TRENDS IN CHOROIDAL VASCULARITY INDEX IN COGNITIVELY NORMAL INDIVIDUALS

Purpose: To identify correlations of subfoveal choroidal thickness (SFCT) and choroidal vascularity index (CVI) with age and best corrected visual acuity in eyes with pachychoroid spectrum diseases (PSD) and their association to systemic hypertension using a retrospective study design.Methods: Our study included 82 eyes of 45 patients with PSD: 15 eyes had uncomplicated pachychoroid (UCP), 27 had pachychoroid pigment epitheliopathy (PPE), 32 had central serous chorioretinopathy (CSC) and 8 had pachychoroid neovasculopathy (PNV). All patients underwent DRI TRITON Swept‐Source Optical Coherence Tomography (SS‐OCT). A 1500 mm width subfoveal choroidal area was defined in SS‐OCT B‐scans and divided into luminal area (LA) and stromal area (SA) by the imageJ binarization technique. CVI was defined as the ratio of LA to the total subfoveal choroidal area (TCA).Results: The mean SFCT was 393, 23 ± 95, 65 μm and it was correlated negatively with age (p = 0.003, R = −0.326). We found a negative correlation of TCA and LA with age (p = 0.043, r = −0.227, p = 0.04, r = −0.230). Mean choroidal vascularity index was 64.45 ± 2, 74% with no correlation with age (p = 0.169, R = −0.155). No parameter among SFCT, CVI, TCA, LA and SA had a significant correlation with BCVA or spherical equivalent. Patients with essential hypertension were found to have significantly thinner SFCT when compared with healthy controls (374, 49 ± 83 141 μm vs. 423, 98 ± 130 466 μm, p = 0.046). CVI was not affected by a history of systemic hypertension (64.05 ± 1.97 vs. 64.83 ± 3.3, p = 0.207). The total choroidal area, luminal area, and stromal area, as well as the CVI correlated with SFCT (p < 0.001, r = 0.817, p < 0.001, r = 0.821, p < 0.001, r = 0.750 and p < 0.001, r = 0.371 respectively).Conclusions: SFCT and CVI are dynamic parameters that are affected in patients with pachychoroid diseases. Unlike CVI, SFCT is also affected by age, ocular and systemic factors like hypertension. CVI may be a more specific biomarker for PSD.

The choroidal vascularity index (CVI) is a new marker for the choroid. The decrease in CVI following latanoprost use can provide a better understanding of the pathogenesis of the posterior segment side effects of latanoprost such as cystoid macular edema and central serous choroidopathy. The purpose of this paper is to evaluate the changes in the CVI, total choroidal area (TCA), stromal area (SA), luminal area (LA), and choroidal thickness (CT) following latanoprost therapy in patients with primary open angle glaucoma and ocular hypertension. Patients with newly diagnosed primary open angle glaucoma or ocular hypertension who had never received antiglaucoma therapy were included. Each patient received latanoprost 0.005% once daily. Enhanced depth imaging mode of spectral-domain optical coherence tomography scans was taken before the start of latanoprost therapy and in the first and third months. Subfoveal CT, CVI, TCA, LA, and SA for the submacular area, and 4 quadrants of the peripapillary area were calculated from the scans. A total of 36 eyes of 18 patients were analyzed. Subfoveal CT increased significantly ( P =0.007). Mean TCA ( P =0.008) and SA ( P <0.001) in the first and third months were higher than baseline in the submacular regions. Mean CVI was lower in the first and third months ( P <0.001). There was an increase in the mean TCA and SA in the peripapillary temporal ( P =0.001 and 0.028) and inferior ( P =0.002 and <0.001) quadrants and a decrease in mean CVI in the temporal ( P =0.027) and inferior ( P =0.003) peripapillary quadrants. A negative correlation was found between the rate of decrease in intraocular pressure and the macular region CVI. Following latanoprost use for several months, the CVI was significantly decreased in newly treated patients with glaucoma or ocular hypertension, among other changes to the choroid. These findings may contribute to a better understanding of the effects of prostaglandins on the posterior segment of the eye.

Choroidal vascularity index in adults with different refractive status

How does Covid-19 affect the choroidal structures at the early post-infectious period?

Comparison of the choroidal structural components and choroidal vascularity index between patients with obstructive sleep apnea syndrome and healthy controls

Factors effecting the choroidal vascularity index in children with mild to moderate myopia

Clinical relevance Vitiligo is a skin disease characterised by depigmentation and loss of melanocytes. Melanocyte loss may not be limited to the skin in vitiligo, and various abnormalities may occur in the choroid, which is dense in melanocytes. Background To evaluate structural changes in the choroid by measuring choroidal thickness and vascularity index using optical coherence tomography in patients with vitiligo and comparing them to healthy subjects. Methods This study included 168 participants: 84 with vitiligo (30 females, 54 males) and 84 controls (36 females, 48 males). Choroidal thickness and vascularity index were measured using the enhanced depth imaging mode in spectral-domain optical coherence tomography. The choroidal thickness was measured at the following five points; subfoveal (SF), 500 μm (NCT1) and 1000 μm (NCT2) nasal to the fovea; and 500 μm (TCT1) and 1000 μm (TCT2) temporal to the fovea. The choroidal vascularity index was calculated using the ImageJ software. Results SF (p < 0.001), NCT1 (p < 0.001), NCT2 (p = 0.021), TCT1 (p = 0.001), and TCT2 (p < 0.006) choroidal thicknesses were significantly smaller in the vitiligo group than in the control group. Total choroidal (p < 0.001) and stromal (p < 0.001) areas were significantly smaller in the vitiligo group than in the control group. Choroidal vascularity indices were significantly higher in the vitiligo group than in the control group (p < 0.001). However, luminal areas did not differ significantly between groups (p = 0.935). Conclusion Patients with vitiligo should be regularly monitored for choroidal alterations and, if necessary, referred to an ophthalmologist.

This study aimed to investigate the effect of orbital wall decompression surgery and reduction of proptosis on the choroidal vascularity index (CVI) and subfoveal choroidal thickness (SFCT) in patients with thyroid eye disease (TED). Fifty-one eyes from 38 patients with controlled TED and proptosis were enrolled in this study. The majority of the patients (50.9%) had a clinical activity score (CAS) of zero, and none had a CAS greater than 2. The patients underwent a complete baseline ophthalmologic examination, and their choroidal profile alterations were monitored using enhanced depth imaging optical coherence tomography (EDI-OCT) before and during the three months after surgery. Changes in SFCT, luminance area (LA), total choroidal area (TCA), and the choroidal vascularity index (CVI) were measured as the ratio of LA to TCA in EDI-OCT images. The participants had an average age of 46.47 years, and 22 were female (57.9%). The SFCT of the patients exhibited a significant reduction over the follow-up period, decreasing from 388 ± 103 to 355 ± 95 µm in the first month (p < 0.001) and further decreasing to 342 ± 109 µm by the third month compared to baseline (p < 0.001). The CVI exhibited a drop from 0.685 ± 0.037 at baseline to 0.682 ± 0.035 and 0.675 ± 0.030 at 1 and 3 months post-surgery, respectively. However, these changes were not statistically significant, indicating comparable decreases in both LA and TCA. There was a significant correlation between improved proptosis and reduction in SFCT (p < 0.001) but not with CVI (p = 0.171). In conclusion, during the three months of follow-up following orbital wall decompression, CVI did not change, while SFCT reduced significantly. Additionally, SFCT was significantly correlated with proptosis reduction, whereas CVI was not.

The aim of this study was to investigate choroidal parameters in patients with systemic sclerosis (SSc) using enhanced depth imaging spectral-domain optical coherence tomography (EDI-SD-OCT) and to determine their relationships with clinical variables and ocular features. Thirty-three patients with SSc and 40 controls were enrolled. The groups did not differ with regard to age, sex, and axial length. The mean choroidal thickness and volume were obtained in each conventional Early Treatment of Diabetic Retinopathy Study grid subfield. The choroidal vascularity index (CVI), which provides a quantitative analysis of vasculature by calculating the proportion of the luminal area (LA) to the total choroidal area (TCA), was determined. Lower choroidal thickness and volume were observed in the SSc group. The CVI was significantly higher in SSc patients, whereas the TCA, LA, and stromal area were significantly lower in the SSc group; however, the significant difference of the stromal component was more pronounced than that of the luminal component. Regression analyses did not identify any clinical factors associated with the CVI (except Ca-blocker use), central macular thickness, or volume. No significant differences in choroidal parameters were found within the SSc subtypes (diffuse cutaneous systemic sclerosis (dcSSc) vs. limited cutaneous systemic sclerosis (lcSSc)), or between eyes stratified according to SSc pattern (early, active, or late) using nailfold capillaroscopy (p > 0.05 for all). Our results, with notably higher CVI values, may shed new light on choroidal impairment in patients with SSc. Stromal involvement appeared to dominate the vascular component.

To assess choroidal changes using enhanced depth imaging optical coherence tomography in coronavirus disease (COVID-19). Thirty-two patients with moderate COVID-19 and 34 healthy subjects were included in the study. Choroidal thickness was measured at 3 points as follows: at the subfovea, 1500 mm nasal to the fovea, and 1500 mm temporal to the fovea. The total choroidal area, luminal area, stromal area, and choroidal vascular index were measured with Image-J. All the measurements were performed during the disease and at 4 months after remission. In the patient group, the subfoveal, nasal, and temporal choroidal thicknesses were decreased as compared with those in the controls, but without statistically significant differences (p=0.534, p=0.437, and p=0.077, respectively). The mean total choroidal, stromal, and luminal areas and choroidal vascular index were statistically significantly decreased in the patient group (p&lt;0.001, p=0.001, p=0.001, and p=0.003; respectively). At 4 months after remission, the choroidal structural parameters and choroidal vascular index revealed statistically significant increases as compared with the baseline measurements in the patients with COVID-19 (all p&lt;0.001 and p=0.047, respectively). The choroidal vascular and stromal parameters showed significant transient decreases during the disease course of COVID-19.

To evaluate choroidal structural changes in exudative age-related macular degeneration (AMD) using choroidal vascularity index computed from image binarization on spectral domain optical coherence tomography with enhanced depth imaging. This prospective case series included 42 consecutive patients with unilateral exudative AMD. Choroidal images were segmented into luminal area and stromal area. Choroidal vascularity index was defined as the ratio of luminal area to total choroid area. Mean choroidal vascularity index and mean choroidal thickness between study and fellow eyes of the same patient with dry AMD were compared using Student's t-test. There was a significantly lower choroidal vascularity index in eyes with exudative AMD (60.14 ± 4.55 vs. 62.75 ± 4.82, P < 0.01). Luminal area (P < 0.01) was decreased in eyes with exudative AMD but there was no significant difference in total choroid area (P = 0.05) and choroidal thickness (P = 0.93) between study and fellow eyes. Eyes with exudative AMD demonstrated reduced choroidal vascularity index but insignificant differences in choroidal thickness compared with their fellow eyes. Choroidal vascularity index may be a potential noninvasive tool for studying structural changes in choroid and monitoring choroidal disease in exudative AMD.

The vascularity of the choroid has been implicated in the pathogenesis of various eye diseases. To date, no established quantifiable parameters to estimate vascular status of the choroid exists. Choroidal vascularity index (CVI) may potentially be used to assess vascular status of the choroid. We aimed to establish normative database for CVI and identify factors associated with CVI in healthy eyes. In this population-based study on 345 healthy eyes, choroidal enhanced depth imaging optical coherence tomography scans were segmented by modified image binarization technique. Total subfoveal choroidal area (TCA) was segmented into luminal (LA) and stromal (SA) area. CVI was calculated as the proportion of LA to TCA. Linear regression was used to identify ocular and systemic factors associated with CVI and subfoveal choroidal thickness (SFCT). Subfoveal CVI ranged from 60.07 to 71.27% with a mean value of 65.61 ± 2.33%. CVI was less variable than SFCT (coefficient of variation for CVI was 3.55 vs 40.30 for SFCT). Higher CVI was associated with thicker SFCT, but not associated with most physiological variables. CVI was elucidated as a significant determinant of SFCT. While SFCT was affected by many factors, CVI remained unaffected suggesting CVI to be a more robust marker of choroidal diseases.

To correlate changes in choroidal thickness and vascularity index with disease activity in patients with neovascular age-related macular degeneration (nAMD). Eyes diagnosed with AMD that had two sequential visits within 12 months and that had no choroidal neovascularization (CNV) or had inactive CNV at the first visit were included. Those that had active CNV at follow-up were enrolled as cases. Eyes that did not developed a CNV or that were still inactive at the second visit were enrolled as controls. Disease activity was based on optical coherence tomography (OCT) and fluorescein angiography findings. Subfoveal choroidal thickness (SCT), mean choroidal thickness (MCT), and choroidal vascularity index (CVI) were assessed on enhanced depth imaging OCT and compared between the baseline and follow-up visit. Subgroup analysis accounting for lesion type and previous treatment, if any, were performed. Sixty-five eyes from 60 patients (35 females) and 50 age- and sex-matched controls were included. At the active visit, cases had an increase from 164 ± 67 μm to 175 ± 70 μm in mean ± SD SCT and from 144 ± 45 μm to 152 ± 45 μm in MCT (both P < 0.0001). The mean CVI also increased at from 54.5% ± 3.3% to 55.4% ± 3.8% (P = 0.04). Controls did not show significant changes in choroidal measurements between the two visits. Mean SCT, MCT, and CVI values were similar for previously treated and treatment-naive eyes. Choroidal thickness and CVI significantly increased with active disease in nAMD eyes. Changes in choroidal thickness may predict CNV development or recurrence before they are otherwise evident clinically.

To investigate the changes in the choroidal vascularity index (CVI) with age and to compare the effect of the binarised area on CVI in healthy eyes using spectral-domain optical coherence tomography (SD-OCT). Two hundred and twenty-four eyes of 224 healthy subjects were included in this prospective cross-sectional study.The eyes were divided into different age groups to analyse the possible age-related choroidal structural changes. Subfoveal choroidal thickness (SFCT), CVI, total choroidal area (TCA), stromal area (SA), luminal area (LA), and CVI within the central 1500µm of the macula were analysed using enhanced depth imaging SD-OCT. The CVI was defined as the proportion of the LA to the TCA, and its values for the two binarised areas were compared (CVItotal vs. CVI1500). The mean age was 34.77 ± 20.97 (range: 5-70) years. The mean CVItotal was statistically lower (66.71 ± 2.58%) than the mean CVI1500 (67.54 ± 3.13%, p = 0.008) among all the healthy participants. TCA, LA, CVItotal, and CVI1500 were statistically higher in the ≤ 18-year-old group compared to the > 18-year-old group (p < 0.05), but SA was not significantly different between the groups (p = 0.327). Similarly, TCA, LA, CVItotal, and CVI1500 between the five studied age groups were statistically different (p < 0.001), showing larger figures in the 0-10-year-old group. However, this was not true for the stromal region (p = 0.139). CVItotal exhibited a very strong positive correlation with CVI1500. No significant gender-related difference was observed in CVI. Decreased LA, TCA, and CVI were observed in healthy eyes with increasing age. CVI1500 was higher than CVItotal in a single B scan OCT. This result may provide valuable information about the choroid under different conditions, such as its physiological changes and disease pathophysiology.

Choroidal vascular index in cystoid macular edema associated with retinitis pigmentosa