Thicker Subfoveal Choroid Research Articles

Evaluating the Quantitative Foveal Avascular Zone and Retino-Choroidal Vessel Density Using Optical Coherence Tomography Angiography in a Healthy Indian Population.

Objective: The foveal avascular zone (FAZ) is the round capillary-free zone within the macula and is supplied only by a single-layered parafoveal capillary arcade. This study aimed to evaluate the quantitative FAZ and retino-choroidal vessel density (VD) using optical coherence tomography angiography (OCTA) in a healthy Indian population.Methods: This was a cross-sectional observational study that was conducted for evaluating the quantitative FAZ and retino-choroidal VD of 200 eyes of 100 healthy Indian subjects, including 62 males and 38 females (age range 17-50 years) having the best-corrected visual acuity (BCVA) of logMAR 0 (20/20; 6/6) and spherical equivalent refractive error of not more than 1 D. The subjects were examined using OCTA automated software on spectral-domain OCT (SD-OCT; Nidek RS 3000 Advance 2; Nidek, Inc., Fremont, CA) on a 3 x 3 mm OCTA macular scan centred on the fovea. The FAZ size, perimeter and circularity index, VD in superficial, deep, and outer retina (OR), outer retinal chorio-capillaries (ORCC), chorio-capillaries (CC) and choroid (C) were analysed in the circular and quadrant-segmented zones. A correlation was found between the FAZ size, perimeter and circularity, and VD in retino-choroidal layers, and between BCVA, age, central foveal thickness (CFT) and sub-foveal choroidal thickness (SFCT), and OCTA parameters.Results: The FAZ and surrounding vascular arcades were intact in all eyes, showing either a vertical or horizontal oval-shaped symmetrical formation without gaps, holes or interruption of the capillary network. The mean value of CFT was 237.5±26.0 microns and SFCT was 269.6±53.0 microns. The mean FAZ area was 0.42±0.23 mm2, FAZ perimeter was 3.3±1.0 mm and FAZ circularity index was 0.46±0.1. The mean VD in superficial capillary plexus (SCP) was 23.87±10.66, in deep capillary plexus (DCP) was 16.03±9.90, in OR was 13.22± 12.27, in ORCC was 39.74±14.32, in CC was 37.02±16.43 and in choroid was 37.43±16.76. The increasing order of VD in different retino-choroidal layers was OR<DCP<SCP<CC<C<ORCC. The FAZ area and perimeter had a statistically significant (SS) negative correlation with the VD in SCP, DCP and OR, while the FAZ perimeter additionally had a SS negative correlation with the VD in the choroid. The FAZ circularity had a SS positive correlation with VD in SCP, DCP and OR. There was no SS correlation between the age of subjects and OCTA parameters. The BCVA had a SS correlation with only one parameter, i.e. ORCC foveal (r=-0.15; p=0.03). There was a SS negative correlation between CFT and FAZ area and perimeter, and a SS positive correlation between the CFT and VD in SCP, DCP and OR. There was a SS positive correlation between the SFCT and VD in different layers including SCP, DCP, ORCC, CC and choroid.Conclusions: VD is the highest in the ORCC and lowest in the OR segment. A better VD in SCP, DCP and OR is associated with a reduced FAZ area/FAZ perimeter and an increased FAZ circularity index. A lower VD in the ORCC is associated with worse BCVA. In a healthy subject, a relatively thicker foveal region is likely to have better vascularity of SCP, DCP and OR and a smaller FAZ area/FAZ perimeter. In the absence of diseases, relatively thicker sub-foveal choroid is expected to have better vascularity of SCP, DCP, ORCC, CC and choroid.

Baseline predictors for good visual gains after anti-vascular endothelial growth factor therapy for myopic choroidal neovascularization

To investigate optical coherence tomography (OCT) and OCT angiography (OCTA) biomarkers for good visual outcomes in eyes with myopic choroidal neovascularization (mCNV) following anti-vascular endothelial growth factor (anti-VEGF) therapy. Patients diagnosed with mCNV via multimodal imaging were retrospectively reviewed. Baseline demographic data and biomarkers were collected. Anti-VEGF treatment based on a pro re nata (PRN) regimen was conducted on all eyes. The visual gains of ≥ 15 ETDRS letters or < 15 letters at 12-month were classified into two groups. Regression analysis was used to identify variables associated with significant best-corrected visual acuity (BCVA) improvement. Among 34 patients, 17 eyes and 17 eyes were classified into the two groups. There were no statistically significant differences in qualitative OCTA biomarkers between the two groups. The ≥ 15 letters group had significantly thicker subfoveal choroid thickness (SFCT) (79.97 ± 33.15 vs. 50.66 ± 18.31, P = 0.003), more ellipsoid zone integrity (58.8% vs. 23.5%, P = 0.037) and lower levels of fractal dimension (1.45 ± 0.101 vs. 1.53 ± 0.082, P = 0.031) than the < 15 letters group. SFCT and the ellipsoid zone integrity were correlated with 15 letters or more VA improvement in both univariable and multivariable analyses (P = 0.023 and P = 0.044, respectively). Thicker SFCT and integrity of the ellipsoid zone at baseline were associated with greater visual gains at 12 months. OCTA biomarkers seem to play a less important role in predicting the visual outcome of mCNV.

Evaluating the association of clinical factors and optical coherence tomography retinal imaging with axial length and axial length growth among preterm infants.

To study the association of clinical factors and optical coherence tomography (OCT) retinal imaging with axial length (AL) and AL growth in preterm infants METHODS: Among a subgroup of infants from the prospective BabySTEPS study who were screened for retinopathy of prematurity (ROP) and had both AL measured and OCT imaging performed, we analyzed data collected prior to 42 weeks postmenstrual age (PMA) and prior to ROP treatment. Using linear mixed effects models, we evaluated associations between AL and AL growth with gestational age (GA), birthweight, PMA, sex, race, multiparity, maximum ROP stage, and OCT features. We included 66 infants (132 eyes), mean GA = 27.6 weeks (SD = 2.3; range: 23.0-34.4) and mean birthweight = 961 g (SD = 269, range: 490-1580). In the final predictive model, longer AL was associated with earlier GA, higher birthweight, later PMA, non-White race, and thicker subfoveal choroid (all p values ≤ 0.01). AL increased linearly up to 42 weeks PMA. There was no difference in AL growth rate by GA, sex, race, multiparity, maximum ROP severity, central foveal thickness, or subfoveal choroidal thickness (all p values > 0.05); but AL growth rate was slower in infants with lower birthweight (p = 0.01). Among preterm infants, those with earlier GA, higher birthweight, later PMA, non-White race, and thicker subfoveal choroid had the longest AL. AL increased linearly up to 42 weeks PMA and lower birthweight was associated with slower AL growth. These findings may improve the accuracy of measurements taken on preterm infants using imaging techniques affected by AL (e.g., measuring lateral dimensions on OCT). https://clinicaltrials.gov/ct2/show/NCT02887157 , date of registration: August 25, 2016.

Choroidal Vascular Abnormalities by Ultra-widefield Indocyanine Green Angiography in Polypoidal Choroidal Vasculopathy

PurposeTo evaluate vortex vein engorgement and choroidal vascular hyperpermeability in patients with polypoidal choroidal vasculopathy (PCV) using ultra-widefield indocyanine green angiography (ICGA).MethodsThis retrospective case control study included 51 patients with unilateral PCV, 7 patients with bilateral PCV, and 43 age-matched controls. The number of quadrants of vortex vein engorgement was evaluated in the middle phase of ICGA, which was classified as extended engorgement if the dilated choroidal vessels expanded to the macula. The area of choroidal vascular hyperpermeability was quantified stereographically from the late-phase ICGA and correlated with clinical and optical coherence tomography findings.ResultsAffected eyes had a larger choroidal hyperpermeability area and a thicker subfoveal choroid than eyes in the control group or fellow eyes (P < 0.001, P < 0.001). More quadrants with extended vortex vein engorgement were observed in affected eyes than in fellow eyes (P < 0.001). Significant differences were observed in the area of choroidal hyperpermeability, Haller layer thickness and greatest linear dimension according to the extended vortex vein engorgement in eyes with PCV (P < 0.001, P = 0.001, and P = 0.001, respectively). The area of choroidal hyperpermeability was significantly correlated with subfoveal choroidal thickness (P < 0.001, Pearson's correlation coefficient = 0.471).ConclusionsUltra-widefield ICGA results revealed that patients with PCV had vortex vein engorgement and an increased choroidal hyperpermeability area. The results from this study provide substantial information to clarify the pathogenesis and predict the prognosis in the patients with PCV.

This issue of acta

This issue of acta

Impact of Cardiovascular Disease Risk Factors on Subfoveal Choroidal Thickness by Enhanced-depth Spectral Domain Optical Coherence Tomography.

Risk stratification plays a large role in cardiovascular disease (CVD) management. Spectral-domain optical coherence tomography (SD-OCT) allows for noninvasive analysis of the ophthalmic vasculature, with potential for systemic disease surveillance. Subfoveal choroidal thickness (SFCT) may serve as a marker for CVD risk and play a role in risk stratification. This study aimed to explore the association of major CVD risk factors CVD on SFCT measured from SD-OCT images in a general population of U.S. veterans. One hundred fifty veterans were prospectively recruited at the Jamaica Plain VA Hospital (Boston, MA). A total of 143 participants were included in the final analysis. The SFCT was manually measured from Spectralis SD-OCT macular scans, and medical chart review was analyzed for CVD data. The SFCT measurements were correlated with CVD risk factors and CVD clinical makers while controlling for age and refractive error. Mean differences in SFCT between those with and without CVD risk factors were analyzed. In multivariate analysis, diabetes diagnosis was independently associated with thinner subfoveal choroid (P = .001) and hypertension and hyperlipidemia with thicker subfoveal choroid (P = .006 and P = .05). After adjusting for age and refractive error, veterans with diabetes had thinner choroids than those without (P = .02), and veterans with hypertension and hyperlipidemia had thicker choroids than those without, although these differences did not reach statistical significance (P = .07 and P = .1). Comorbid risk factors for CVD are independently associated with optical coherence tomography-derived measurements of subfoveal choroidal thickness in a vasculopathic population of U.S. veterans, and there are detectable differences in subfoveal choroidal thickness between groups with and without CVD risk factors. Larger studies with adequate controls and longitudinal design are necessary to assess the clinical role of SFCT measurements in CVD risk analysis.

Subfoveal choroidal thickness at age 9years in relation to clinical and perinatal characteristics in the population-based Generation R Study.

To assess the association between clinical and perinatal characteristics and subfoveal choroidal thickness in 9-year-old children. The study included data from the population-based Generation R cohort, whose participants underwent cycloplegic refractometry, ocular biometry, height, weight and subfoveal choroidal thickness measurements using a swept-source optical coherence tomography (SS-OCT) instrument. Birth parameters were obtained using medical records. Statistical analyses were performed using multivariate regression models adjusted for age, ethnicity and sex. A total of 1018 children (52.5% girls, 47.5% boys) with a mean age of 9.9±0.3years and a mean cycloplegic spherical equivalent refraction of 0.80±1.1 D in boys and 0.81±1.4 in girls were eligible for analysis. The subfoveal choroid was 17μm thicker in girls (298±60.6μm) than in boys (281±55.0μm; p<0.001), a difference of 9.1μm persisting after adjustment for age, ethnicity and axial length (p=0.017). Subfoveal choroidal thickness decreased with increasing ocular axial length (-16.2μm/mm, 95% CI -21.2 to -12.4, p<0.001) and with increasing myopic refraction (-10.0μm/D, 95% CI 6.8-13.1; p<0.001, adjusted for age, ethnicity, axial length and sex) while it increased with increasing body height (1.3μm/cm, 95% CI 0.8 to 1.9, p<0.001). Additionally, choroidal thickness increased with increasing birthweight (13.0μm/kg; 95% CI 0.006-0.020; p<0.001) and increasing size for gestational age (8.2μm/kg; 95% CI 4.6-11.8; p<0.001). Smoking up until the time that pregnancy became known was associated with a thinner choroid (p=0.016). There was no detectable effect of alcohol consumption. The distributions of axial length, refraction and choroidal thickness were narrower than in older populations. The subfoveal choroid was thicker in girls than in boys, and higher body height, higher birthweight and larger size for gestational age were associated with a thicker subfoveal choroid. The implications of these findings for myopia development need further evaluation in longitudinal studies.

Small Hard Macular Drusen and Associations in 11- to 12-Year-Old Children in the Copenhagen Child Cohort 2000 Eye Study.

To assess the prevalence and associations of small hard drusen in a child cohort. Cross-sectional study of 11- to 12-year-old Danish children from the population-based Copenhagen Child Cohort 2000 Eye Study. Fovea-centered, 45° color images of both eyes were graded for macular drusen (within one optic-disc-rim-to-fovea distance of the foveal center) and for extramacular drusen. Analyses tested for associations between drusen and anthropometric measures including choroidal thickness. Gradable fundus images from both eyes were available for 1333 children (640 boys, 693 girls) with a mean (SD) age of 11.7 (0.40) years. One or more small hard macular drusen (diameter <63 μm) were present in 82 (6.2%) right eyes and 82 (6.2%) left eyes and in 147 (11.0%) subjects. Four children (0.30%) had 20 or more small hard macular drusen in one or both eyes. Extramacular small hard drusen were present in 10.7% of children, and 19% of children had such drusen anywhere. The odds for having one or more small hard macular drusen increased with subfoveal choroidal thickness with an odds ratio of 1.15 (95% confidence interval, 1.03-1.28; P = 0.013) per 50-μm thicker choroid, adjusted for age and sex. The association with choroidal thickness was also present for extramacular drusen. Having one or more small hard macular drusen was common in 11- to 12-year old children and it was associated with a thicker subfoveal choroid. Few children had many small hard drusen. There is no apparent clinical impact of small hard drusen in childhood.

This issue of Acta

This issue of Acta

Subfoveal choroidal thickness as a prognostic factor in exudative age-related macular degeneration

AimsTo investigate the relationship between subfoveal choroidal thickness (SFCT), visual acuity (VA), optical coherence tomography (OCT) features and total anti-vascular endothelial growth factor (VEGF) treatments to determine whether SFCT serves...

Choroidal vascularity index in type-2 diabetes analyzed by swept-source optical coherence tomography

The relationships between changes in choroidal vasculature and the severity of diabetic retinopathy (DR) remain unclear. We assessed choroidal changes in diabetic patients by measuring choroidal vascularity index (CVI) in conjunction with DR stage. In this study, patients with diabetes and healthy controls were retrospectively analyzed. Subjects were divided into seven groups as follows: Healthy controls, no DR, mild/moderate non-proliferative DR (NPDR), severe NPDR, proliferative DR (PDR), panretinal photocoagulation-treated DR, and clinically significant macular edema. The mean CVI values in the above groups were 69.08, 67.07, 66.28, 66.20, 63.48, 65.38, and 66.28, respectively. The eyes of diabetic patients exhibited a significantly lower CVI value than those of healthy controls even without DR. The PDR group exhibited a significantly lower CVI value than the healthy control, no DR, and mild/moderate NPDR groups. Age, sex, disease duration, glycated hemoglobin, fasting blood sugar, or intraocular pressure had no correlation with CVI. In multivariate regression analysis, thicker subfoveal choroid and thinner central retina were significantly associated with higher CVI values. These findings carefully suggest that changes in choroidal vasculature could be the primary event in diabetes even where there is no DR.

Choroidal thickness and visual prognosis in type 1 lesion due to neovascular age-related macular degeneration.

To evaluate the association between subfoveal choroidal thickness and the visual outcome in eyes with type 1 choroidal neovascularization (CNV) due to neovascular age-related macular degeneration (nAMD). This was a retrospective, longitudinal, cross-sectional study including patients diagnosed with nAMD type 1 lesions managed with intravitreal injections of ranibizumab in a PRN strategy during 24 months. Retrospective chart review of patients with type 1 CNV recording the visual acuity, number of intravitreal injections, multimodal imaging data, and follow-up period was performed. Subfoveal choroidal thickness was measured using enhanced depth imaging scans obtained with spectral-domain optical coherence tomography. Twenty-five eyes of 21 patients were included. The mean baseline logMAR best-corrected visual acuity was 0.52 (+0.35) (median 0.5; range 0.1-1; interquartile range (IQR) 0.3-0.8) and improved to 0.39 (+0.39) (median 0.4; range 0.1-1; IQR 0.2-0.5) by the end of the follow-up (p = 0.038). Subfoveal choroidal thickness was 202.8 (+60.3) μm (median 218; range 81-285; IQR 146-258). Statistical mixed effects model demonstrated an association between rate of improvement of visual acuity with subfoveal choroidal thickness after 24 months (p<0.001) (95% confidence interval 0.0002-0.0001 logMAR month μm); higher thickness values were correlated with better visual acuity. Thicker subfoveal choroid was associated with better visual outcomes in patients with type 1 CNV due to nAMD following a strict PRN regimen with intravitreal ranibizumab at 24 months of follow-up.

Clinical characteristics of responders to intravitreal bevacizumab in central serous chorioretinopathy patients.

To investigate factors associated with good response to intravitreal bevacizumab (IVB) in central serous chorioretinopathy (CSC) patients. We retrospectively reviewed 42 eyes of CSC patients of symptom duration more than 3 months who received a single or multiple successive IVBs on an as-needed basis (0.05 ml, 1.25 mg). High responders (HRs) were defined as complete resolution of subretinal fluid (SRF) on spectral domain optical coherence tomography (SD-OCT). Moderate responders (MRs) were defined as SRF resolution of 50-99% of pretreatment volume and poor responders (PRs) as SRF resolution <50%. Clinical, SD-OCT, fluorescein, and indocyanine green angiography findings were analyzed to find factors associated with HR. Descriptive statistics for all demographic and clinical variables were calculated, and comparisons were made using Wilcoxon's matched-pairs signed-rank test, the Mann-Whitney U-test for means with continuous data, Pearson's χ(2) test, and Fisher's exact test for categorical data. The mean number of IVB was 1.9. At postoperative 1 month, there were 10 (24%) HRs, 18 (43%) MRs, and 14 (33%) PRs. At the last follow-up (the mean 8.6 months), there were 25 HRs (60%), 9 MRs (21%), and 8 PRs (19%). Thicker subfoveal choroid (P=0.036), smaller lesion diameter (P=0.019), and better baseline best-corrected visual acuity (P=0.002) predicted HRs at postoperative 1 month. HR at the last follow-up was associated with classic pattern fluorescein angiography finding. Suboptimal effects of IVB on persistent CSC suggest primary IVB on selective cases with better vision, smaller lesion, and thicker choroid at baseline.

Subfoveal Choroidal Thickness and Axial Length in Preschool Children with Hyperopic Anisometropic Amblyopia

Purpose: To investigate the relationship between subfoveal choroidal thickness and axial length in Japanese preschool children with hyperopic anisometropic amblyopia. Methods: Twenty-four children between the age of 3 and 6 years exhibiting hyperopic anisometropic amblyopia were examined. Differences in spherical equivalent between the two eyes were over 1.5 D in all children. Twenty-four eyes in 12 children without anisometropia and amblyopia were examined as age-matched normal controls. Subfoveal choroidal thickness was measured by using enhanced depth imaging optical coherence tomography. Axial length was measured with noncontact optical biometer. Results: The spherical equivalent ranged from +3.50 to +7.25 D in amblyopic eyes and from +0.75 to +3.50 D in fellow eyes. The subfoveal choroidal thickness was significantly greater in the amblyopic eyes than that in the fellow eyes (407.3 ± 54.2 μm versus 357.7 ± 54.3 μm, Paired t-test, p < 0.05). The axial length in the amblyopic eyes was significantly shorter than that in the fellow eyes (21.16 ± 0.64 mm versus 22.08 ± 0.72 mm, Paired t-test, p < 0.05). The mean choroidal thickness of the fellow eyes in hyperopic anisometropic amblyopia was greater than that in age matched normal children, although this difference did not reach statistical significance (326.0 ± 62.1 μm, p = 0.07). The subfoveal choroidal thickness in amblyopic children was negatively correlated with their axial length (r = −0.50, p < 0.01). Conclusion: The subfoveal choroidal thickness of amblyopic children abnormally increased and the thicker subfoveal choroid is mildly correlated with their shorter axial length. The anomalous subfoveal choroidal thicknesses in our amblyopic children may reflect a delay in emmetropization.

Visual Acuity and Subfoveal Choroidal Thickness: The Beijing Eye Study

To examine the association between best corrected visual acuity (BCVA) and subfoveal choroidal thickness. Population-based study. The Beijing Eye Study 2011 included 3468 subjects with ages of 50+ years. The participants underwent an ophthalmologic examination including spectral-domain optical coherence tomography with enhanced depth imaging for measurement of choroidal thickness. BCVA was measured as logarithm of the minimal angle of resolution. Of the 3468 participants, choroidal measurements were available for 3233 (93.2%) subjects. In multivariate analysis, better BCVA was significantly associated with thicker subfoveal choroid (P < 0.001) in general and a subfoveal choroid thicker than 30 μm (P < 0.001) in particular, after adjusting for younger age (P < 0.001), higher level of education (P < 0.001), taller body stature (P < 0.001), higher body mass index (P = 0.005), absence of glaucoma (P = 0.001), absence of diabetic retinopathy (P < 0.001), absence of late-stage age-related macular degeneration (P < 0.001), and axial length shorter than 26.0 mm (P < 0.001) (correlation coefficient r:0.56). If eyes with glaucoma, diabetic retinopathy, late-stage age-related macular degeneration or myopic retinopathy were excluded, better BCVA was still significantly associated with thicker subfoveal choroid (P < 0.001) and subfoveal choroid thicker than 30 μm (P < 0.001) in multivariate analysis. In a reverse manner, thicker subfoveal choroid was associated with better BCVA (P < 0.001) after adjusting for younger age (P < 0.001), male gender (P < 0.001), longer axial length (P < 0.001), and higher corneal curvature radius (P < 0.001). Better visual acuity is strongly associated with thicker subfoveal choroid independent of additional factors, such as age, axial length, education level, and major ocular diseases.

Subfoveal Choroidal Thickness and Cerebrospinal Fluid Pressure: The Beijing Eye Study 2011

The venous choroidal blood drains through the superior orbital vein into the intracranial cavernous sinus. The cerebrospinal fluid pressure (CSFP) may thus influence the choroidal venous blood pressure. Since volume and thickness of the choroid depend on its pressure, we tested the hypothesis whether the subfoveal choroidal thickness (SFCT) is associated with CSFP. The population-based Beijing Eye Study 2011 included 3468 individuals. A detailed ophthalmic examination was performed including spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging for measurement of SFCT. The CSFP was calculated as CSFP (mm Hg) = 0.44 × Body Mass Index (kg/m(2)) + 0.16 × Diastolic Blood Pressure (mm Hg) - 0.18 × Age (years) - 1.91. Mean calculated CSFP was 8.8 ± 3.7 mm Hg and mean SFCT was 254 ± 107 μm. In multivariate analysis, SFCT was significantly associated with higher CSFP (P = 0.009; standardized coefficient β: 0.08; regression coefficient B: 2.27) after adjusting for lower age (P < 0.001; β: -0.36; B: -3.99), shorter axial length (P < 0.001; β: -0.37; B: -35.7), lower body mass index (P = 0.02; β: -0.05; B: -1.51), and higher corneal curvature radius (P < 0.001; β: 0.10; B: 41.1). In univariate analysis, SFCT increased by 9.2 μm (95% confidence interval: 8.3, 10.1) for each mm Hg increase in CSFP. In a reverse manner, CSFP was significantly associated with thicker SFCT (P < 0.001; B: 0.007; β: 0.21), after adjusting for region of habitation (P < 0.001; B: -0.31; β: -2.32), higher levels of glucose (P = 0.02; B: 0.10; β: 0.04) and triglycerides (P < 0.001; B: 0.13; β: 0.09), higher intraocular pressure (P < 0.001; B: 0.17; β: 0.12), and thinner lens (P < 0.001; B: -2.39; β: -0.22). Thicker subfoveal choroid was associated with higher CSFP after adjustment for age, axial length, body mass index, and corneal curvature radius. This association may explain thicker SFCT measurements in the morning than evening. It shows the importance of the CSFP for the physiology of the eye.

Subfoveal Choroidal Thickness as a Potential Predictor of Visual Outcome and Treatment Response After Intravitreal Ranibizumab Injections for Typical Exudative Age-Related Macular Degeneration

To investigate the prognostic implication of subfoveal choroidal thickness on treatment outcome after intravitreal ranibizumab injections for typical exudative age-related macular degeneration (AMD). Retrospective study. A total of 40 eyes of 37 patients who completed 6-month follow-up were analyzed. Patients' data were retrieved from medical records including best-corrected visual acuity (BCVA). Subfoveal choroidal thickness at baseline, 3months, and 6months was measured by enhanced depth imaging optical coherence tomography and adjusted for age and sex before statistical analysis. Treatment response was after 3monthly intravitreal ranibizumab injections. Responders (responder group) were defined as a 100μm or more decrease or complete resolution of subretinal fluid, whereas nonresponders (nonresponder group) were defined as changes less than 100μm or more than 100μm increase of subretinal fluid by optical coherence tomography. Mean age at diagnosis was 72.1 ± 8.1 years, and 22 eyes (55.0%) were responders. The responder group had thicker subfoveal choroid (257.2 ± 108.3μm) and smaller lesions (1.3 ± 0.8μm) at baseline than the nonresponder group (167.1 ± 62.4μm, P= .003; and 2.0 ± 1.0μm, P= .008). The responder group showed significantly better BCVA and thicker subfoveal choroid than the nonresponder group at 3months (P= .002 and P= .023) and 6months (P= .004 and P= .031). Stepwise and binary regression analysis demonstrated that subfoveal choroidal thickness was significantly correlated with visual outcome (B=-0.002, P= .003) and treatment response (B= 8.136, P= .018). Subfoveal choroidal thickness may be a predictive factor for visual outcome and treatment response in typical exudative AMD after intravitreal ranibizumab injections.

Subfoveal Choroidal Thickness in Diabetes and Diabetic Retinopathy

To examine subfoveal choroidal thickness (SFCT) in patients with diabetes mellitus and patients with diabetic retinopathy. Population-based, cross-sectional study. The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6 ± 9.8 years (range, 50-93 years). A detailed ophthalmic examination was performed including spectral-domain optical coherence tomography (OCT) with enhanced depth imaging for measurement of SFCT and fundus photography for the assessment of diabetic retinopathy. Subfoveal choroidal thickness. Fasting blood samples, fundus photographs, and choroidal OCT images were available for 2041 subjects (58.8%), with 246 subjects (12.1 ± 0.7%) fulfilling the diagnosis of diabetes mellitus and 23 subjects having diabetic retinopathy. Mean SFCT did not differ significantly between patients with diabetes mellitus and nondiabetic subjects (266 ± 108 vs. 261 ± 103 μm; P=0.43) nor between patients with diabetic retinopathy and subjects without retinopathy (249 ± 86 vs. 262 ± 104 μm; P = 0.56). After adjustment for age, sex, axial length, lens thickness, anterior chamber depth, corneal curvature radius, and best-corrected visual acuity, SFCT was associated with a higher glycosylated hemoglobin (HbA1c) value (P<0.001; regression coefficient B, 8.18; 95% confidence interval [CI], 4.02-12.3); standardized coefficient β, 0.08) or with the presence of diabetes mellitus (P = 0.001; B, 21.3; 95% CI, 9.12-33.5) but not with presence of diabetic retinopathy (P = 0.61) or stage of diabetic retinopathy (P = 0.14). As a corollary, after adjusting for age, region of habitation, body mass index, systolic and diastolic blood pressure, and level of education, diabetes mellitus was associated with a thicker SFCT (P<0.001). In contrast, neither presence of diabetic retinopathy (P = 0.61) nor stage of diabetic retinopathy (P = 0.09) were associated significantly with SFCT after adjusting for body mass index, diastolic and systolic blood pressure, and level of education and after adjusting for blood glucose concentrations, HbA1c value, diagnosis of diabetes mellitus, and systolic and diastolic blood pressure, respectively. Patients with diabetes mellitus had a slightly, but statistically significantly, thicker subfoveal choroid, whereas presence and stage of diabetic retinopathy were not associated additionally with an abnormal SFCT. Whereas diabetes mellitus as a systemic disease leads to a slight thickening of the choroid, diabetic retinopathy as an ocular disorder was not associated with choroidal thickness abnormalities after adjusting for the presence of diabetes mellitus. The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Changes in Choroidal Thickness in Relation to the Severity of Retinopathy and Macular Edema in Type 2 Diabetic Patients

To assess changes in choroidal thickness in type 2 diabetic patients with diabetic retinopathy (DR) and diabetic macular edema (DME) using enhanced-depth imaging spectral domain optical coherence tomography (EDI-OCT). Among 235 eyes from 145 patients, 195 treatment-naïve eyes were divided into no DR, mild/moderate nonproliferative DR (NPDR), severe NPDR, proliferative DR (PDR), and 40 eyes having a history of laser panretinal photocoagulation (PRP) were classified as PRP-treated DR. Eyes with no ocular treatment (195 eyes) were divided according to the presence of and to the subtypes of DME. Subfoveal choroidal thickness (SFChT) and parafoveal choroidal thickness (PFChT) at 1500 μm were measured using EDI-OCT. Mean age was 62.6 ± 12.4 years, and mean duration of DM was 15.1 ± 7.2 years. Mean SFChT in groups with no DR (40 eyes), mild/moderate NPDR (47 eyes), severe NPDR (72 eyes), PDR (36 eyes), and PRP-treated DR (40 eyes) was 262.3 ± 68.4 μm, 244.6 ± 77.0 μm, 291.1 ± 107.7 μm, 363.5 ± 74.9 μm, and 239.9 ± 57.4 μm, respectively. Mean SFChT was significantly greater in eyes with PDR than in those with no DR (P < 0.01), mild/moderate NPDR (P < 0.01), or severe NPDR (P < 0.05). Mean SFChT decreased significantly in PRP-treated DR compared with PDR (P < 0.01). Eyes with DME (67 eyes) had a thicker subfoveal choroid than eyes without DME (128 eyes; P < 0.05) and, compared with cystoid or diffuse types, SFChT was thickest in subretinal detachment (SRD)-type DME (P < 0.05). Choroidal thickness increased significantly as the severity worsened from mild/moderate/NPDR to PDR, and decreased in PRP-treated eyes. The subfoveal choroid was thicker in eyes with DME than in those without, and was thickest in eyes with SRD-type DME.