence tomography and subretinal fluid resolution and best-corrected visual acuity were evaluated, at baseline and 1, 3, 6 and 12 months. Prognostic factors determining the need for treatment were evaluated.

RESULTS

Choroidal thickness decreased in eyes with central serous chorioretinopathy (p < 0.001) but not in fellow eyes (p = 0.24) during one-year follow-up since the acute episode. The estimated mean choroidal thickness in symptomatic eyes was 465 µm (SE: 17.18) at baseline and decreased 58.1 µm (CI 95%: 30.1-85.9) at 12 months (p < 0.001). Best-corrected visual acuity improved over time (p = 0.037), with a decrease of logMAR 0.086 (CI95%: 0-0.172).The macular thickness changed over time (p < 0.001), with a decrease from baseline of 124.6 µm (CI95%: 61.4-187.9). Subretinal fluid resolved in 67% (CI 95%: 51-82) of patients at 6 months. There was no significant association between baseline choroidal thickness, macular thickness, best-corrected visual acuity, age or sex and the need for treatment.

CONCLUSIONS

The choroidal thickness decreased in acute central serous chorioretinopathy episodes during a one-year follow-up. Subretinal fluid persisted in less than 20% of patients at the end of the one-year follow-up. No prognostic factors determining the need for treatment were found.

Short-term anatomic response of the choroid to tropicamide in myopic patients

We aimed to investigate how tropicamide alters subfoveal choroidal thickness (SFChT) and choriocapillaris flow density (CD) and determine the predictive factors of choroid thickness and vascular density in myopic eyes. This retrospective study was conducted from September 2018 to March 2019. SFChT was measured with enhanced depth spectrum-domain optical coherence tomography. The choriocapillaris was imaged using optical coherence tomography angiograms. Ocular parameters were measured thirty minutes before and after 1% tropicamide instillation. Twenty-five eyes of 15 patients (mean age 38.12 ± 6.35 years old and refractive error-8.57 ± 3.37 D) met the study criteria. The baseline linear regression model showed an association of thinner choroid with older age (P = .027) and high myopic patients (P = .001). Tropicamide substantially increased SFChT (P = .001), but had no significant influence on CD (P = .526). Moreover, SFChT variation after tropicamide instillation positively correlated with diopter changes in spherical equivalent (P = .005) and percentage changes in CD (P = .046). In myopic eyes, choroidal layer thickened substantially in response to tropicamide. The increase of SFChT only correlates with variations in spherical equivalent and CD. Short-term tropicamide installation altered both choroid thickness and choroid microvasculature, which implies an interplay among choroidal volume, perfusion, and ciliary muscle tone.

Choroidal Thickness Measured by Ocular Coherence Tomography (SD-OCT) and Body Mass Index in Healthy Saudi Women: A Cross-sectional Controlled Study

BACKGROUND

Obesity is one of the major public health problems globally, especially among women. Obesity is associated with glaucoma, cataract, age-related macular degeneration and diabetic retinopathy. Although it is clear that the anatomy and physiologic functions of the choroid may be affected by obesity, data investigating the effect of obesity on the choroid is limited and/or unavailable for the Saudi population.

OBJECTIVE

To assess Choroidal Thickness (CT) changes in a sample of healthy Saudi Arabian women with different Body Mass Index (BMI) using Spectral-domain Ocular Coherence Tomography (SD-OCT).

METHODS

A total of 140 healthy women aged 18-29 years (mean age ± standard deviation SD, 24.5 ± 1.7 years) with different BMI, axial length (AL) ≤ 24 ± 1.0 mm, and spherical equivalent refraction (SER) of ≤ ±2.0 dioptres were enrolled for the study. The participants were age and refractionmatched, and grouped into underweight (BMI ≤ 18.0 kg/m2) (n = 30), normal (control group) (18.5-24.9 kg/m2) (n = 43), overweight (25.0-29.9 kg/m2) (n=37), and obese study groups (≥ 30.0 kg/m2) (n = 30). SD-OCT imaging was performed on one eye of each participant. Comparisons among groups for all locations and the associations between CT and other variables were examined.

RESULTS

The mean CT at the subfoveal region (285 ± 31 μm, range: 203 μm to 399 μm) was significantly greater, and it was the lowest in the nasal region (248 ± 26 μm, range 154 to 304) compared with other locations, across all the groups (p < 0.05). Compared with the control, the subfoveal choroid was thinner in the obese group (mean difference: 22.6 μm, 95% Confidence Interval; CI: 8.6 μm to 36.6 μm; p = 0.02) and across all locations (p < 0.05) but thicker at the temporal location in the underweight group (12.4 μm, 95% CI: -23.7 μm to -1.04 μm; p = 0.01). No significant association of subfoveal CT with any of the measured parameters, including age (p-values ranged from 0.10 to 0.90), was found.

CONCLUSION

BMI may have an influence on the CT of healthy individuals and could be a cofounder in research studies on CT. It is, therefore, recommended that BMI should be evaluated in the clinical diagnosis and management of conditions associated with choroid in healthy individuals.

Choroidal Thickening During Young Adulthood and Baseline Choroidal Thickness Predicts Refractive Error Change

Purpose

The purpose of this study was to explore the age-related change in choroidal thickness (ChT) and test the hypothesis that baseline ChT is predictive of refractive error change in healthy young adults.

Methods

Participants underwent spectral-domain optical coherence tomography (SD-OCT) imaging and autorefraction at 20 (baseline) and 28 years old. The enhanced depth imaging mode on the SD-OCT was used to obtain images of the choroid. Scans were exported from the SD-OCT and analyzed with a custom software that automatically measures the central ChT. The longitudinal change in subfoveal ChT and association between baseline subfoveal ChT and 8-year change in refractive error (spherical equivalent) were determined using linear mixed models.

Results

In total, 395 eyes of 198 participants (44% men; 18-22 years at baseline) were included. Over 8 years, mean spherical equivalent decreased by 0.25 diopters (D) and axial length increased by 0.09 mm. Subfoveal choroid thickened by 1.3 µm/year (95% confidence interval [CI] = 0.6-2.0), but this was reduced by 0.9 µm/year (95% CI = 1.6-0.2) for every 1 mm increase in axial length. For every 10 µm increase in baseline ChT, average annual change in spherical equivalent and axial length reduced by 0.006 D/year and 0.003 mm/year, respectively.

Conclusions

In a community-based cohort of young adults, the choroid continued to change during early adulthood. Choroidal thickening was less in eyes that were longer at baseline, and the choroid thinned in eyes that showed myopia progression. The association between baseline ChT and longitudinal changes in spherical equivalent and axial length supports the hypothesis that ChT may be predictive of refractive error development and/or myopia progression.

Choroidal Thickness and Its Association With Age, Axial Length, and Refractive Error in Chinese Adults

Purpose

To identify the association between the choroidal thickness (ChT) with age and axial length (AL) under different refractive errors (REs) in Chinese adults.

Methods

Swept-source optical coherence tomography was used to measure ChT in 2126 right eyes of 2126 participants. The participants were classified as having pathologic myopia (PM), high myopia without PM (HM), low myopia (LM), and nonmyopia (non-M) according to their REs and META-PM (the Meta-Analysis of Pathologic Myopia) classification criteria.

Results

The mean age was 52.49 ± 20.39 years (range, 18−93 years), and the mean RE was −5.27 ± 5.37 diopters (D; range, −25.5 to +7.75 D). The mean average ChT was 159.25 ± 80.75 µm and decreased in a linear relationship from non-M to PM (190.04 ± 72.64 µm to 60.99 ± 37.58 µm, P < 0.001). A significant decline in ChT was noted between 50 and 70 years (r = −0.302, P < 0.001) and less rapidly after the age of 70 years (r = −0.105, P = 0.024). No correlation was noted between age and ChT under 50 years (P = 0.260). A significantly higher association with AL was noted in the central fovea (β^HM = −23.92, β^LM = −23.88, β^Non-M = −18.80, all P < 0.001) and parafoveal ChT (β^HM = −22.87, β^LM = −22.31, β^Non-M = −18.61, all P < 0.001) when compared with the perifoveal region (β^HM = −19.80, β^LM = −18.29, β^Non-M = −13.95, all P < 0.001). Within each group of PM, HM, LM, and non-M, regression analysis showed that the coefficients of age and AL with different macular regions of ChT varied significantly.

Conclusions

ChT was negatively correlated with age after 50 years. The thinning of the choroid was more prominent in the center and parafoveal regions as AL increased. Varied distributions of ChT decrease associated with AL and age were noted among different refractive groups.

Morphometrical analysis of the canine choroid in relation to age and sex using spectral domain optical coherence tomography

This study determined the choroidal thickness of senior (SN, n = 24) and middle-aged (MA, n = 17) healthy, mixed-breed mesocephalic dogs, both males (M) and females (F), using spectral domain optical coherence tomography (SD-OCT). The dogs were divided into two groups for examination: MA dogs (4-7 years old; 6 M, 11 F) and SN dogs (8-13 years old; 12 M, 12 F). Choroidal thickness of the dogs was investigated using SD-OCT radial and linear scans. The software of the device allowed determination of the exact measurement location on the choroid. Measurements of the choroid were taken manually using the SD-OCT calliper function at distances of 5,000-6,000 μm (dorsal and ventral) and 4,000-7,000 μm (nasal and temporal) from the optic disc. Mean (µm ± SD) (MA, SN) dorsal (188 ± 28, 184 ± 33), ventral (116 ± 23, 111 ± 16), temporal (152 ± 31, 151 ± 26), and nasal (135 ± 27, 132 ± 18) choroidal thicknesses demonstrated significant differences (P < 0.02-0.001) between all areas within each group. The choroid was thickest in the dorsal region and thinnest in the ventral region. There were no significant differences based on age. Mean (µm ± SD) (M, F) dorsal (181 ± 32, 190 ± 30), ventral (117 ± 16, 11 ± 21), temporal (150 ± 26, 153 ± 30), and nasal (128 ± 20, 138 ± 23) choroidal thicknesses demonstrated significant differences (P < 0.05) between dorsal and nasal regions. The choroidal thickness in dogs depends on the area assessed independently of their age and sex.

Wide-field choroidal thickness and vascularity index in myopes and emmetropes

PURPOSE

To study regional variations in choroidal thickness (CT), luminal thickness and stromal thickness of the choroid, and choroidal vascularity index (CVI) in low myopic and emmetropic eyes using wide-field optical coherence tomography (OCT).

METHODS

Sixty-nine healthy young adults between 20 and 38 years of age participated in this study, including 40 low myopes (mean ± SD spherical equivalent (MSE) refractive error: -3.00 ± 1.39 D, range: -6.00 to -0.62 D) and 29 emmetropes (MSE: -0.05 ± 0.09 D, range: -0.25 to +0.12 D). Wide-field CT, luminal thickness, stromal thickness and CVI were measured across five eccentricities (fovea, parafovea, perifovea; near-periphery and periphery) and four quadrants (nasal, temporal, inferior and superior), in vertical and horizontal meridians, while controlling for a range of extraneous factors potentially influencing the CT. Custom-written software was used to segment and binarize the OCT images.

RESULTS

Wide-field CT, luminal thickness and stromal thickness, averaged across all participants, exhibited significant topographical variation, with the foveal (379 ± 8 µm, 200 ± 4 µm, 179 ± 4 µm, respectively) and peripheral (275 ± 8 µm, 161 ± 4 µm, 114 ± 4 µm, respectively) regions presenting the thickest and thinnest regions (all p < 0.001). Wide-field CVI showed a progressively higher percentage (greater vascularity) with increasing eccentricity from the fovea towards the periphery (p < 0.001). Macular CT and stromal choroidal thickness were significantly thinner in myopes compared to emmetropes (p < 0.05). Myopes (55.7 ± 0.3%) showed a slightly higher CVI compared with emmetropes (54.4 ± 0.4%) (p < 0.05).

CONCLUSIONS

Low myopia in young adults was associated with significant choroidal thinning across the macular, but not extramacular regions, with this decrease in choroidal thickness mostly attributed to thinning in the stromal component of the choroid, rather than the luminal (vascular) component.

Association between ocular axial length and anthropometrics of Asian adults

Objective

The purpose of this study is to analyze axial length, body height, hand length, and foot length to find new factors that predict myopia and to identify gender differences as one of the factors of high myopia. A cross-sectional study was conducted as a single observation. Body height, hand length, and foot length were measured according to standard anthropometric methods. Axial length, retinal thickness, and choroidal thickness were measured using the IOL Master 700 and the Heidelberg Spectralis-OCT. To account for body height differences among participants, foot length/body height and hand length/body height were analyzed using a mixed-effects model.

Results

A total of 80 eyes (men, n = 20, 40 eyes; women, n = 20, 40 eyes) were analyzed. The mean age was 33.5 years (range 21–59 years, SD: 9.6). For choroidal thickness, there was a significant association with axial length in men (p < 0.001) and a trend toward an association in women (p = 0.072). There was also a significant association between foot length/body height and axial length in men (p = 0.015), but not in women (p = 0.58). These results suggest that factors that determine body height and foot length may be related to axial length, although they vary by gender.

Evaluation of choroidal thickness in light-coloured eyes

OBJECTIVE

The aim of this study was to determine whether iris colour is related to the choroidal thickness of healthy individuals.

METHODS

Healthy participants were divided into two groups. Group 1 had light-coloured eyes (blue and green), and group 2 had dark-coloured eyes (brown). The main outcome measures were iris thickness, subfoveal choroidal thickness and nasal and temporal choroidal thicknesses 500 µm away from the fovea.

RESULTS

Group 1 comprised 31 subjects with light-coloured eyes, and group 2 had 31 subjects with dark eyes. The mean ages of groups 1 and 2 were 26.7 ± 7.5 years and 24.1 ± 5.8 years, respectively (p = 0.14). The choroidal thicknesses of the subfoveal, nasal and temporal regions were 336.3 ± 52.1 µm, 321.9 ± 43.6 µm and 318.4 ± 49.2 µm, respectively, in group 1 and 396.5 ± 76.9 µm, 372 ± 79.3 µm and 379.6 ± 82.4 µm, respectively, in group 2. All the values in group 1 were statistically lower than those in group 2 (p = 0.001, p = 0.001 and p = 0.003, respectively). The iris thickness in group 1 (493.73 ± 95.44 µm) was thinner than in group 2 (524.61 ± 69.74 µm) but not statistically significant (p = 0.141).

CONCLUSION

The results showed that a thinner choroid can be seen in disease-free light-coloured eyes. The iris colour should be considered among the factors affecting the choroidal thickness, such as age, sex, race and refractive error.

Choroidal thickness alterations in idiopathic acute retinal vasculitis

Background:

To evaluate changes in sub-foveal choroidal thickness in patients with acute idiopathic retinal vasculitis compared with age-matched healthy subjects and unaffected fellow eyes.

Methods:

This prospective observational study included 36 eyes of 23 acute idiopathic retinal vasculitis patients (group V) which included a sub-group of 10 eyes of 10 patients with unilateral vasculitis (group UV), and 50 eyes of 25 healthy subjects (group N). The assessment involved demographics, systemic examination, comprehensive ocular examination, fundus photography with/without fundus fluorescein angiography, and spectral domain–optical coherence tomography with enhanced depth imaging.

Results:

There was significant difference between the mean sub-foveal choroidal thickness in groups V and N (V: 338.86 ± 28.72 um; N: 296.72 ± 19.45 μm; p< 0.001). The eyes of patients with unilateral vasculitis compared with unaffected fellow eyes had no significant difference in best corrected visual acuity (group UV: median = 0.2; range = (0.0–0.3) and group N: median = 0.2; range = (0.0–0.3); p = 0.35) but the sub-foveal choroidal thickness was significantly increased in the involved eye (group UV: 333.5 ± 16.68 um; group N: 284.4 ± 15.68 um; p⩽ 0.001). The BCVA was significantly lower in the eyes with anterior chamber inflammation (median = 0.2; range = (0.0–0.3) and; median = 0.1; range (0.0–0.3); p = 0.002), but there was no statistically significant difference in sub-foveal choroidal thickness measurement between the two groups of vasculitis patients with and without anterior chamber inflammation (334.3 ± 18.85 um and 336 ± 31.56 um; p = 0.22).

Conclusion:

The sub-foveal choroidal thickness increases during active inflammation in eyes with idiopathic retinal vasculitis compared with unaffected fellow eyes and healthy control eyes. Thus, measurement of the sub-foveal choroidal thickness on optical coherence tomography with enhanced depth imaging can serve as a non-invasive modality in the diagnosis and monitoring of acute idiopathic retinal vasculitis.

Multifactor analysis of delayed absorption of subretinal fluid after scleral buckling surgery

Background

The purpose of this study is to assess the absorption of subretinal fluid (SRF) after scleral buckling (SB) surgery for the treatment of rhegmatogenous retinal detachment (RRD). We also examined related factors that may affect the delayed absorption of SRF.

Methods

This retrospective study included patients who underwent successful SB surgery for the treatment of macula-off RRD and in which the retina was reattached after the surgery. The patients were categorized according to gender, duration, age, the number, and location of retinal breaks. Subfoveal choroidal thickness (SFCT), height of subretinal fluid (SRFH), and the choriocapillaris flow density (CCFD) within 3 × 3 mm macular fovea were included. Delayed absorption was determined by the SRF that remained unabsorbed for 3 months after the procedure. The endpoint was determined when the SRF could no longer be observed.

Results

A total of 62 patients (63 eyes) were enrolled. In 35 eyes (56.45%) SRF was completely absorbed and in 28 (43.55%) eyes delayed absorption of SRF in macular areas was observed at 3 months after surgery. A young age (< 35 years), inferior retinal breaks were associated with good outcomes by applying multivariable analysis on the rate of SRF absorption after SB instead of gender, the number of breaks, and duration (p < 0.05). CCFD was significantly different between the SRF group and the non-SRF group after SB (0.66 ± 0.04% vs 0.63 ± 0.05%, P < 0.05). SRFH showed a moderate positive correlation with SFCT (r_s = 0.462, p = 0.000), however, using binary logistic regression analysis it was determined that SFCT was not related to the absorption of the SRF.

Conclusions

The absorption of SRF after SB may be correlated with choriocapillaris flow density. Age and location of breaks are significant factors affecting the absorption of SRF. The duration of disease is an uncertain factor due to several subjective reasons.

[Evaluation of choriocapillaris with high-speed spectral-domain optical coherence tomography angiography and image averaging]

PURPOSE

To study the capabilities of high-speed spectral-domain optical coherence tomography angiography (SD-OCTA) with image averaging in the evaluation of choriocapillaries in healthy individuals and patients with central serous chorioretinopathy (CSC).

MATERIAL AND METHODS

All participants underwent OCTA examination on the SOLIX tomograph (Optovue, USA) using quadruplicate 3×3 mm scan with image averaging. Image analysis was performed in 9-µm custom slab with Phansalkar auto local threshold algorithm and calculation of flow voids larger than 5000 µm² and 10 000 µm². The optimal slab depth was determined in healthy eyes by consecutive analysis of the slabs with a 3-µm shift from zero position to 33 µm below Bruch's membrane.

RESULTS

The study included 18 eyes of 18 healthy volunteers (40.4±6.0 years old) and 18 fellow eyes of 18 unilateral CSC patients (37.4±10.7 years old). The slab 12 µm below the Bruch's membrane showed the minimal number of flow voids (23.1±7.0 of >5000 µm² voids per scan) and was chosen for further analysis. The number of flow voids of >5000 µm² in healthy paired eyes of CSC patients was statistically significantly higher than in the eyes of healthy individuals (32.7±10.7 and 25.3±8.1 voids/scan, respectively; p=0.022). The number of flow voids of >10000 µm² was also statistically significantly higher in CSC eyes compared to healthy eyes (5.6±3.3 and 3.5±1.9 voids/scan, respectively; p=0.045). There was no statistically significant difference in total area of the voids between the eyes of healthy individuals and CSC patients (96406.1±3924.5 µm² and 95395.7 ± 3615.1 µm², respectively; p=0.42).

CONCLUSION

The optimal settings for choriocapillaris imaging on the SOLIX tomograph include 9-µm slab 9 to 18 µm below the Bruch's membrane. Using a 9-µm slab 12 µm below the Bruch's membrane, a substantial difference was found in choriocapillaris perfusion between eyes of healthy individuals and CSC patients.

Choroidal Thickness in Diabetes and Diabetic Retinopathy: A Swept Source OCT Study

Purpose

Previous studies on the association between choroidal thickness (CT) and severity of diabetic retinopathy (DR) gave conflicting results. The aim of this study was to evaluate the CT changes in diabetic patients and associated factors in a large sample of Chinese patients with diabetes.

Methods

Type 2 diabetes mellitus patients without history of ocular treatment were recruited from the community health system in Guangzhou, China. The swept source OCT instrument was used to obtain high-definition retina and choroid images. The diabetic retinopathy (DR) status was graded based on the guidelines of the United Kingdom National Diabetic Eye Screening Programme. Univariate and multivariate linear regression analyses was used to explore the association of CT with DR severity, diabetic macular edema (DME), hemoglobin A1c, and vision function.

Results

A total of 1347 patients were included in the final analysis. After adjusting for other factors, the patients with stage R3 DR had significantly thinner CT (β = –29.1 µm, 95% CI –53.8 to –4.4, P = 0.021) in comparison in those with R0. After adjusting for other factors, the CTs were thicker than those in R0 patients with difference of 15.6 µm (95% CI 4.3-26.9, P = 0.007) for outer nasal sector, 15.7 µm (95% CI 3.8-25.5, P = 0.008) for outer inferior, and 12.2 µm (95% CI 0.4-24.0, P = 0.042) for inner inferior sector. The presence of DME and hemoglobin A1c levels did not significantly affect average CT. Higher average CT was significantly associated with better best corrected visual acuity, with a –0.02 LogMAR unit per 100 µm increase in average CT (95% CI –0.03 to –0.01, P < 0.001).

Conclusions

CT increased in the early stage of DR, and further decreased with DR progression. DME was not significantly associated with CT. These findings provide more clues to suggest that choroid alterations play a role in the pathogenesis of DR.

Relationship Between Renal Function and Choroidal Thickness in Type 2 Diabetic Patients Detected by Swept-Source Optical Coherence Tomography

Purpose

To investigate the relationship between renal function and choroidal thickness (CT) in ocular treatment-naïve patients with diabetes mellitus using swept-source optical coherence tomography (SS-OCT).

Methods

This cross-sectional study recruited type 2 diabetes mellitus (T2DM) patients with no history of ocular treatment from communities in Guangzhou, China. The estimated glomerular filtration rates (eGFR) were calculated by using the Xiangya formula. The impaired renal function was defined as eGFR < 60 mL/(min 1.73 m²). The choroid was imaged by using an SS-OCT, and the macular CT was quantified automatically in Early Treatment Diabetic Retinopathy Study maps, and only data from one eye was used. Univariate and multivariate linear regression analyses were performed to explore the influence of eGFR on CT.

Results

A total of 1395 patients with T2DM were included in the final analysis. The CT of all macular regions were significantly thinner in patients with renal impairment (all P < 0.001). A significantly positive correlation was observed between the average CT and eGFR (β = 0.4; 95% confidence interval, 0.041-0.8; P = 0.029) independent of age, sex, and other potential confounding factors. After adjusting for other factors, a higher eGFR was also associated with higher CT values in the central field (P = 0.019) and in the outer superior (P = 0.047), inner superior (P = 0.018), inner inferior (P = 0.025), and inner temporal (P = 0.038) regions.

Conclusions

CT decreased in parallel with renal impairment in ocular treatment naïve diabetic patients, providing an accessible window for monitoring renal status.

Translational Relevance

Knowledge of association between retinal microvasculature and renal microcirculation would allow applying in both clinical and research settings.

Associations of grip strength with retinal and choroidal thickness in patients with type 2 diabetes mellitus without retinopathy: a cross-sectional study

OBJECTIVE

To evaluate the associations of grip strength with retinal or choroidal thickness in patients with type 2 diabetes mellitus without retinopathy.

DESIGN

Observational study-cross-sectional design.

SETTING AND PARTICIPANTS

This study included the Chinese patients with type 2 diabetes without retinopathy registered in the community health system in Guangzhou, China.

MEASURES

The grip strength in both hands were measured by using a dynamometer. The retinal and choroidal thickness in macular region stratified by Early Treatment Diabetic Retinopathy Study (ETDRS) sectors were measured by a swept-source optical coherence tomography.

RESULTS

A total of 1029 patients were included. Both retinal thickness and choroidal thickness decreased with the lower quartile of grip strength. Regression analyses indicated that the average retinal and choroidal thickness increased by 0.14 µm (95% CI: 0.03 to 0.25 µm, p=0.011) and 0.57 µm (95% CI: 0.03 to 1.11 µm, p=0.037), respectively, for each additional kilogram of grip strength following adjustment for age and sex. Further adjustments were made for axial length, haemoglobin A1c, length of time the patient had diabetes, insulin usage, height, weight and systolic and diastolic blood pressure, which resulted in an average retinal and choroidal thickness increase of 0.13 µm (95% CI: 0.02 to 0.24 µm, p=0.024) and 0.65 µm (95% CI: 0.13 to 1.16 µm, p=0.013), respectively, for each additional kilogram of grip strength. Consistent results were obtained in the analyses in ETDRS 9 sectors.

CONCLUSION

Lower hand grip strength was found to be significantly associated with thinner retinal and choroidal layers in patients with diabetes. Grip strength may provide a useful and easily administered indicator of retinal status in patients with diabetes.

Choroidal Thickness in Young Adults and its Association with Visual Acuity

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.

Central serous chorioretinopathy with and without steroids: A multicenter survey

We investigated the rates of the use of steroids in Japanese central serous chorioretinopathy (CSC) cases and differences in the characteristics of CSC with and without steroids. A total of 538 eyes of 477 patients diagnosed with CSC, with 3 months or more of follow-up between April 2013 and June 2017 at 8 institutions. Patients with CSC with more than 3 months of follow-up were identified by OCT and fluorescein angiography at 8 institutions. Data collected included patient demographics, history of corticosteroid medication and smoking, spherical errors, findings of angiography, subfoveal choroidal thickness, and changes through the follow-up period. Differences in these findings were analyzed in cases with and without corticosteroid treatment. Among the 477 patients (344 men,133 women), 74 (15.5%) (39 men, 35 women) underwent current or prior steroid treatment. Cases with steroids were higher age (p = 0.0403) and showed no male prevalence, more bilateral involvement (p < 0.0001), and the affected eyes had multiple pigment epithelial detachment (p <0.0001), more fluorescein leakage sites (p < 0.0001), greater choroidal thickness (p = 0.0287) and a higher recurrence rate (p = 0.0412). Steroids can cause severer CSC through an effect on choroidal vessels and an impairment of retinal pigment epithelium.

Choroid thickness profile in patients with lupus nephritis

BACKGROUND

Choroidopathy is a rare manifestation of systemic lupus erythematosus (SLE). This entity is associated with active phases of severe SLE and it is frequently accompanied by acute kidney failure, central nervous system involvement and coagulopathy.

PURPOSE

To evaluate the choroid thickness of patients with lupus nephritis (LN) without choroidopathy, and to compare this with that of age-matched SLE patients without LN and healthy control subjects.

STUDY DESIGN

Cross-sectional case control study.

MATERIAL AND METHODS

Fifteen women with LN in remission phase (study group), 15 women with SLE in remission without LN (SLE control group), and 15 healthy women (healthy control group), without ocular diseases or significant refractive error, were recruited. Full ophthalmological examination and a macular optical coherence tomography in enhanced depth imaging mode were performed. The choroid thickness was measured at nine macular points and six lines of mean choroidal thickness were determined. A comparative analysis between the three groups was performed using the one-way ANOVA test and the paired t-test. The choroid thickness of patients under corticotherapy was also compared to that of patients without corticotherapy. Additionally, the correlation between choroid thickness and disease duration was evaluated using the Pearson analysis.

RESULTS

The mean macular choroidal thickness was 295.73 ± 67.62 μm in the study group, 233.34 ± 41.01 µm in the SLE control group, and 240.98 ± 37.93 μm in the control group ( p = 0.00006 and p = 0.0003, respectively). Additionally, the choroid thickness was significantly thicker than in the SLE and healthy control groups at the foveal ( p = 0.004 and p < 0.000), nasal ( p < 0.000 and p = 0.001), superior ( p = 0.002 and p < 0.000) and inferior ( p < 0.000 and p = 0.001) mean lines. The choroidal thickness in this group was not associated with the duration of the disease. The subgroup of patients with LN under corticotherapy did not reveal a significantly different choroidal thickness.

CONCLUSION

This study suggests a relationship between LN and choroidal changes, which may represent an increased risk for choroidopathy in these patients. Choroid thickening was not related with the duration of the disease. This thickening may be correlated with histopathological changes similar to those occurring in kidney glomeruli.

Change in subfoveal choroidal thickness in diabetes and in various grades of diabetic retinopathy

Background

To evaluate subfoveal choroidal thickness (SFCT) change in diabetes and in various grades of diabetic retinopathy (DR) in comparison to age-matched healthy subjects.

Methods

This prospective observational study included 100 eyes of diabetic patients without DR (group D), 100 eyes with DR (group R), and 100 eyes of healthy subjects (group N). The assessment included demographics, duration of diabetes, comprehensive ocular examination, fundus photography with/without fundus fluorescein angiography, spectral domain optical coherence tomography with enhanced depth imaging to assess SFCT.

Results

The SFCT was comparable between groups N (310.65 ± 37.34 µm) and D (308.48 ± 30.06 µm; P = 0.60), but was significantly lower in R (296.52 ± 21.41 µm; P < 0.01). The SFCT was significantly lower in proliferative DR (n = 36; SFCT = 284.56 ± 21.09 µm) as compared to non-proliferative DR (n = 64; SFCT = 303.25 ± 18.59 µm; P < 0.001). The SFCT had moderately negative correlation with severity of DR (R = − 0.50; P < 0.01). The difference in SFCT when compared with normal subjects was significant only in severe/very severe non-proliferative DR (294.47 ± 15.65 µm; P < 0.01) and in proliferative DR (284.56 ± 21.09 µm; P < 0.01). There was a negative correlation of SFCT with the duration of diabetes (R = − 0.41; P < 0.01).

Conclusion

SFCT decreases with increasing duration of diabetes. The decrease is significant after the onset of severe DR, and is proportionate to the severity of DR.