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Shi Y, Chen X, Tian Q, Bi C. OCTA on the density of optic nerve microvessels in myopic population with ocular hypertension. Photodiagnosis Photodyn Ther 2024; 46:104013. [PMID: 38346468 DOI: 10.1016/j.pdpdt.2024.104013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/06/2024] [Accepted: 02/09/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To measure functional, structural, and blood flow parameters of the optic disk in myopic patients with ocular hypertension (OHT) and myopic patients using optical coherence tomography angiography (OCTA), this study aims to investigate the variability of each parameter between the two groups, and to analyze the correlation between the RNFL thickness and blood flow parameters, as well as the diagnostic value of these blood flow parameters for myopic patients with OHT. METHODS This was a cross-sectional study. Myopic adults who were attending the Eye Center of Jinan Second People's Hospital between December 2020 and January 2022, and who had a confirmed diagnosis of OHT, were enrolled. This cohort constituted the myopic group. In these subjects, retinal nerve fiber layer (RNFL) thickness and blood flow parameters within the superficial optic disk 6 × 6 mm area were measured using OCTA. The optic disk blood flow parameters included radial peripapillary capillaries (RPC) perfusion density (PD) in nasal, temporal, superior, and inferior sectors. Visual field assessments were conducted using a Humphrey visual field meter to obtain the visual field index (VFI) and pattern standard deviation (PSD). SPSS 22.0 statistical software was utilized to determine if statistical differences existed between the parameters of the two groups and to analyze the correlation between blood flow parameters and RNFL thickness. Additionally, the area under the subject's operating characteristic curve (AUROC) was used to assess the diagnostic value of blood flow parameters for myopic patients with OHT. RESULTS There was no statistical difference in PSD and VFI in the OHT group compared with the myopic group (P = 0.351, 0.242). The RNFL thickness was (103.64 ± 8.13) μm and (97.56 ± 12.94) μm in the myopic and OHT groups, respectively. There was no statistical difference in RNFL thickness between the OHT and myopic group (P = 0.052). The PD of radial peripapillary capillaries (RPC) in nasal, temporal, superior, and inferior sectors showed an overall decreasing trend between the myopic and OHT groups, but there was a statistical difference only in the temporal sector (P = 0.008). Correlation analysis of blood flow parameters and structural parameters showed that the PD in the temporal sector and RNFL thickness were not correlated (P = 0.263). By plotting the AUROC of blood flow parameter, it was found that OCTA had good value in diagnosing myopic patients with OHT, and the PD of the temporal sector had higher diagnostic value for differentiating the OHT group from myopic group (AUROC = 0.718, P = 0.008) CONCLUSIONS: Compared with the myopic group, blood flow parameters decreased in the OHT group, while structural and functional parameters did not change significantly, suggesting that blood flow damage may have occurred earlier in myopic patients with OHT, by the correlation analysis between structural and blood flow parameters. OCTA has good diagnostic value for myopic patients with OHT.
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Affiliation(s)
- Yeqiang Shi
- Ophthalmology Department, Jinan No. 2 People's Hospital, Jinan 250000, China
| | - Xuan Chen
- Ophthalmology Department, Jinan No. 2 People's Hospital, Jinan 250000, China
| | - Qingfen Tian
- Ophthalmology Department, Jinan No. 2 People's Hospital, Jinan 250000, China
| | - Chao Bi
- Ophthalmology Department, Jinan No. 2 People's Hospital, Jinan 250000, China.
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Tian L, Cao K, Ma DL, Lu LX, Zhao SQ, Li A, Chen CX, Ma ZF, Jin ZB, Ma CR, Jie Y. Six-month repeated irradiation of 650 nm low-level red light reduces the risk of myopia in children: a randomized controlled trial. Int Ophthalmol 2023; 43:3549-3558. [PMID: 37318667 DOI: 10.1007/s10792-023-02762-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/21/2023] [Indexed: 06/16/2023]
Abstract
PURPOSE To evaluate whether the six-month repeated irradiation of 650 nm low-level red light (LLRL) decreases the risk of myopia onset in children. METHODS This was a single-masked, randomized controlled trial. A total of 112 children (aged 6-12 years) were enrolled and randomized to the treatment group or control group in a 1:1 ratio. The cycloplegic spherical equivalent error (SER) of children at baseline was -0.5 diopter (D) to 3D. Children in the treatment group were irradiated with the 650 nm LLRL for 6 min daily. No intervention was given to the control. The primary outcomes are myopia incidence, change in cycloplegic SER, and change in axial length (AL). RESULTS For the treatment group and control group, the six-month myopia incidence rates were 1.8% (95% confidence interval, CI: 0.2-4.9%) and 12.5% (95% CI: 5.5-21.9%), respectively. The difference was significant (p = 0.028). The median changes in AL for the treatment group and control group were -0.02 (interquartile range, IQR: -0.12 to 0.06) mm, and 0.09 (IQR: 0-0.18) mm, respectively. The difference was significant (p < 0.001). The median changes in cycloplegic SER for the treatment group and control group were 0 (IQR: 0-0.25) D, and -0.125 (IQR: -0.375 to 0) D, respectively. The difference was significant (p < 0.001). There was no adverse event. CONCLUSION The repeated irradiation of 650 nm LLRL may have a strong effect for myopia prevention in children, without risk of adverse events. TRIAL REGISTRATION this trial is retrospectively registered in the Chinese Clinical Trial Registry ( http://www.chictr.org.cn/ ), the registration number is ChiCTR2200058963.
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Affiliation(s)
- Lei Tian
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No. 17, Hougou Alley, Dongcheng District, Beijing, 100730, China
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Kai Cao
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No. 17, Hougou Alley, Dongcheng District, Beijing, 100730, China
| | - Dong-Li Ma
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Li-Xin Lu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Shi-Qiang Zhao
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Ao Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Chang-Xi Chen
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No. 17, Hougou Alley, Dongcheng District, Beijing, 100730, China
| | - Zhang-Fang Ma
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Zi-Bing Jin
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No. 17, Hougou Alley, Dongcheng District, Beijing, 100730, China
| | - Chun-Rong Ma
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China
| | - Ying Jie
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, No. 17, Hougou Alley, Dongcheng District, Beijing, 100730, China.
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing, 100730, China.
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Zhang Y, Jeong H, Mori K, Ikeda SI, Shoda C, Miwa Y, Nakai A, Chen J, Ma Z, Jiang X, Torii H, Kubota Y, Negishi K, Kurihara T, Tsubota K. Vascular endothelial growth factor from retinal pigment epithelium is essential in choriocapillaris and axial length maintenance. PNAS NEXUS 2022; 1:pgac166. [PMID: 36714840 PMCID: PMC9802415 DOI: 10.1093/pnasnexus/pgac166] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/16/2022] [Indexed: 06/18/2023]
Abstract
Myopia, which prevalence is rapidly increasing, causes visual impairment; however, the onset mechanism of pathological axial length (AL) elongation remains unclear. A highly vascularized choroid between the retinal pigment epithelium (RPE) and sclera not only maintains physiological activities, but also contributes to ocular development and growth regulation. Vascular endothelial growth factor (VEGF) secreted from the RPE to the choroid is essential for retinal function and maintenance of the choriocapillaris. Herein, we demonstrated that the loss of VEGF secreted from the RPE caused abnormal choriocapillaris development and AL elongation, with features similar to those of the lens-induced myopia (LIM) mouse model, whereas VEGF overexpression by knocking-out von Hippel-Lindau (VHL) specific to the RPE expands the choriocapillaris and shortens the AL. Additionally, LDL Receptor Related Protein 2 (LRP2) deletion in the RPE downregulated VEGF expression and leads to pathological AL elongation. Furthermore, high-myopia patients without choriocapillaris demonstrated longer ALs than did those with preserved choriocapillaris. These results suggest that physiological secretion of VEGF from the RPE is required for proper AL development by maintaining the choriocapillaris. The pinpoint application of VEGF to the choriocapillaris may become a potential intervention for the prevention and treatment of axial myopia progression.
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Affiliation(s)
- Yan Zhang
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Heonuk Jeong
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kiwako Mori
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Shin-Ichi Ikeda
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Chiho Shoda
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Ophthalmology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan
| | - Yukihiro Miwa
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Aichi Animal Eye Clinic, 3 Chome-17-3 Honjitori, Minami Ward, Nagoya, Aichi 457-0074, Japan
| | - Ayaka Nakai
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Ophthalmology, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi City, Tokyo 173-8610, Japan
| | - Junhan Chen
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Ziyan Ma
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Xiaoyan Jiang
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Hidemasa Torii
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Yoshiaki Kubota
- Department of Anatomy, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kazuno Negishi
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Toshihide Kurihara
- Laboratory of Photobiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
| | - Kazuo Tsubota
- Department of Ophthalmology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan
- Tsubota Laboratory Inc., 34 Shinanomachi, 304 Toshin Shinanomachi Ekimae Building, Shinjuku-ku, Tokyo 160-0016, Japan
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Wang X, Xia L. Effect of macular vascular density on visual quality in young myopic adults. Front Med (Lausanne) 2022; 9:950731. [PMID: 36052335 PMCID: PMC9424549 DOI: 10.3389/fmed.2022.950731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/22/2022] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate macular vascular density using optical coherence tomography angiography (OCTA) and to investigate its impact on best-corrected visual acuity (BCVA), contrast sensitivity function (CSF), and higher-order aberrations (HOAs) in young myopic adults. Methods This cross-sectional study included 109 eyes with axial length (AL) between 22 and 26 mm in the medium AL group and 90 eyes with AL > 26 mm in the long AL group. OCTA was used to obtain 3 × 3 mm en face images, and the vessel length density (VLD), perfusion density (PD), and fovea avascular zone (FAZ) of the superficial layer were evaluated. Visual quality was assessed using the CSF and HOAs. Results Significant differences were found in the inferior VLD, parafoveal PD, and FAZ areas between the groups. AL and macular vascular density showed negative correlations in the inferior and nasal areas. The spherical correction (SE) also showed a positive correlation with vascular density in these two areas. FAZ area and perimeter had a significant negative association with AL, and FAZ circularity was correlated with SE. CSF with bright around 6 and 12 spatial frequencies showed positive correlations with nasal PD. The parafoveal PD showed a significant correlation with BCVA after adjusting for other factors. Conclusion The superficial macular vascular density of young myopic adults decreased with lower SE and longer AL in the parafovea area. An eye with a long AL has a smaller FAZ, and myopia decreases the FAZ circularity index. The decrease in vessel density could contribute to worse BCVA and may be correlated with lower CSF, but not with HOAs.
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Alterations in the Choroidal Sublayers in Relationship to Severity and Progression of Diabetic Retinopathy. OPHTHALMOLOGY SCIENCE 2022; 2:100130. [PMID: 36249687 PMCID: PMC9560641 DOI: 10.1016/j.xops.2022.100130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 02/14/2022] [Accepted: 02/18/2022] [Indexed: 12/03/2022]
Abstract
Purpose To examine the association of baseline choroidal sublayers metrics with the risk of diabetic retinopathy (DR) progression over 2 years, with adjustment for confounding factors that affect choroidal measurements. Design Prospective, observational cohort study. Participants One hundred three eyes from 62 patients with diabetes mellitus (DM). Methods Patients were followed up at 6-month intervals for at least 2 years. Choroidal metrics including choroidal area, choroidal thickness (CT), and choroidal vascularity index were measured for both (1) the choriocapillaris plus Sattler’s layer and (2) the Haller’s layer within the subfoveal and parafoveal region. Cox proportional models were constructed to estimate the relationship between baseline choroidal metrics and DR progression, adjusted for intereye correlation, established risk factors (i.e., duration of DM, glycated hemoglobin [HbA1c] level, body mass index [BMI], use of insulin, and mean arterial blood pressure [MABP]) and confounding factors of choroidal measurements (i.e., age and axial length). Additional predictive value of choroidal metrics was assessed using the C-statistic. Main Outcome Measures Hazard ratios (HRs) calculated by Cox proportional hazards model to demonstrate the associations between baseline choroidal metrics and DR progression. Results After adjusting for age, axial length, and intereye correlation, choroidal metrics in Haller’s layer at baseline that were associated with a higher risk of DR progression included increases in subfoveal choroidal area (HR, 2.033; 95% confidence interval [CI], 1.179–3.505; P = 0.011), subfoveal plus parafoveal choroidal area (HR, 1.909; 95% CI, 1.096–3.326; P = 0.022), subfoveal CT (HR, 2.032; 95% CI, 1.181–3.498; P = 0.010), and subfoveal plus parafoveal CT (HR, 1.908; 95% CI, 1.097–3.319; P = 0.022). These associations remained statistically significant after additionally adjusting for duration of DM, HbA1c level, BMI, use of insulin, and MABP. Addition of these choroidal metrics significantly improved the discrimination for DR progression when compared with established risk factors alone (e.g., duration of DM and HbA1c; increase in C-statistic ranged from 8.08% to 9.67% [P < 0.05]). Conclusions Eyes with a larger choroidal area and CT in Haller’s layer at baseline were associated with a higher risk of DR progression over 2 years.
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Lin C, Toychiev A, Ablordeppey R, Slavi N, Srinivas M, Benavente-Perez A. Myopia Alters the Structural Organization of the Retinal Vasculature, GFAP-Positive Glia, and Ganglion Cell Layer Thickness. Int J Mol Sci 2022; 23:6202. [PMID: 35682880 PMCID: PMC9181442 DOI: 10.3390/ijms23116202] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/22/2022] [Accepted: 05/30/2022] [Indexed: 11/17/2022] Open
Abstract
To describe the effect of myopic eye growth on the structure and distribution of astrocytes, vasculature, and retinal nerve fiber layer thickness, which are critical for inner retinal tissue homeostasis and survival. Astrocyte and capillary distribution, retinal nerve fiber (RNFL), and ganglion cell layer (GCL) thicknesses were assessed using immunochemistry and spectral domain optical coherence tomography on eleven retinas of juvenile common marmosets (Callithrix Jacchus), six of which were induced with lens-induced myopia (refraction, Rx: -7.01 ± 1.8D). Five untreated age-matched juvenile marmoset retinas were used as controls (Rx: -0.74 ± 0.4D). Untreated marmoset eyes grew normally, their RNFL thickened and their astrocyte numbers were associated with RNFL thickness. Marmosets with induced myopia did not show this trend and, on the contrary, had reduced astrocyte numbers, increased GFAP-immunopositive staining, thinner RNFL, lower peripheral capillary branching, and increased numbers of string vessels. The myopic changes in retinal astrocytes, vasculature, and retinal nerve fiber layer thickness suggest a reorganization of the astrocyte and vascular templates during myopia development and progression. Whether these adaptations are beneficial or harmful to the retina remains to be investigated.
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Affiliation(s)
| | | | | | | | | | - Alexandra Benavente-Perez
- Department of Biological Sciences, SUNY College of Optometry, New York, NY 10036, USA; (C.L.); (A.T.); (R.A.); (N.S.); (M.S.)
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Lv L, Li M, Chang X, Zhu M, Liu Y, Wang P, Xiang Y. Macular Retinal Microvasculature of Hyperopia, Emmetropia, and Myopia in Children. Front Med (Lausanne) 2022; 9:900486. [PMID: 35669923 PMCID: PMC9163362 DOI: 10.3389/fmed.2022.900486] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 04/22/2022] [Indexed: 12/15/2022] Open
Abstract
PurposeTo compare macular retinal microcirculation in myopia, emmetropia, and hyperopia groups and investigate the relationship between macular retinal microcirculation and axial length (AL) in children.MethodsForty myopic, 29 emmetropic, and 34 hyperopic eyes were included. All the recruited eyes underwent optical coherence tomography angiography (OCTA) examinations. After adjusting the image size by the Littmann method and Bennett formula, the vessel density (VD) of the deep capillary plexus (DCP) and superficial vascular plexus (SVP) were assessed.ResultsThe VD of the DCP was significantly lower in the myopia group than in the hyperopia group, whereas no significant differences in the VD of the SVP were observed among the myopia, emmetropia, and hyperopia groups. The VD of the DCP was significantly associated with AL, spherical equivalent (SE), and foveal retinal thickness (FRT), whereas the VD of the SVP was only significantly associated with FRT but not with AL or SE.ConclusionsThe myopic VD of the DCP was significantly lower than the hyperopic one, and the VD of the DCP was significantly associated with AL, indicating that myopia has a lower VD of the DCP, and AL could have a negative effect on the VD of the DCP. Thus, early myopic axial stretching might decrease retinal blood perfusion of the DCP in children.
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Affiliation(s)
- Liang Lv
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Department of Ophthalmology, Hankou Aier Eye Hospital, Wuhan, China
| | - Mu Li
- Department of Ophthalmology, Wuhan Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuejiao Chang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Mengxia Zhu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Liu
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Wang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- *Correspondence: Ping Wang,
| | - Yan Xiang
- Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Yan Xiang,
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Wang W, Li L, Wang J, Chen Y, Kun X, Gong X, Wei D, Wang D, Liang X, Liu H, Huang W. Macular Choroidal Thickness and the Risk of Referable Diabetic Retinopathy in Type 2 Diabetes: A 2-Year Longitudinal Study. Invest Ophthalmol Vis Sci 2022; 63:9. [PMID: 35420642 PMCID: PMC9034727 DOI: 10.1167/iovs.63.4.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 02/19/2022] [Indexed: 11/27/2022] Open
Abstract
Purpose The purpose of this study was to evaluate the associations between choroidal thickness (CT) and the 2-year incidence of referable diabetic retinopathy (RDR). Methods This was a prospective cohort study. Patients with type 2 diabetes in Guangzhou, China, aged 30 to 80 years underwent comprehensive examinations, including standard 7-field fundus photography. Macular CT was measured using a commercial swept-source optical coherence tomography (SS-OCT) device (DRI OCT Triton; Topcon, Tokyo, Japan). The relative risk (RR) with 95% confidence intervals (CIs) was used to quantify the association between CT and new-onset RDR. The prognostic value of CT was assessed using the area under the receiver operating characteristic curve (AUC), net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results A total of 1345 patients with diabetes were included in the study, and 120 (8.92%) of them had newly developed RDR at the 2-year follow-up. After adjusting for other factors, the increased RDR risk was associated with greater HbA1c (RR = 1.35, 95% CI = 1.17-1.55, P < 0.001), higher systolic blood pressure (SBP; RR = 1.02, 95% CI = 1.01-1.03, P = 0.005), lower triglyceride (TG) level (RR = 0.81, 95% CI = 0.69-0.96, P = 0.015), presence of diabetic retinopathy (DR; RR = 8.16, 95% CI = 4.47-14.89, P < 0.001), and thinner average CT (RR = 0.903, 95% CI = 0.871-0.935, P < 0.001). The addition of average CT improved NRI (0.464 ± 0.096, P < 0.001) and IDI (0.0321 ± 0.0068, P < 0.001) for risk of RDR, and it also improved the AUC from 0.708 (95% CI = 0.659-0.757) to 0.761 (95% CI = 0.719-0.804). Conclusions CT thinning measured by SS-OCT is an early imaging biomarker for the development of RDR, suggesting that alterations in CT play an essential role in DR occurrence.
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Affiliation(s)
- Wei Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Longyue Li
- School of Medicine, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jun Wang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Yifan Chen
- John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Xiong Kun
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Xia Gong
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Daheng Wei
- Institute of Eyes, Jinzhou Medical University, Jinzhou, Liaoning, People's Republic of China
| | - Dongning Wang
- Institute of Eyes, Jinzhou Medical University, Jinzhou, Liaoning, People's Republic of China
| | - Xiaolin Liang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Hua Liu
- Institute of Eyes, Jinzhou Medical University, Jinzhou, Liaoning, People's Republic of China
| | - Wenyong Huang
- Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, People's Republic of China
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Karasu B, Celebi ARC. The efficacy of different anti-vascular endothelial growth factor agents and prognostic biomarkers in monitoring of the treatment for myopic choroidal neovascularization. Int Ophthalmol 2022; 42:2729-2740. [PMID: 35357641 DOI: 10.1007/s10792-022-02261-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Accepted: 03/12/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate anatomical and visual results of eyes with naive myopic choroidal neovascularization (mCNV) in patients treated with intravitreal anti-vascular endothelial growth factor (VEGF) therapies. MATERIAL AND METHODS This is a retrospective, non-randomized, comperative, intervetional study. One hundred fourteen eyes of 114 patients with mCNV who underwent intravitreal bevacizumab (IVB), intravitreal ranibizumab (IVR) or intravitreal aflibercept (IVA) monotherapy injections were enrolled into the study. The best corrected visual acuity (BCVA), central macular thickness (CMT) and subfoveal choroidal thickness (SFCT) were compared among the groups during the follow-up periods at the beginning, months 1, 3, 6, 12, and the final visit. RESULTS The mean age of the patients was 47.76 ± 10.57 years (range, 33-72 years) and the mean follow-up period was 23.34 ± 6.81 months (range, 13-38 months). The mean BCVA denoted a significantly improve at each group (p < 0.05). In terms of an inter-group analysis of all 3 groups, at months 1, 6, and 12 and final visit, the BCVA were statistically significantly better in the IVA group when compared to both IVB and IVR groups (p = 0.021, p = 0.032, p = 0.024, p = 0.012). There was a significant decrease in CMT following IVB (236.49 ± 40.91 μm-190.74 ± 50.12 μm), IVA (232.91 ± 46.29 μm-193.73 ± 46.81 μm) and IVR (234.78 ± 45.37 μm-192.21 ± 37.27 μm) between baseline and final visit (p = 0.018, p = 0.002, p < 0.001, respectively). There was a statistically significant decrease in SFCT values between baseline and final examination only in the IVA group (p < 0.001). The mean number of injections were 9.18 ± 3.18 (range; 3 to 13) in IVB, 6.46 ± 2.93 (range; 3-11) in IVR and 4.45 ± 1.42 (range; 2-7) in IVA (p = 0.028). CONCLUSION All three anti-VEGFs were found to be effective in terms of visual results in patients with mCNV. However, we demonstrated that IVA reduces the need for anti-VEGF when compared to patients who received both IVB and IVR. Furthermore, IVA induced a prominent reduction in SFCT, whereas IVR and IVB did not have a significant action on SFCT.
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Affiliation(s)
- Buğra Karasu
- Department of Ophthalmology, Tuzla State Hospital, İçmeler Mahallesi, Piri Reis Caddesi, No: 74 Tuzla/İstanbul, 34947, Istanbul, Turkey. .,Department of Ophthalmology, Beyoglu Eye Research and Training Hospital, Istanbul, Turkey.
| | - Ali Rıza Cenk Celebi
- Department of Ophthalmology Istanbul, School of Medicine, Acibadem University, Istanbul, Turkey
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10
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Yao H, Xin D, Li Z. The Deep Vascular Plexus Density is Closely Related to Myopic Severity. Ophthalmic Res 2022; 65:455-465. [PMID: 35294948 DOI: 10.1159/000523938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 02/01/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate the relationship between myopic severity and the retinal microvasculature based on quantitative variables using optical coherence tomography angiography (OCTA) and to identify OCTA indicators of microvascular network loss in myopia. METHODS This cross-sectional study included 123 eyes of 123 myopic subjects. The included eyes were divided into three groups according to the spherical equivalent (SE) and axial length (AL): low myopia (LM) (-3.00 D ≤ SE ≤ -0.50 D), moderate myopia (MM) (-6.00 D ≤ SE <-3.00 D) and high myopia (HM) (-9.00 D ≤ SE < -6.00 D or AL > 26 mm). All the eyes underwent OCTA scans. The densities and thicknesses of the macular and peripapillary zones, including the foveal avascular zone (FAZ) area, superficial vascular plexus (SVP) density, deep vascular plexus (DVP) density, ganglion cell complex (GCC) thickness, full retinal thickness, radial peripapillary capillary plexus (RPCP) density and retinal nerve fibre layer (RNFL) thickness, were automatically exported. RESULTS Compared to the LM or MM group, the HM group had a significantly reduced FAZ area (p < 0.05). In most sectors of the parafoveal and perifoveal areas, the HM group had significantly lower DVP density and higher retinal thickness than the LM and MM groups (all p < 0.05). However, significant differences among the three groups in only one or several sectors were observed with regard to SVP density, GCC thickness and RNFL thickness, and no significant differences among the three groups in any sector were noticed in RPCP density. Perifoveal DVP density and perifoveal full retinal thickness were positively associated with SE and negatively associated with AL in stepwise multiple linear regression analyses adjusted for sex and age. CONCLUSION DVP density was closely related to myopic severity. Reduced perifoveal DVP density may serve as an indicator of microvascular network loss in myopia. OCTA may provide useful and crucial information for monitoring the progression of myopia.
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Affiliation(s)
- Hongyan Yao
- Ningbo Eye Hospital, Ningbo University, Ningbo, China
| | - Danli Xin
- Ningbo Eye Hospital, Ningbo University, Ningbo, China
| | - Zijing Li
- Department of Ophthalmology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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11
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Liu Y, Wang L, Xu Y, Pang Z, Mu G. The influence of the choroid on the onset and development of myopia: from perspectives of choroidal thickness and blood flow. Acta Ophthalmol 2021; 99:730-738. [PMID: 33550704 DOI: 10.1111/aos.14773] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 01/12/2021] [Indexed: 12/11/2022]
Abstract
Myopia is the most common type of refractive errors characterized by excessive elongation of the ocular globe. With the increasing prevalence of myopia, improved knowledge of factors involved in myopia development is of particular importance. There are growing evidence suggesting that the choroid plays an important role in the regulation of eye growth and the development of myopia. Studies have demonstrated that thinning choroid is a structural feature of myopia, with a negative correlation between choroidal thickness and axial length, suggesting that the change in choroidal thickness may be a predictive biomarker for long-term changes in ocular elongation. Given the fact that the choroid is primarily a vascular structure capable of rapidly changing blood flow, variations of choroidal thickness might be primarily caused by changes in choroidal blood flow. Considering that hypoxia is associated with myopia and choroidal blood flow is the main source of oxygen and nourishment supply, apart from the effect on myopia possibly by changing choroidal thickness, decreasing choroidal blood flow may contribute to scleral ischaemia and hypoxia, resulting in alterations in the scleral structure and thus leading to myopia. This review aims to provide an overview of recent work exploring the influence of the choroid on myopia from perspectives of choroidal thickness and blood flow, which may present new predictive indicators for the onset of myopia and new targets for the development of novel therapeutic approaches for myopia.
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Affiliation(s)
- Yilin Liu
- Department of Ophthalmology Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University Jinan China
| | - Lijun Wang
- Department of Ophthalmology Binzhou Medical University Hospital Binzhou China
| | - Yanyun Xu
- Department of Ophthalmology Shandong Second Provincial General Hospital, Shandong Provincial ENT Hospital Jinan China
| | - Zuoxiang Pang
- Department of Ophthalmology Weifang People's Hospital Weifang China
| | - Guoying Mu
- Department of Ophthalmology Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University Jinan China
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12
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Wen X, Li Z, Xiao J, Liu X, Zhang Y, Lan Y. Association of Myopia With Microvascular Alterations in Patients With Type 2 Diabetes: An Optical Coherence Tomography Angiography Study. Front Med (Lausanne) 2021; 8:715074. [PMID: 34660628 PMCID: PMC8517071 DOI: 10.3389/fmed.2021.715074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 08/23/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose: To determine the association of myopia with peripapillary and macular microvasculature in eyes with type 2 diabetes using optical coherence tomography angiography (OCTA). Methods: Diabetic patients with and without diabetic retinopathy (DR) were recruited and grouped according to myopic status in this cross-sectional study. Axial length, refractive error, and OCTA parameters were measured. OCTA parameters were analyzed with adjustment of confounding factors and further Bonferroni analysis was performed to determine the differences in multiple group comparisons. Results: Compared with the diabetic eyes without myopia, those with myopia had lower rate of DR (21.82 vs. 35.90%, χ2 = 6.190, P = 0.013), longer axial lengths (24.94 ± 0.75 vs. 23.16 ± 0.64, F = 311.055, P < 0.001) and reduced whole vessel density (VD) of optic nerve head (ONH) (45.89 ± 5.76 vs. 49.14 ± 4.33, F = 19.052, P < 0.001), peripapillary VD (48.75 ± 6.56 vs. 50.76 ± 4.51, F = 7.600, P = 0.006), and reduced thickness of the retinal nerve fiber layer (RNFL) (95.50 ± 12.35 vs. 100.67 ± 13.68, F = 5.020, P = 0.026). In eyes without myopia, the superficial vessel density (SVD) (46.58 ± 4.90 vs. 43.01 ± 4.25; 95% CI, 1.80-4.61; P < 0.001), deep vessel density (DVD) (45.64 ± 6.34 vs. 42.15 ± 6.31; 95% CI, 1.07-5.00; P < 0.001), and FD300 area density (50.31 ± 5.74 vs. 44.95 ± 6.96; 95% CI, 2.88-7.27; P < 0.001) were significant reduced in eyes with DR(DR eyes) comparing to those without DR (NoDR eyes). In eyes with myopia, only SVD were significantly reduced in DR eyes comparing to NoDR eyes (41.68 ± 3.34 vs. 45.99 ± 4.17; 95% CI, 1.10-7.22; P = 0.002). In NoDR eyes, both whole VD of ONH and Peripapillary VD demonstrated a significant decrease in eyes with myopia comparing to those without myopia (49.91 ± 4.36 vs. 45.61 ± 6.32; 95% CI, 1.95-6.27; P < 0.001 and 51.36 ± 4.24 vs. 48.52 ± 6.99; 95% CI, 0.56-5.11; P = 0.006, respectively). Conclusions: In diabetic patients, myopic eyes exhibited lower prevalence of DR and thinner thickness of RNFL. The refractive status could possibly impact the retinal microvascular changes from NoDR to DR stage.
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Lim HB, Shin YI, Lee MW, Lee JU, Lee WH, Kim JY. Association of Myopia with Peripapillary Retinal Nerve Fiber Layer Thickness in Diabetic Patients Without Diabetic Retinopathy. Invest Ophthalmol Vis Sci 2021; 61:30. [PMID: 32797199 PMCID: PMC7443111 DOI: 10.1167/iovs.61.10.30] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the association between myopia and peripapillary retinal nerve fiber layer (pRNFL) thickness in diabetic patients without diabetic retinopathy (DR). Methods A total of 271 eyes of 271 participants were included. They were divided into four groups according to the presence of myopia (≤ -3 diopters [D]) and diabetes without DR: (1) control group (n = 76), (2) myopia group (n = 57), (3) diabetes group (n = 82), and (4) diabetes + myopia group (n = 56). The peripapillary average and sector RNFL thicknesses were measured and compared among the four groups to determine the effects of myopia and diabetes. Covariates were adjusted using analyses of covariance. Linear regression analyses were fitted to evaluate the factors associated with pRNFL. Results Spherical equivalents were 0.12 ± 1.31 D in the control group, -4.00 ± 1.47 D in the myopia group, 0.00 ± 1.05 D in the diabetes group, and -4.33 ± 1.70 D in the diabetes + myopia group (P < 0.001). The respective axial lengths (ALs) were 23.91 ± 0.99 mm, 25.16 ± 0.94 mm, 23.68 ± 0.77 mm, and 25.34 ± 1.33 mm (P < 0.001). The average pRNFL showed a progressive decrease from the control group (97.16 ± 8.73 µm) to the myopia group (94.04 ± 9.13 µm) to the diabetes group (93.33 ± 9.07 µm) to the diabetes + myopia group (91.25 ± 9.72 µm) (P = 0.009). Age, diabetes, hypertension, and AL were significantly correlated with the pRNFL. The rate of reduction of pRNFL with increasing age was higher in the diabetes + myopia group than in the other groups, and pRNFL in the diabetes groups decreased more steeply with increasing AL compared to the non-diabetic groups. Conclusions Myopia and diabetes are important factors affecting pRNFL thickness, and the simultaneous presence of diabetes and myopia results in greater pRNFL damage than observed with either pathology alone.
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Affiliation(s)
- Hyung Bin Lim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Yong-Il Shin
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea.,Rhee's Eye Hospital, Daejeon, Republic of Korea
| | - Min Woo Lee
- Department of Ophthalmology, Konyang University Hospital, Daejeon, Republic of Korea
| | - Jong-Uk Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Woo Hyuk Lee
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
| | - Jung-Yeul Kim
- Department of Ophthalmology, Chungnam National University College of Medicine, Daejeon, Republic of Korea
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14
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Chen W, Li Z, Wang Q, Wang Y, Zhang Y. The Role of C-Jun N-terminal Kinase-1 in Controlling Aquaporin-1 and Choroidal Thickness during Recovery from Form-deprivation Myopia in Guinea Pigs. Curr Eye Res 2020; 46:885-894. [PMID: 33115288 DOI: 10.1080/02713683.2020.1839107] [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: 10/23/2022]
Abstract
PURPOSE The development and recovery(REC) of myopia is associated with changing of choroidal thickness(CT) in model of guinea pigs. Aquaporin-1 (AQP-1) is related to the changes of CT during the recovery from myopia, but the corresponding signaling pathway has not been clarified. This study aimed to investigate the effect of JNK1 on CT/AQP-1 and the recovery from myopia. MATERIALS AND METHODS According to the different single intravitreal injections in eyes that underwent form deprivation for 21 days, guinea pigs were divided into four groups: the REC group, the REC+anisomycin (REC-AN, agonist for JNK1, 0.2 nmol) group, the REC+SP600125 (REC-SP, inhibitor for JNK1, 0.2 nmol) group, and the REC+dimethyl sulfoxide (REC-DM) group. Each group was divided into three subgroups based on the duration of the form deprivation: 3 days (d), 7 d and 10 d. All animals underwent biometric measurements (refractive error, axial length (AL), and CT), and the protein expression of AQP-1 and p-JNK1 in the choroid was also measured. RESULTS In REC and REC-DM groups, significant differences in CT/refractive error/AL/p-JNK1 or AQP-1 were only found in the 3d group compared with normal control (NC) group (all p < .05). In REC-AN group, CT/p-JNK1 or AQP-1 in 3d group was significantly higher than that in other 3d groups (all p < .05), but no significant difference in refractive error or AL was found compared with NC group at three time points (all p > .05). In REC-SP group, a significant difference in refractive error/CT/p-JNK1 or AQP1 was found in 3d/7d group compared with NC group (all p < .05), but AL was only found in 3d groups (p = .001). CONCLUSIONS Changes in JNK1 phosphorylation can regulate AQP-1 and CT during the recovery from myopia and the recovery time. Thus, JNK1 may be a potential therapeutic target for preventing/treating myopia.
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Affiliation(s)
- Wei Chen
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China
| | - Zhiwei Li
- Department of Ophthalmology, Shandong Provincial Hospital Affilliated to Shandong University, Jinan, China
| | - Qimiao Wang
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China
| | - Yan Wang
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China
| | - Yue Zhang
- Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin, China
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15
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Khan MH, Lam AKC, Armitage JA, Hanna L, To CH, Gentle A. Impact of Axial Eye Size on Retinal Microvasculature Density in the Macular Region. J Clin Med 2020; 9:jcm9082539. [PMID: 32781548 PMCID: PMC7463769 DOI: 10.3390/jcm9082539] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 01/21/2023] Open
Abstract
Mechanical tissue stresses are important contributors to the increased risk of sight-threatening pathology in larger, more myopic eyes. The contribution of altered ocular vasculature to the development of this pathology is less well defined. The current study investigated the impact of eye size on the superficial vasculature of the macula. Subjects (n = 104) aged 18–50, with no history of ocular or vascular disease, or myopia control, were recruited from university staff and student populations in Australia and Hong Kong. Refractive error, ocular size, retinal morphology and vascular morphology were quantified through open field autorefraction, ocular biometry and ocular coherence tomography angiography. Morphology of the superficial retinal capillary plexus was assessed over a 3 × 3 mm fovea-centred area. Perfusion area and vessel length densities were analysed relative to axial eye length and retinal thickness. A significant inverse association was found between axial length and vascular density measures (perfusion area density r2 = 0.186, p < 0.001; and vessel length density r2 = 0.102, p = 0.001). Perfusion area and vessel length densities were reduced by 5.8% (p = 0.001) in the longest, relative to the shortest, eyes. The aggregated ganglion cell layer inner plexiform layer thickness was also inversely associated with eye size (r2 = 0.083, p = 0.003), and reduced, by 8.1% (p < 0.001), in the longest eyes. An inverse association of eye size and superficial retinal vasculature density, that is not simply explained by retinal expansion or image magnification factors, was confirmed. These data support the hypothesis that ongoing metabolic challenges may underlie the development of myopia-related and -associated pathology in larger eyes.
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Affiliation(s)
- M. Hafi Khan
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, VIC 3216, Australia; (M.H.K.); (J.A.A.)
| | - Andrew K. C. Lam
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong 00852, China; (A.K.C.L.); (C.-h.T.)
| | - James A. Armitage
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, VIC 3216, Australia; (M.H.K.); (J.A.A.)
| | - Lisa Hanna
- School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC 3220, Australia;
| | - Chi-ho To
- Centre for Myopia Research, School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong 00852, China; (A.K.C.L.); (C.-h.T.)
| | - Alex Gentle
- School of Medicine, Faculty of Health, Deakin University, Waurn Ponds, VIC 3216, Australia; (M.H.K.); (J.A.A.)
- Correspondence:
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16
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Chen W, Zhang H, Zhang Y, Wang Q, Wang Y, Li ZW. Relationship between Aquaporin-1 Protein Expression and Choroidal Thickness during the Recovery of Form-deprivation Myopia in Guinea Pigs. Curr Eye Res 2019; 45:705-712. [PMID: 31697570 DOI: 10.1080/02713683.2019.1689275] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Purpose: The purpose of this study was to investigate the relationship between aquaporin-1 (AQP-1) protein expression in the choroid and choroid thickness (CT) during the recovery of form-deprivation (FD) myopia in guinea pigs.Materials and Methods: Seventy-two guinea pigs were randomly assigned to the normal control (NC) group, FD 21 group (animals wore a latex facemask in the right eye for 21 days to induce FD myopia) and four recovery (REC) groups. Guinea pigs in the REC groups also wore the facemask for 21 days to induce myopia; then, the facemask was removed, and the eye was re-exposed to the normal environment for 12 hours (REC ½ group), 1 day (REC 1 group), 2 days (REC 2 group), and 7 days (REC 7 group). All animals underwent biometric measurements (refraction, axial length, and CT), and the protein expression of AQP-1 in the choroid was determined using western blotting.Results: The protein expression of AQP-1 and CT were significantly decreased in the FD 21 group as compared with those in the NC group (p = .007 and p < .001). Both AQP-1 protein expression and CT gradually increased and peaked in the REC 2 group. Additionally, there were significant differences in AQP-1 protein expression and CT between the REC 2 group and all other groups (all p < .05). We observed a complete recovery in the in REC 7 group as compared with the NC group (p > .05). AQP-1 protein expression was significantly associated with CT (p = .001) in all groups; however, there was a significant negative correlation (p = .029) between AQP-1 protein expression and axial length in the REC groups.Conclusions: AQP-1 protein expression in the choroid was upregulated following recovery of FD myopia in guinea pigs, and these changes correlated with alterations in CT and axial length.
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Affiliation(s)
- Wei Chen
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Eye Institute, Tianjin, China
| | - Hongyuan Zhang
- Department of Gynaecology, Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Yue Zhang
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Eye Institute, Tianjin, China
| | - Qimiao Wang
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Eye Institute, Tianjin, China
| | - Yan Wang
- Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Hospital, Nankai University Affiliated Eye Hospital, Clinical College of Ophthalmology, Tianjin Medical University, Tianjin Eye Institute, Tianjin, China
| | - Zhi Wei Li
- Department of Ophthalmology, Shandong Provincial Hospital Affilliated to Shandong University, Jinan, China
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17
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Wong CW, Yanagi Y, Tsai ASH, Shihabuddeen WA, Cheung N, Lee SY, Jonas JB, Cheung CMG. Correlation of axial length and myopic macular degeneration to levels of molecular factors in the aqueous. Sci Rep 2019; 9:15708. [PMID: 31673022 PMCID: PMC6823508 DOI: 10.1038/s41598-019-52156-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 07/22/2019] [Indexed: 02/06/2023] Open
Abstract
To elucidate the molecular processes associated with the development of myopic macular degeneration (MMD), we measured the intraocular concentrations of molecular factors in emmetropic and myopic eyes. This is a retrospective clinic-based case-control study that included eyes undergoing routine cataract surgery whereby aqueous humour samples were obtained. We measured the concentrations of pigment epithelium derived factor(PEDF), matrix metalloproteinase 2(MMP-2), tissue inhibitor of metalloproteinase(TIMP-2), vascular endothelial growth factor isoform A(VEGF-A), interleukin 8(IL-8), interleukin 6(IL-6), C-reactive protein(CRP), angiopoietin 2(Ang2), and amphiregulin. 38 eyes (axial length (AL): 22.4–32.4 mm), including 12 highly myopic (HM) eyes (AL ≥ 26.5 mm) without MMD and 12 HM eyes with MMD but without neovascularization were included. Eyes with MMD were found to have significantly lower VEGF-A levels (p = 0.007) and higher MMP-2 levels (p = 0.02) than control eyes after adjusting for age and gender. MMP-2 levels correlated positively (r = 0.58, p = 0.002), while VEGF-A levels correlated negatively with longer axial length (r = −0.75, p < 0.001). Both the concentrations of VEGF-A (P = 0.25) and MMP-2 (P = 0.69) were not significantly associated with MMD after adjusting for AL. These findings suggest that the predominant mechanism underlying the development of non-neovascular MMD may be axial elongation, driven in part by MMP-2 related mechanisms.
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Affiliation(s)
- Chee Wai Wong
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Yasuo Yanagi
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Andrew Shih Hsiang Tsai
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Mannheim, Germany
| | | | - Ning Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Shu Yen Lee
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore.,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | - Jost B Jonas
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University, Mannheim, Germany
| | - Chui Ming Gemmy Cheung
- Singapore Eye Research Institute, Singapore National Eye Centre, Singapore, Singapore. .,Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore, Singapore.
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18
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Suwan Y, Fard MA, Geyman LS, Tantraworasin A, Chui TY, Rosen RB, Ritch R. Association of Myopia With Peripapillary Perfused Capillary Density in Patients With Glaucoma: An Optical Coherence Tomography Angiography Study. JAMA Ophthalmol 2019; 136:507-513. [PMID: 29621390 DOI: 10.1001/jamaophthalmol.2018.0776] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Importance This study used optical coherence tomographic angiography to assess for impaired blood flow in myopic eyes with or without open-angle glaucoma. Objective To compare the peripapillary perfused capillary density (PCD) between eyes with and without glaucoma. Design, Setting, and Participants In this cross-sectional study at a tertiary glaucoma referral practice, we recruited patients with myopic eyes of spherical equivalent of more than -3.0 diopters with and without open-angle glaucoma, patients with nonmyopic eyes with glaucoma, and patients with no disease from February 2016 to October 2016. We obtained 4.5 × 4.5-mm optical coherence tomographic angiography images of the optic nerve head and calculated PCD as the ratio of pixels associated with capillaries to the number of pixels in the region of interest after large blood vessel removal. Both eyes of each patient were used in the analysis. Continuous variables were assessed by analysis of variance and Tukey tests. A marginal model of generalized estimating equations was performed to adjust for confounding factors and intraclass correlations. Main Outcomes and Measures Mean PCD. Results We matched 87 patients with myopic eyes with glaucoma (of whom 39 [45%] were women), 17 with myopic eyes without glaucoma (of whom 10 [59%] were women), and 93 with non-myopic eyes with glaucoma (of whom 55 [59%] were women) for visual field defects and included 51 control participants (or whom 38 [75%] were women). Mean (SD) ages were 67.5 (12.0) years for patients with myopia and glaucoma, 48.2 (19.0) years for those with myopia without glaucoma, 67.3 (11.0) years for those with glaucoma without myopia, and 64.7 (8.9) years in control participants. Global PCD demonstrated a progressive decrease from the control group (mean [SD], 41.0 [4.2]) to those with myopia without glaucoma (38.4 [5.8]) to those with glaucoma without myopia (31.9 [7.5]) to those with both (28.2 [6.0]; all P < .001). The mean difference in global PCD between the 3 groups and control group, adjusted for age and axial length, was greatest in those with myopia and glaucoma (-11.1; 95% CI, -14.0 to -8.1; P < .001), followed by those with glaucoma without myopia (-8.6; 95% CI, -10.9 to -6.3; P < .001) and those with myopia without glaucoma (-2.8; 95% CI, -6.9 to 1.2; P = .17). No interaction was found between glaucoma and myopia. Conclusions and Relevance These findings demonstrate peripapillary microvascular attenuation to a greater extent in open-angle glaucoma than myopia. The cross-sectional design means we cannot determine if this association is a cause and/or is associated with other confounding factors.
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Affiliation(s)
- Yanin Suwan
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York.,Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | | | - Lawrence S Geyman
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York.,Icahn School Medicine at Mount Sinai, New York, New York
| | - Apichat Tantraworasin
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Toco Y Chui
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York
| | - Richard B Rosen
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York
| | - Robert Ritch
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York
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Chen W, Li L, Zhang H, Li Y, Chen X, Zhang Y. Macular choroidal thickness in highly myopic women during pregnancy and postpartum: a longitudinal study. BMC Pregnancy Childbirth 2018; 18:220. [PMID: 29884130 PMCID: PMC5994060 DOI: 10.1186/s12884-018-1865-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 05/29/2018] [Indexed: 12/05/2022] Open
Abstract
Background High myopia, a cause of serious visual impairment, is a significant global public health concern. We investigate longitudinal changes in macular choroidal thickness (CT) during pregnancy and 6-months postpartum in women with high myopia (HM). Methods A prospective longitudinal study was conducted in HM-pregnant women during the course of pregnancy (n = 42 eyes, 42 patients) and 6 months postpartum (n = 40 eyes, 40 patients, two cases lost).Macular CT was measured via enhanced-depth imaging (EDI)-optical coherence tomography (OCT) (EDI-OCT). Intraocular pressure (IOP), axial length (AL), refractive error, mean arterial pressure (MAP), mean ocular perfusion pressure (MOPP), and body mass index (BMI) were also measured. Results Macular CTs of HM pregnant women (214.3 ± 52.3 μm) had increased significantly during the third trimester of pregnancy compared with postpartum women (192.7 ± 51.9 μm, p = 0.014). No significant differences in AL, refractive error, or MAP were found between pregnant and postpartum groups (p > 0.05 for all parameters).During pregnancy, macular CT was negatively correlated with AL (first trimester: p = 0.010; second trimester: p = 0.013; and third trimester: p = 0.008) and positively correlated with refractive error (first trimester: p = 0.038; second trimester: p = 0.024; and third trimester: p = 0.010). No correlations between macular CT and age, IOP, MOPP, MAP, or BMI were found. Conclusions Our study revealed the presence of a significantly thicker choroid during the third trimester of pregnancy compared with 6-mo postpartum in HM women. Macular CT positively correlated with refractive error and negatively correlated with AL during pregnancy, but did not correlate with gestational age, MOPP, IOP, MAP, or BMI.
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Affiliation(s)
- Wei Chen
- Clinical College of Ophthalmology, Tianjin Medical University, No.4, Gansu Road, Tianjin City, People's Republic of China
| | - Li Li
- Clinical College of Ophthalmology, Tianjin Medical University, No.4, Gansu Road, Tianjin City, People's Republic of China
| | - Hongyuan Zhang
- Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Yan Li
- Clinical College of Ophthalmology, Tianjin Medical University, No.4, Gansu Road, Tianjin City, People's Republic of China
| | - Xu Chen
- Tianjin Central Hospital of Gynecology and Obstetrics, Tianjin, China
| | - Yue Zhang
- Clinical College of Ophthalmology, Tianjin Medical University, No.4, Gansu Road, Tianjin City, People's Republic of China.
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Suwan Y, Geyman LS, Fard MA, Tantraworasin A, Chui TY, Rosen RB, Ritch R. Peripapillary Perfused Capillary Density in Exfoliation Syndrome and Exfoliation Glaucoma versus POAG and Healthy Controls: An OCTA Study. Asia Pac J Ophthalmol (Phila) 2018; 7:84-89. [PMID: 29165935 DOI: 10.22608/apo.2017318] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To compare the peripapillary perfused capillary density (PCD) among eyes with exfoliation syndrome (XFS), exfoliation glaucoma (XFG), primary open-angle glaucoma (POAG), and controls. DESIGN Observational, cross-sectional study. METHODS Optical coherence tomography angiography (OCTA) images (4.5×4.5 mm) of the optic nerve head were obtained using a commercial spectral domain OCTA system (AngioVue Avanti RTVue-XR, OptoVue, Fremont, CA). Two concentric circles with 1.95-mm (inner) and 3.45-mm (outer) diameters were placed manually, producing an annulus of width 0.75 mm centered at the optic disc. PCD was calculated as the ratio of pixels associated with capillaries to the pixels in the annulus after large blood vessel removal. Continuous variables were assessed by analysis of variance and Tukey honest significant difference (HSD) test. Multiple linear regression analysis was performed to adjust for confounding factors. RESULTS Forty-three XFG eyes, 31 POAG eyes matched for visual field mean deviation, 33 XFS eyes, and 45 control eyes were analyzed. PCD demonstrated a progressive decrease from controls to XFS to POAG to XFG. Pairwise comparisons revealed significant differences in PCD between each pair of groups (all P<0.01) except for PCD between XFS and POAG (P = 0.08). A multivariable model adjusting for age and stage showed a more significant decrease in PCD in XFG compared with POAG (P = 0.001). CONCLUSIONS PCD was more significantly decreased in XFG compared with POAG eyes and in XFS compared with control eyes. OCTA provides the first quantitative evidence of the microvascular disturbance that accompanies XFS.
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Affiliation(s)
- Yanin Suwan
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
- Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Lawrence S Geyman
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
- Icahn School Medicine at Mount Sinai, New York, NY
| | | | - Apichat Tantraworasin
- Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Toco Y Chui
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | - Richard B Rosen
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
| | - Robert Ritch
- Eihorn Clinical Research Center, New York Eye and Ear Infirmary of Mount Sinai, New York, NY
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Wang W, He M, Zhong X. Sex-Dependent Choroidal Thickness Differences in Healthy Adults: A Study Based on Original and Synthesized Data. Curr Eye Res 2018; 43:796-803. [PMID: 29451995 DOI: 10.1080/02713683.2018.1428995] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study is to determine the influence of sex on choroidal thickness (CT) in healthy adults. METHODS Healthy Chinese adults were recruited and complete ophthalmic examinations were performed. The choroid was imaged by swept-source optical coherence tomography and the macular CT in Early Treatment Diabetic Retinopathy Study grids was obtained by the intrinsic automated segmentation software. CT in males and females was compared after controlling other factors. All of the published studies in PubMed were systemically tracked, and a syntheses analysis of the combined data of the present study and previous studies was performed to address this issue further. RESULTS A total of 104 healthy adults were included, of whom 38 (37%) were male and 66 (63%) were female. Older age and longer axial length (AL) each were significantly associated with thinner CT. After controlling for age and AL, the foveal CT and average macular CT were 25.5 μm (95% CI: 0.5-50.4 μm) and 22.1 μm (95% CI: 2.7-41.4 μm) thicker in men than in women, respectively. Significant differences in CT between males and females were also observed in inner and outer rings after controlling for age and AL (P < 0.05). After strict screening, 15 previously reported studies were determined to be eligible for inclusion. The combination of data collected from 2821 males and 3389 females provided further evidence that the choroid is thicker in males, with a pooled mean difference of 19.5 μm (95% CI: 11.4 to 27.6) for foveal CT and 14.7 μm (95% CI: 6.8 to 22.6) for average CT. CONCLUSION Our study of Chinese subjects, along with the syntheses analysis, strengthens the evidence that CT is greater in males than in females, based on OCT measurements. This observation may be pertinent for the sex disparities in some clinical conditions related to CT.
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Affiliation(s)
- Wei Wang
- a Zhongshan Ophthalmic Center and State Key Laboratory of Ophthalmology , Sun Yat-sen University , Guangzhou China.,b Hainan Eye Hospital, Zhongshan Ophthalmic Center , Sun Yat-sen University , Haikou China
| | - Miao He
- a Zhongshan Ophthalmic Center and State Key Laboratory of Ophthalmology , Sun Yat-sen University , Guangzhou China.,b Hainan Eye Hospital, Zhongshan Ophthalmic Center , Sun Yat-sen University , Haikou China
| | - Xingwu Zhong
- a Zhongshan Ophthalmic Center and State Key Laboratory of Ophthalmology , Sun Yat-sen University , Guangzhou China.,b Hainan Eye Hospital, Zhongshan Ophthalmic Center , Sun Yat-sen University , Haikou China
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Zuo C, Mi L, Yang S, Guo X, Xiao H, Liu X. The linear artifact in enhanced depth imaging spectral domain optical coherence tomography. Sci Rep 2017; 7:8464. [PMID: 28814750 PMCID: PMC5559621 DOI: 10.1038/s41598-017-08811-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Accepted: 07/12/2017] [Indexed: 02/08/2023] Open
Abstract
Optical coherence tomography (OCT) is a valuable ancillary test in the diagnosis and management of chorioretinal disease. The evaluation of choroid thickness using OCT has become the focus of clinical applications. We report a linear artifact that acts as a confounding factor in choroidal thickness measurements by enhanced depth imaging OCT. We found that the linear artifact is located stably at a depth of 485 μm beneath the retinal pigment epithelium in 81.88% of subjects. The study suggested that the linear artifact was a confounding factor in assessing choroidal thickness and that caution should be used in the interpretation of the choroidal thickness, especially when it is approximately 485 μm.
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Affiliation(s)
- Chengguo Zuo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Lan Mi
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Shasha Yang
- Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Xinxing Guo
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Hui Xiao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China
| | - Xing Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou 510060, China.
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Li M, Yang Y, Jiang H, Gregori G, Roisman L, Zheng F, Ke B, Qu D, Wang J. Retinal Microvascular Network and Microcirculation Assessments in High Myopia. Am J Ophthalmol 2017; 174:56-67. [PMID: 27818204 DOI: 10.1016/j.ajo.2016.10.018] [Citation(s) in RCA: 148] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/23/2016] [Accepted: 10/26/2016] [Indexed: 12/29/2022]
Abstract
PURPOSE To investigate the changes of the retinal microvascular network and microcirculation in high myopia. DESIGN A cross-sectional, matched, comparative clinical study. PARTICIPANTS Twenty eyes of 20 subjects with nonpathological high myopia (28 ± 5 years of age) with a refractive error of -6.31 ± 1.23 D (mean ± SD) and 20 eyes of 20 age- and sex-matched control subjects (30 ± 6 years of age) with a refractive error of -1.40 ± 1.00 D were recruited. METHODS Optical coherence tomography angiography (OCTA) was used to image the retinal microvascular network, which was later quantified by fractal analysis (box counting [Dbox], representing vessel density) in both superficial and deep vascular plexuses. The Retinal Function Imager was used to image the retinal microvessel blood flow velocity (BFV). The BFV and microvascular density in the myopia group were corrected for ocular magnification using Bennett's formula. RESULTS The density of both superficial and deep microvascular plexuses was significantly decreased in the myopia group in comparison to the controls (P < .05). The decrease of the microvessel density of the annular zone (0.6-2.5 mm), measured as Dbox, was 2.1% and 2.9% in the superficial and deep vascular plexuses, respectively. Microvessel density reached a plateau from 0.5 mm to 1.25 mm from the fovea in both groups, but that in the myopic group was about 3% lower than the control group. No significant differences were detected between the groups in retinal microvascular BFV in either arterioles or venules (P > .05). Microvascular densities in both superficial (r = -0.45, P = .047) and deep (r = -0.54, P = .01) vascular plexuses were negatively correlated with the axial lengths in the myopic eye. No correlations were observed between BFV and vessel density (P > .05). CONCLUSIONS Retinal microvascular decrease was observed in the high myopia subjects, whereas the retinal microvessel BFV remained unchanged. The retinal microvascular network alteration may be attributed to ocular elongation that occurs with the progression of myopia. The novel quantitative analyses of the retinal microvasculature may help to characterize the underlying pathophysiology of myopia and enable early detection and prevention of myopic retinopathy.
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Vuong VS, Moisseiev E, Cunefare D, Farsiu S, Moshiri A, Yiu G. Repeatability of Choroidal Thickness Measurements on Enhanced Depth Imaging Optical Coherence Tomography Using Different Posterior Boundaries. Am J Ophthalmol 2016; 169:104-112. [PMID: 27345731 DOI: 10.1016/j.ajo.2016.06.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/14/2016] [Accepted: 06/15/2016] [Indexed: 11/19/2022]
Abstract
PURPOSE To assess the reliability of manual choroidal thickness measurements by comparing different posterior boundary definitions of the choroidal-scleral junction on enhanced depth imaging optical coherence tomography (EDI-OCT). DESIGN Reliability analysis. METHODS Two graders marked the choroidal-scleral junction with segmentation software using different posterior boundaries: (1) the outer border of the choroidal vessel lumen, (2) the outer border of the choroid stroma, and (3) the inner border of the sclera, to measure the vascular choroidal thickness (VCT), stromal choroidal thickness (SCT), and total choroidal thickness (TCT), respectively. Measurements were taken at 0.5-mm intervals from 1.5 mm nasal to 1.5 mm temporal to the fovea, and averaged continuously across the central 3 mm of the macula. Intraclass correlation coefficient (ICC) and coefficient of reliability (CR) were compared to assess intergrader and intragrader reliability. RESULTS Choroidal thickness measurements varied significantly with different posterior boundaries (P < .001 for all). Intergrader ICCs were greater for SCT (0.959-0.980) than for TCT (0.928-0.963) and VCT (0.750-0.869), even in eyes where choroidal-scleral junction visibility was <75%. Intergrader CRs were lower for SCT (41.40-62.31) than for TCT (61.13-74.24) or VCT (72.44-115.11). ICCs and CRs showed greater reliability for averaged VCT, SCT, or TCT measurements than at individual locations. Intragrader ICCs and CRs were comparable to intergrader values. CONCLUSIONS Choroidal thickness measurements are more reproducible when measured to the border of the choroid stroma (SCT) than the vascular lumen (VCT) or sclera (TCT).
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Affiliation(s)
- Vivian S Vuong
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California; School of Medicine, University of California, Davis, Sacramento, California
| | - Elad Moisseiev
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California
| | - David Cunefare
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Sina Farsiu
- Department of Biomedical Engineering, Duke University, Durham, North Carolina
| | - Ala Moshiri
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California
| | - Glenn Yiu
- Department of Ophthalmology & Vision Science, University of California, Davis, Sacramento, California.
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Impact of Valsalva maneuver on central choroid, central macula, and disk fiber layer thickness among high myopic and hyperopic patients. Eur J Ophthalmol 2016; 27:331-335. [PMID: 27445069 DOI: 10.5301/ejo.5000834] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate the alterations in mean central choroidal, central macular, and disk retinal nerve fiber layer (RNFL) thickness measured by optical coherence tomography (OCT) during Valsalva maneuver among patients with high refractive errors. METHODS A total of 60 high myopic (≥-6.0 D) and 50 high hyperopic (≥ + 3.0 D) eyes of 58 patients aged 19-65 years with visual acuity of 20/20 and without any ophthalmologic or systemic diseases were evaluated by OCT before and after the Valsalva maneuver. The choroidal thickness was measured with enhanced depth imaging OCT method. Central macular thickness, disk RNFL thickness, and axial length were also assessed. RESULTS Mean choroidal thickness increased significantly from 275.0 ± 27.2 μm at rest to 279.8 ± 31.6 μm after Valsalva maneuver in high myopic patients, and from 308.2 ± 27.3 μm to 313.6 ± 28.5 μm in high hyperopic patients (p<0.01 for each). A significant negative correlation of the choroidal thickness was noted with axial length (r = -0.509, p<0.01) and age (r = -0.224, p = 0.01) in the overall study population. Mean central macular thickness was 242.9 ± 44.4 μm and 254.0 ± 22.8 μm, while mean disk RNFL thickness was 81.6 ± 12.4 μm and 98.4 ± 13.3 μm in high myopic and hyperopic patients, respectively. Valsalva maneuver was not associated with significant change in central macular or disk RNFL thickness. CONCLUSIONS Significant association of Valsalva maneuver with an increase in choroidal thickness was noted among patients with high degree of myopia and hyperopia. Our findings emphasize the likelihood of increase in choroidal volume due to venous distension to be responsible for the increase observed in choroidal thickness after Valsalva maneuver.
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Ohno-Matsui K, Lai TY, Lai CC, Cheung CMG. Updates of pathologic myopia. Prog Retin Eye Res 2016; 52:156-87. [DOI: 10.1016/j.preteyeres.2015.12.001] [Citation(s) in RCA: 260] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2015] [Revised: 12/28/2015] [Accepted: 12/30/2015] [Indexed: 12/20/2022]
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Diabetic retinal pigment epitheliopathy: fundus autofluorescence and spectral-domain optical coherence tomography findings. Graefes Arch Clin Exp Ophthalmol 2016; 254:1931-1940. [DOI: 10.1007/s00417-016-3336-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/19/2016] [Accepted: 03/28/2016] [Indexed: 11/26/2022] Open
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Aqueous Levels of Pigment Epithelium-Derived Factor and Macular Choroidal Thickness in High Myopia. J Ophthalmol 2015; 2015:731461. [PMID: 26491554 PMCID: PMC4600559 DOI: 10.1155/2015/731461] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Revised: 10/01/2014] [Accepted: 10/21/2014] [Indexed: 01/22/2023] Open
Abstract
Purpose. To investigate the correlation between aqueous and serum levels of pigment epithelium-derived factor (PEDF) and macular choroidal thickness in high myopia patients, both with and without choroidal neovascularization (CNV). Methods. Serum and aqueous levels of PEDF were measured by enzyme-linked immunosorbent assay in 36 high myopia patients (36 eyes) with no CNV (non-CNV group), 14 high myopia patients (14 eyes) with CNV (CNV group), and 42 nonmyopia patients (42 eyes) (control group). Macular choroidal thickness was measured by enhanced-depth imaging optical coherence tomography. Results. Aqueous levels of PEDF were significantly higher in CNV group compared with non-CNV (P < 0.001) and control (P < 0.001) groups. Macular choroidal thicknesses were significantly decreased in the non-CNV and CNV groups compared with the control (P < 0.001) group. A statistically significant difference (P = 0.012) was found between the CNV and non-CNV groups. There was a positive correlation between aqueous PEDF and macular choroidal thickness in the non-CNV group (P = 0.005), but no correlation with the CNV group. No correlation between serum PEDF and macular choroidal thickness was detected in the three groups. Conclusion. Variations in aqueous PEDF levels coincide with changes in macular choroidal thickness in high myopia patients with no CNV, while no such relationship exists in high myopia patients with CNV.
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Wang S, Wang Y, Gao X, Qian N, Zhuo Y. Choroidal thickness and high myopia: a cross-sectional study and meta-analysis. BMC Ophthalmol 2015; 15:70. [PMID: 26138613 PMCID: PMC4490603 DOI: 10.1186/s12886-015-0059-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 06/18/2015] [Indexed: 01/31/2023] Open
Abstract
Background The purpose of this study was to examine the choroidal thickness of patients with high myopia using enhanced depth imaging optical coherence tomography (EDI-OCT) and compare them with healthy subjects. Methods We first conducted a cross-sectional study and then performed a meta-analysis to address this issue further. Using enhanced depth imaging optical coherence tomography (EDI-OCT), the macular choroidal thickness of high myopic eyes and normal control eyes were measured and compared at each location. Univariate and multivariate linear regression analyses were performed to assess the association between choroidal thickness and clinical factors such as axial length (AL), spherical equivalent (SE), and central corneal thickness. In the high myopic eyes, subgroup analysis of macular choroidal thickness was performed in eyes with or without lacquer cracks and choroidal neovascularization (CNV). The meta-analyses were conducted using the Stata software package. Results The high myopic eyes had a thinner choroid than the control eyes at all macular locations (all P < 0.001). Multivariable linear regression analysis showed that the subfoveal choroidal thickness (SFCT) was not significantly thinner in association with the diagnosis. Subgroup analysis showed that the high myopia with CNV and with lacquer cracks had a significantly thinner choroid than without CNV or lacquer crack eyes. The result of our cross-sectional study is consistent with the results of the further meta-analysis with the pooled weighted mean difference (WMD) of −116.30 μm (95 % CI: −145.68, −86.92) for SFCT. Conclusions The present study, along with the comprehensive meta-analysis, indicated that in the Chinese population, the choroidal thickness in high myopic eyes was thinner than that of normal control eyes, even across different subgroups. This might be secondary to the longer AL but it is not an independent factor. The presence of CNV and of lacquer cracks is associated strongly with eyes with thinner macular choroids.
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Affiliation(s)
- Shiming Wang
- Ningbo Aier Guangming Eye Hospital, 8 Huancheng West Road, 315020, Ningbo, China.
| | - Yong Wang
- Wuhan Aier Eye Hospital, Wuhan, China.
| | - Xiaoming Gao
- Ningbo Aier Guangming Eye Hospital, 8 Huancheng West Road, 315020, Ningbo, China.
| | - Nana Qian
- Ningbo Aier Guangming Eye Hospital, 8 Huancheng West Road, 315020, Ningbo, China.
| | - Youer Zhuo
- Ningbo Aier Guangming Eye Hospital, 8 Huancheng West Road, 315020, Ningbo, China.
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