Thicker Subfoveal Choroidal Thickness Research Articles

Macular Curvature in Adults Born Preterm With and Without ROP: Results from the Gutenberg Prematurity Eye Study.

This study investigated the effects of prematurity and retinopathy of prematurity (ROP) as well as the associations of the ocular geometry with macular curvature in adults. The Gutenberg Prematurity Eye Study is a retrospective cohort study of preterm and full-term participants aged 18 to 52years with a prospective ophthalmologic examination. The main outcome measure was the macular curvature in the central foveal optical coherence tomography (OCT) scan and its associations with gestational age (GA), birth weight and birth weight percentile, ROP occurrence, ROP treatment, and other perinatal factors were evaluated in univariable and multivariable linear regression analyses. Furthermore, a second model assessed the association of ocular geometry with macular curvature. In the present study, 550 eyes of 284 adults born preterm and 277 eyes of 139 adults born full-term were examined (aged = 28.7 ± 8.7years, 240 female subjects). In multivariable analyses for perinatal parameters, ROP treatment (B = -52.44, P = 0.023) and maternal smoking during pregnancy (B = 26.41, P = 0.019) showed an association with macular curvature. Regarding ocular geometric parameters, posterior segment length (B = 9.07, P < 0.001) and subfoveal choroidal thickness (B = -0.26, P < 0.001) were associated with macular curvature, central corneal thickness, anterior chamber depth, lens thickness, and foveal retinal thickness were not associated. Adults treated for ROP had relatively more negative curvature values compared to the full-term group, indicating a macular protrusion toward the vitreous cave. A thicker subfoveal choroidal thickness was associated with a flatter macular curvature, whereas a longer posterior segment length was associated with a steeper macular curvature indicating the characteristics of the myopic elongation of the eye.

Three-dimensional choroidal vascularity index and choroidal thickness in fellow eyes of acute and chronic primary angle-closure using swept-source optical coherence tomography.

To compare the three-dimensional choroidal vascularity index (CVI) and choroidal thickness between fellow eyes of acute primary angle-closure (F-APAC) and chronic primary angle-closure glaucoma (F-CPACG) and the eyes of normal controls. This study included 37 patients with unilateral APAC, 37 with asymmetric CPACG without prior treatment, and 36 healthy participants. Using swept-source optical coherence tomography (SS-OCT), the macular and peripapillary choroidal thickness and three-dimensional CVI were measured and compared globally and sectorally. Pearson's correlation analysis and multivariate regression models were used to evaluate choroidal thickness or CVI with related factors. The mean subfoveal CVIs were 0.35±0.10, 0.33±0.09, and 0.29±0.04, and the mean subfoveal choroidal thickness were 315.62±52.92, 306.22±59.29, and 262.69±45.55 µm in the F-APAC, F-CPACG, and normal groups, respectively. All macular sectors showed significantly higher CVIs and choroidal thickness in the F-APAC and F-CPACG eyes than in the normal eyes (P<0.05), while there were no significant differences between the F-APAC and F-CPACG eyes. In the peripapillary region, the mean overall CVIs were 0.21±0.08, 0.20±0.08, and 0.19±0.05, and the mean overall choroidal thickness were 180.45±54.18, 174.82±50.67, and 176.18±37.94 µm in the F-APAC, F-CPACG, and normal groups, respectively. There were no significant differences between any of the two groups in all peripapillary sectors. Younger age, shorter axial length, and the F-APAC or F-CPACG diagnosis were significantly associated with higher subfoveal CVI and thicker subfoveal choroidal thickness (P<0.05). The fellow eyes of unilateral APAC or asymmetric CPACG have higher macular CVI and choroidal thickness than those of the normal controls. Neither CVI nor choroidal thickness can distinguish between eyes predisposed to APAC or CPACG. A thicker choroid with a higher vascular volume may play a role in the pathogenesis of primary angle-closure glaucoma.

Macular outer nuclear layer, ellipsoid zone and outer photoreceptor segment band thickness, axial length and other determinants

The study aims to assess the thickness of the retinal outer nuclear layer (ONL), ellipsoid zone (EZ) and photoreceptor outer segment (POS) band in various macular regions and its associations with axial length and other parameters. Participants of the Beijing Eye Study 2011 underwent a series of examinations including spectral-domain optical coherence tomography of the macula. The current study included 2213 participants without retinal or optic nerve diseases (age: 61.7 ± 8.4 years; range 50–93 years); axial length: 23.15 ± 0.95 mm; range 18.96–29.15 mm). The ONL (fovea: 98.9 ± 8.8 µm), EZ (fovea: 24.1 ± 0.5 µm) and POS band (fovea: 24.3 ± 3.5 µm) were the thickest (P < 0.001) in the fovea (defined as the thinnest central point), followed by the temporal inner, nasal inner, inferior inner, superior inner, inferior outer, temporal outer, nasal outer, and superior outer region. In multivariable analysis, a thicker retinal ONL was associated (correlation coefficient r: 0.40) with shorter axial length (beta: − 0.14; P < 0.001) and shorter disc–fovea distance (beta: − 0.10; P = 0.001), after adjusting for younger age (beta: − 0.26; P < 0.001), male sex (beta: 0.24; P < 0.001), lower serum cholesterol concentration (beta: − 0.05; P = 0.04), and thicker subfoveal choroidal thickness (beta: 0.08; P < 0.001). The POS thickness increased with shorter axial length (beta: − 0.06; P < 0.001) and shorter optic disc–fovea distance (beta: − 0.05; P = 0.03), after adjusting for younger age (beta: − 0.34; P < 0.001), male sex (beta: 0.15; P < 0.001), and thicker subfoveal choroidal thickness (beta: 0.24; P < 0.001). As a conclusion, the photoreceptor ONL, EZ and POS band vary in thickness between different macular regions and differ in their correlations with axial length, disc–fovea distance, age, sex, and subfoveal choroidal thickness. The ONL thickness decrease with longer axial length and longer disc–fovea distance may point to an axial elongation-associated retinal stretching in the macula.

Choroidal thickness and vascular microstructure parameters in Chinese school-age children with high hyperopia using optical coherence tomography.

The current study was to evaluate the choroidal thickness (CT) and vascular microstructure parameters in Chinese children with high hyperopia through enhanced depth imaging optical coherence tomography (EDI-OCT). Cross-sectional study. A total of 23 children with high hyperopia and 29 children with normal refractive status were retrospectively enrolled in the study. The measurement of the macular CT, 7 points: the sub-foveal area point, the temporal and nasal points at a radius of 0.5-mm, 1.5-mm, and 3-mm were measured. After binarization of the OCT images, the total choroidal area (TCA), stromal area (SA) as well as the luminal area (LA) were identified and measured. The choroidal vascularity index (CVI) was defined as the ratio of LA to TCA. The independent t-test for normal distributions and Kruskal-Wallis tests for non-normal distributions were used to compare other parameters between groups. The Tamhane's T2 test was performed to adjust for multiple comparisons between groups within each analysis. The subfoveal CT (SFCT) in the high hypermetropic group was significantly thicker than that in normal controls (309.22 ± 53.14 μm vs. 291.27 ± 38.27 μm; P = 0.019). At 0.5 mm, 1.5 mm, and 3.0 mm in diameter, the nasal choroidal sectors of the high hyperopia eyes were significantly thicker than that of the control (P < 0.05). There was significant difference in the choroidal vascular parameters. TCA and LA in the high hyperopia eyes was significantly larger than that of the normal control eyes (3078129.54 ± 448271.18 μm2 vs. 2765218.17 ± 317827.19 μm2, 1926819.54 ± 229817.56 μm2 vs. 1748817.18 ± 191827.98 μm2; P = 0.009, P = 0.011; Table 2). SA values were 1086287.55 ± 212712.11 um2 in the high hyperopia eyes and 999712.71 ± 209838.12 μm2 in the control eyes. The CVI and LA/SA ratio values were differed significantly in the two groups (P = 0.019, P = 0.030, respectively). AL was significantly correlated with SFCT (r = -0.325, P = 0.047), but not significantly correlated with other parameters. Spherical equivalent (SE) was significantly correlated with AL and SFCT (r = -0.711, r = 0.311; P = 0.001, P = 0.016), whereas no significant association between sphere and other parameters. The choroidal structure of the high hyperopia eyes was different from the normal control eyes. The thicker SFCT, higher LA, and TCA were characteristic of high hyperopia eyes. Choroidal blood flow may be decreased in amblyopic eyes. SFCT of high hyperopia children abnormally increased and correlated with shorter AL and higher SE. AL and SE affect choroidal structure and vascular density.

MULTIMODAL IMAGING FEATURES AND TREATMENT RESPONSES OF CHOROIDAL NEOVASCULARIZATION SECONDARY TO CENTRAL SEROUS CHORIORETINOPATHY

To investigate features of central serous chorioretinopathy with choroidal neovascularization (CNV) on multimodal imaging and analyze their association with treatment response. A total of 37 patients with chronic central serous chorioretinopathy complicated by CNV were divided into bevacizumab and photodynamic therapy groups, and each group was subdivided into responders and nonresponders according to subretinal fluid status at 3 months. We assessed multimodal imaging parameters (subfoveal choroidal thickness; vortex vein engorgement; choroidal vascular hyperpermeability; and CNV morphologic pattern, area, and vessel density) and analyzed their association with treatment responses. Responders in the bevacizumab group showed thinner subfoveal choroidal thickness (384.0 ± 103.2 vs. 398.3 ± 87.1 µm, P = 0.042), smaller CNV area (0.512 ± 0.267 vs. 1.323 ± 0.481 mm2, P = 0.007), open-circuit pattern (84.6% vs. 12.5%, P < 0.001), and capillary fringe (69.2% vs. 37.5%, P = 0.001) than nonresponders. Responders in the photodynamic therapy group had thicker subfoveal choroidal thickness (420.1 ± 93.5 vs. 395.7 ± 6.5 µm, P = 0.021), more quadrants with engorged vortex veins extending to the macula (P = 0.012), and intense choroidal vascular hyperpermeability (57.1% vs. 50.0%, P = 0.026) than nonresponders. Choroidal neovascularization showing closed-circuit pattern (85.7% vs. 0%, P = 0.001) and peripheral loop (64.3% vs. 0%, P = 0.001) demonstrated a good response to photodynamic therapy. Heterogeneous features of choroidal hyperpermeability, thickness, and CNV morphology in CNV accompanying central serous chorioretinopathy are associated with different therapeutic responses to bevacizumab and photodynamic therapy treatments.

ASSOCIATION OF CHOROIDAL THICKNESS WITH RHEGMATOGENOUS RETINAL DETACHMENT REPAIR.

To compare the choroidal thickness before and after pars plana vitrectomy for rhegmatogenous retinal detachment repair. A retrospective case series of rhegmatogenous retinal detachment patients presenting between January 2015 and September 2020. Subfoveal choroidal thickness (SFCT) and anatomical success were measured in operated eyes and fellow eyes at presentation, as well as 3 months and 6 months after pars plana vitrectomy for rhegmatogenous retinal detachment repair. A total of 93 patients (males 59%) with a mean age of 61.8 ± 15.2 years were included. Eighty-one patients were anatomically successful (Group 1) and 12 redetached (Group 2). The mean SFCT of the operated eye at presentation was 258.3 ± 82.0 µm in comparison with 257.5 ± 83.7 µm in the fellow eye (P = 0.96). Group 2 presented with thicker SFCT than Group 1 at baseline (309.2 ± 56.2 vs. 250.7 ± 82.8 µm; P = 0.01). Both groups demonstrated thinning trend throughout follow-up. At 6-month follow-up, the mean SFCT was 225.6 ± 75.5 µm (P = 0.05). Fellow-eye SFCT was stable throughout follow-up (257 ± 83.7 at baseline vs. 255 ± 80.2 µm at 6 months). Eyes with rhegmatogenous retinal detachment demonstrated thinning in the SFCT after vitrectomy surgery. Eyes with recurrent retinal detachment presented with a thicker choroid at baseline. Thicker SFCT at presentation may play a role in retinal redetachment.

CHOROIDAL IMAGING BIOMARKERS TO PREDICT HIGHLY RESPONSIVE AND RESISTANT CASES TREATED WITH STANDARDIZED ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR REGIMEN IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION.

To determine structural predictors of treatment response in neovascular age-related macular degeneration analyzing optical coherence tomography (OCT)-related biomarkers. A retrospective review of patients undergoing treatment for neovascular age-related macular degeneration at a tertiary institute was performed at presentation. High-intensity regimen included eyes on long-term anti-vascular endothelial growth factor treatment with the inability to extend beyond a month without a relapse and needed double the dose of medication (n = 25). Low-intensity regimen had eyes that went into long-term remission after at least three injections and remained dry for more than a year until the last visit (n = 20). Multimodal imaging including fluorescein angiogram, OCT, and comprehensive ocular evaluation were done. Choroidal vascularity index, total choroidal area, luminal area, subfoveal choroidal thickness, choriocapillaris thickness and Haller and Sattler layer thickness were analyzed for statistical significance. The groups had no significant difference at baseline in age, gender, incidence of reticular pseudodrusen, polypoidal choroidal vasculopathy feature on OCT, type of choroidal neovascular membrane, and geographic atrophy. Multinomial logistic regression revealed that thicker subfoveal choroidal thickness and larger total choroidal area were the significant predictors of poor response to anti-vascular endothelial growth factor treatment (E = 0.02; P = 0.02; E = 1.82; P = 0.0075). Thicker subfoveal choroidal thickness and higher total choroidal area are useful variables to predict a poor treatment response.

THE INCIDENCE, CHARACTERISTICS, MANAGEMENT, PROGNOSIS, AND CLASSIFICATION OF BREAKTHROUGH VITREOUS HEMORRHAGE SECONDARY TO POLYPOIDAL CHOROIDAL VASCULOPATHY.

To describe breakthrough vitreous hemorrhage secondary to polypoidal choroidal vasculopathy (PCV). Patients with the diagnosis of PCV from January 2005 to March 2020 at Peking Union Medical College Hospital were retrospectively reviewed, cases with breakthrough vitreous hemorrhage were analyzed. Subgroup analysis was conducted regarding pachychoroid PCV and nonpachychoroid PCV. Among 722 PCV patients (834 eyes), 103 eyes with breakthrough vitreous hemorrhage (12.4%) were included. Pars plana vitrectomy and proper further interventions could significantly improve the best-corrected visual acuity from logMAR 2.15 ± 0.48 (Snellen 20/2825) to 1.65 ± 0.67 (20/893). Hemorrhagic retinal detachment, baseline central macular thickness, and best-corrected visual acuity were factors associated with final best-corrected visual acuity (P < 0.05). In the pachychoroid PCV group, patients were younger, all had hemorrhagic pigment epithelial detachment, with a higher prevalence of choroidal vascular hyperpermeability and hemorrhagic retinal detachment, thicker subfoveal choroidal thickness, and thinner central macular thickness; besides, the initial pars plana vitrectomy were more complicated, more additional surgeries had to be performed. More eyes in the nonpachychoroid PCV group had received anti-vascular endothelial growth factor or photodynamic therapy, mostly fibrovascular pigment epithelial detachment, the best-corrected visual acuity and the status of the fellow eye were significantly worse. For the final ocular status, more eyes in nonpachychoroid PCV group were taking anti-vascular endothelial growth factor monotherapy, whereas more eyes in pachychoroid PCV group were stable. The choroidal parameters of these two groups were all significantly different. Breakthrough vitreous hemorrhage is a troublesome complication of PCV. Pars plana vitrectomy and additional interventions are required for better prognosis. Vitreous hemorrhage secondary to pachychoroid PCV or nonpachychoroid PCV have different characteristics and prognosis.

Clinical Characteristics of Neovascular Age-Related Macular Degeneration without Typical Drusen.

Purpose To evaluate the clinical characteristics of neovascular age-related macular degeneration (nAMD) patients without typical drusen. Methods We retrospectively studied 165 eyes in 165 patients with treatment-naïve nAMD, including typical AMD and polypoidal choroidal vasculopathy (PCV). According to the fellow eye condition, the patients were divided into nAMD with and without typical drusen groups. Eyes with soft drusen or subretinal drusenoid deposits were classified into the nAMD with the typical drusen group. Smoking status and diagnoses of hypertension and diabetes were identified from hospital records and patient recall. We assessed best-corrected visual acuity (BCVA), central retinal thickness (CRT) at the fovea, subfoveal choroidal thickness (SFCT), and the number of injections received. Results The nAMD without typical drusen group was significantly younger (77.9 ± 7.6 vs. 71.8 ± 8.3, P < 0.001) and had thicker SFCT at baseline (207.9 ± 99.5 vs. 260.1 ± 113.2 μm, P=0.007) and a higher proportion of PCV (30.6 vs. 63.1%, P < 0.001). The proportion of ever-smokers was significantly higher in the nAMD without typical drusen group (54.8 vs. 70.9%, P=0.036). There were no statistically significant differences in the proportion of patients with hypertension or diabetes; BCVA, CRT, or SFCT changes; or the number of injections between the nAMD with and without typical drusen groups. Conclusion The clinical features of patients in the nAMD without typical drusen group were almost identical to those of pachychoroid-driven choroidal neovascularization (CNV) patients. The nAMD without typical drusen group had a significantly higher proportion of ever-smokers than the nAMD with typical drusen group. Smoking could be a risk factor for the development of pachychoroid-driven CNV.

Spectral-Domain Optical Coherence Tomography-Based Morphofunctional Characterization of Dome-Shaped Maculopathy in Indian Population

Purpose. To study the clinicodemographic profile of dome-shaped maculopathy (DSM) eyes in the Indian population and characterization using spectral-domain optical coherence tomography (SD-OCT). Methods. This observational cross-sectional study included 25 eyes of 14 patients diagnosed with DSM. All eyes underwent SD-OCT for characterization of the dome profile and also to measure central macular thickness (CMT), subfoveal choroidal thickness (SFCT), and dome height (DH) and to detect the presence of subretinal fluid (SRF). Results. The mean age of patients was 48.36 ± 14.23 years (range, 28–65 years). Eleven patients had bilateral involvement. Mean axial length of all eyes was 24.25 ± 1.95 mm and mean spherical equivalent −4.23 ± 3.79 DS. Overall, 11/25 eyes (44%) had round domes, 9/25 eyes (36%) had horizontal domes, and 5/25 eyes (20%) had vertical domes, with a mean dome height at fovea of 500.54 ± 291.58 µm. Vertical domes had higher DH compared to horizontal or combined domes p = 0.02 . Six eyes (6/25, 24%) showed the presence of SRF; 60% of vertical domes had SRF, and 22.2% of horizontal domes had SRF. The eyes having SRF had significantly higher CMT p = 0.017 and DH p = 0.001 , especially in horizontal domes p = 0.023 . The eyes with thicker SFCT tended to have higher DH and poorer visual acuity. Conclusion. Indian DSM eyes may have relatively lesser amounts of myopia. Choroidal thickening may play a role in development of DSM and may also be related to development of subretinal fluid in such eyes.

Retinal Microcirculation Defects on OCTA Correlate with Active Inflammation and Vision in Vogt–Koyanagi–Harada Disease

ABSTRACT Purpose: To analyze quantitative OCT-angiography (OCTA) measurements of Vogt-Koyanagi-Harada (VKH) disease at different disease stages. Methods: OCTA scans of 110 VKH patients in acute uveitic, convalescent and chronic recurrent stage were reviewed; posterior uveitis recurrent cases were excluded. Superficial and deep capillary plexus (SCP and DCP) vascular densities (VD) and subfoveal choroidal thickness (SFCT) were compared. Results: DCP VD was significantly lower and SFCT higher in VKH than normal controls (NC) in all 3 stages (all p < .001). Anterior uveitis recurrent patients had lower SCP and DCP VDs and thicker SFCT than convalescent patients (p = .001, p < .001, and p = .003, respectively). DCP VD was significantly correlated with visual acuity (p < .05). Patients with history of anterior recurrence had lower retinal VDs in the convalescent stage than those without (p < .001). Conclusion: Retinal microcirculation is impaired in VKH. DCP VD might be a sensitive indicator of inflammatory status and appeared to be well associated with visual outcome.

SUBFOVEAL CHOROIDAL THICKNESS AND VASCULAR ARCHITECTURE IN FELLOW EYES OF PATIENTS WITH CIRCUMSCRIBED CHOROIDAL HEMANGIOMA.

To evaluate the subfoveal choroidal thickness (SFCT) and vascular architecture in the fellow eyes of patients with circumscribed choroidal hemangioma (CCH). In this retrospective observational study, patients were selected from outpatient ophthalmology clinics at the Memorial Sloan Kettering Cancer Center and Vitreous Retina Macula Consultants of New York. Subfoveal choroidal thickness was measured using enhanced depth imaging spectral domain optical coherence tomography from the outer portion of Bruch membrane to the choroidal-scleral interface. Choroidal vascular architecture was qualitatively examined. The main outcome measure was SFCT in fellow eyes of patients with CCH, which was compared with an age- and gender-matched control group. Thirty-one fellow eyes (15 right eyes and 16 left eyes) of patients with CCH (23 males and 8 females) were examined. The fellow eye had a mean SFCT of 361.2 ± 99.9 μm compared with 252.0 ± 77.6 μm in the control group (P < 0.0001). Vascular architecture was disorganized in 13 (42%) fellow eyes and 1 (3%) control eye (P < 0.0001), with no apparent gradient of vessel sizes or discrete choroidal layers. The normal association between older age and a thinner choroid existed in control eyes but not in fellow eyes. Hemangioma thickness measured by ultrasound and the presence of subfoveal fluid in the CCH eye did not correlate with the fellow-eye SFCT. In patients with CCH, fellow eyes had thicker SFCT when compared with age- and gender-matched control eyes. Choroidal architecture was often irregular, without segmented vascular layers. These findings suggest that inherent choroidal changes may exist in patients with CCH.

FLAT IRREGULAR PIGMENT EPITHELIUM DETACHMENT IN CENTRAL SEROUS CHORIORETINOPATHY: A Form of Pachychoroid Neovasculopathy?

To investigate the differences in natural course, intravitreal bevacizumab injection (IVB) responsiveness, and optical coherence tomography angiography findings according to the type of pigment epithelial detachment (PED) in patients with central serous chorioretinopathy (CSC). A retrospective review of angiographically proven CSC patients was conducted. Pigment epithelium detachment was classified as flat irregular or focal. To identify the natural course of CSC, we had observed whether subretinal fluid was improved without any treatment until symptom duration was >3 months. When CSC symptom duration was >3 months, IVB injection was performed. Symptom duration, central subfield thickness, subfoveal choroidal thickness, presence of subretinal fluid, natural course, optical coherence tomography angiography findings, and IVB responsiveness were compared between the PED types. One hundred eyes were included (64 flat irregular PED vs. 34 focal PED). Flat irregular PED had a longer symptom duration than focal PED (7.20 ± 11.52 vs. 3.69 ± 3.98 months, P = 0.03). In untreated cases, the rate of complete resolution of subretinal fluid was significantly lower in flat irregular PED than in focal PED (34.78% vs. 65.22%, P = 0.017). In contrast to the natural course, responsiveness to IVB was significantly better in flat irregular PED (72.41% vs. 31.58%, P = 0.005). Optical coherence tomography angiography revealed more CNV in flat irregular PED (42.90% vs. 10.00%, P = 0.014). Subfoveal choroidal thickness in flat irregular PED was significantly thicker. In CSC patients with flat irregular PED, the natural course was poor, but treatment response to IVB was favorable. Flat irregular PED patients showed longer symptom duration and thicker subfoveal choroidal thickness than those with focal PED. Optical coherence tomography angiography revealed more choroidal neovascularization in flat irregular PED. These findings suggest that CSC with flat irregular PED could be considered a form of pachychoroid neovasculopathy.

Optical Coherence Tomography Parameters as Predictors of Treatment Response to Eplerenone in Central Serous Chorioretinopathy.

Purpose: To present data on clinical response to eplerenone over a 1-year period in patients with central serous chorioretinopathy (CSC), and to evaluate optical coherence tomography (OCT) variables as predictors of treatment response at 3- and 12-month follow-up visits. Methods: Patients with acute or chronic CSC treated with eplerenone were retrospectively included. Clinical and imaging characteristics were recorded at baseline and at the 3-month and 12-month follow-up visits. Changes from baseline in quantitative measurements were calculated at each follow-up. Logistic regression analysis was computed to correlate clinical and OCT parameters at baseline with response to treatment at 3 and 12 months of follow-up. Results: A total of 50 eyes of 50 patients were included in the study. Mean ± SD best corrected visual acuity (BCVA) was 0.20 ± 0.14 Logarithm of the Minimum Angle of Resolution (LogMAR) at baseline and significantly improved at both the 3-month (0.12 ± 0.13 LogMAR, p < 0.0001) and 12-month (0.10 ± 0.12 LogMAR, p < 0.0001) follow-up visits. At the 3-month follow-up visit, 25 out of 50 eyes (50.0%) demonstrated macular complete subretinal fluid (SRF) resolution, while 13 eyes (26.0%) showed macular partial SRF resolution, and 12 eyes (24%) had neither partial nor complete macular SRF resolution. Among those patients with macular partial or complete SRF resolution at 3 months and thus not shifted to photodynamic therapy, 36 out of 38 cases had macular complete SRF resolution at the 12-month follow-up visit. There was a significant change from baseline at both follow-up visits in all anatomical OCT parameters (except for reduction in choroidal thickness that did not reach the statistical significance at the 12-month follow-up visit). Several OCT parameters at baseline were independently significant predictors for macular subretinal fluid complete resolution at 3 months, including (i) a thicker subfoveal choroidal thickness; (ii) a smaller subretinal fluid maximum diameter; (iii) a lower number of serous pigment epithelium detachments; and (iv) a lower number of intraretinal hyperreflective foci. Conclusion: Treatment with eplerenone in CSC patients is confirmed to be beneficial for both anatomical and functional outcomes. We identified attractive OCT metrics that could potentially be used as a tool to select patients who might mainly benefit from this treatment.

Cognitive Function and Ophthalmological Diseases: The Beijing Eye Study

To examine associations between cognitive function and ophthalmological parameters, the population-based Beijing Eye Study examined ophthalmologically and physically 3127 individuals (mean age: 64.2 ± 9.8 years). Using the mini–mental state examination, cognitive function was assessed as cognitive function score (CFS). Mean CFS was 26.3 ± 3.7 (median: 27; range: 2–30). Prevalence of mild (CFS: 23–19), moderate (CFS: 18–10) and severe cognitive dysfunction was 9.6% (95% confidence interval (CI): 8.5, 10.6), 3.2% (95% CI: 2.6, 3.9) and 0.6% (95% CI: 0.4,0.9), respectively. In multivariate analysis, better cognition (i.e., higher CFS) was significantly associated with better best corrected visual acuity (r2 = 0.38), smaller amount of undercorrected visual acuity, lower prevalence of primary angle-closure glaucoma, and thicker subfoveal choroidal thickness. Prevalence of age-related macular degeneration, open-angle glaucoma, diabetic retinopathy, any type of cataract, retinal vein occlusions or pseudoexfoliation was not significantly correlated with CFS. Though the causal relationship is unclear, the associations of lower cognitive function with undercorrected visual acuity suggest the need for earlier and more regular refraction testing in the elderly so that providing adequate glasses to the elderly can be provided and vision-associated cognitive decline can be reduced. Associations of cognitive function with primary angle-closure glaucoma and leptochoroid should be further explored.

The Gobi Desert Children Eye Study

Background: To summarize the design and findings of the Gobi Desert Children Eye Study. Methods: The Gobi Desert Children Eye Study is a school-based cohort study. The baseline study was carried out in 2013, with 1,565 out of 1,911 eligible (81.9%) children with a mean age of 11.9±3.5 years (range: 6–21 years) as participants. The study was repeated in 2016 with 958 out of 1,334 eligible children (71.8%, or 61.2% of original participants) with a baseline mean age of 10.3±2.7 years (range: 6–16 years) participated. The participants completed a structured questionnaire and underwent comprehensive ocular examinations including cycloplegic refractometry, pneumotonometry, slit-lamp assisted biomicroscopy, fundus photography and optical coherence tomography. Results: The mean refractive error at baseline in the worse eye was −1.38 diopter (D). In multivariate analysis, more myopic refractive errors were associated with older age (P&lt;0.001; regression coefficient B: −0.26), female gender (P=0.005; B: −0.26), more myopic paternal refractive errors (P&lt;0.001;B: 0.20), more myopic maternal refractive errors (P&lt;0.001; B: 0.18) and fewer hours spent outdoors (P=0.038; B: 0.18). The prevalence of myopia, defined as refractive errors (spherical equivalent) of ≤−0.50 D in the worse eye was 60.0%±1.2%. The prevalence of high myopia (≤−6.00 D) was 2.9%±0.4% in the whole study population, and it was 9.9%±3.0% in 17-year-old. It was not associated with time spent outdoors (P=0.66). The 3-year cumulative incidence of myopia, defined as newly developed refractive error (spherical equivalent) of ≤−0.50 D and ≤−6.00 D in the worse eye during the 3-year follow-up period, was 52.6% and 4.5%, respectively. The mean change of refractive error from baseline was −0.77 and −0.71 D for the right and left eye respectively. The progression of myopia more than −1 diopter happened in 51.0% of participants with baseline myopia ≤−0.50 D. The incidence of myopia (≤−1.00 D) significantly increased with older age (P&lt;0.001; B: 1.14), fewer outdoor activity hours (P=0.07, B: 0.66), higher body height (P=0.002, B: 1.02), more myopic paternal refractive error (P&lt;0.02;B: 0.82), but was not significantly associated with gender (P=0.76), ethnicity (P=0.36), baseline intraocular pressure (P=0.86) and choroidal thickness (P=0.19). The mean subfoveal choroidal thickness (SFCT) was 282±49 µm. In multivariate analysis, thicker SFCT was associated (regression coefficient r: 0.38) with higher hyperopic refractive error (P&lt;0.001; B: 0.31), younger age (P&lt;0.001; B: −0.10), male gender (P=0.03; B: −0.05), higher corneal refractive power (P&lt;0.001; B: 0.12), and non-Han Chinese ethnicity (P=0.03; B: 0.05). Conclusions: Even in Western China, prevalence and incidence of myopia in school children is high. As in East China, low and medium myopia was associated with less time spent outdoors. High myopia was not significantly associated with outdoor time. The relatively high myopia prevalence in school children in China predicts a marked increase in vision-threatening high myopia in future elderly populations in China.

Choroidal vascular abnormalities by UWF ICGA in central serous chorioretinopathy

PurposeTo evaluate vortex vein engorgement and choroidal vascular hyperpermeability in patients with central serous chorioretinopathy (CSC) using ultra‐widefield indocyanine green angiography (UWF ICGA).MethodsTwenty two patients with unilateral (19 patients) or bilateral (3 patients) CSC were consecutively included and imaged by UWF autofluorescence, fluorescein angiography and ICGA, and spectral domain optical coherence tomography (OCT). The number of quadrant of vortex vein engorgement was evaluated in the early phase of ICGA, which was classified as effective if the dilated choroidal vessels affect the macula. The area of choroidal vascular hyperpermeability was quantified in the late phase using by stereographic projection method. And they were correlated with clinical findings and OCT features.ResultsIn all affected eyes, choroidal hyperpermeability from dilated choroidal vessels was observed in association with 1 or more engorged vortex vein. Affected eyes showed significantly greater choroidal hyperpermeability area (P &lt; 0.001) and thicker subfoveal choroidal thickness (P = 0.022) compared with unaffected eyes although both eyes in the patients with unilateral CSC demonstrated symmetry of vortex congestion (78.1%). The choroidal vascular hyperpermeability was significantly correlated with subfoveal choroidal thickness (P=0.012, rho=0.493) and the height of subretinal fluid (P=0.012, rho=0.514). The number of quadrant of the effective vortex vein engorgement was correlated with subfoveal choroidal thickness (P=0.010, rho=0.505).ConclusionsUWF ICGA could demonstrate vortex vein engorgement and choroidal vascular hyperpermeability, suggesting outflow congestion as a potential contributor to the pathogenesis of CSC. And they may serve as diagnostic clues or even predictors of disease course.

Structure versus function: correlation between outer retinal and choroidal thicknesses measured by swept-source OCT with multifocal electroretinography and visual acuity

BackgroundTo correlate retina-choroidal anatomy as assessed via swept-source OCT (SS-OCT) with retinal function as determined by best-corrected visual acuity (BCVA) and multifocal electroretinogram (mfERG).MethodsThirty-three eyes from 33 patients including 16 with neovascular AMD (nvAMD) and 17 controls were included. Patients were included in the present study after a complete ophthalmologic examination, including BCVA, slit-lamp study, intraocular pressure measurement, dilated fundus examination after tropicamide instillation, SD-OCT, SS-OCT, fundus photographs and mfERG. Age, sex, BCVA, number of anti-VEGF intravitreal injections in the nvAMD group, were recollected. Outer retinal and choroidal thickness were determined at the fovea and 500 μm temporal, superior, nasal and inferior. First-order response from mfERG was collected. P1 amplitude was recorded in R1, R2 and the average of R1 + R2. The measurements recollected from the SS-OCT, mfERG and BCVA were compared.ResultsBetter BCVA was found with thicker outer retina foveal thickness (r = 0.349; P = 0.047), with thicker subfoveal choroidal thickness (r = 0.443; P = 0.010), and with higher amplitude in P1 at R1 (r = 0.346; P = 0.037). Outer retina foveal thickness did not correlate with P1 amplitude at R1 (r = 0.072; P = 0.692), R2 (r = 0.265; P = 0.137) either with the average P1 amplitude at R1 + R2 (r = 0.253; P = 0.156). A thicker subfoveal choroidal thickness was related with higher amplitude in P1 at R1 (r = 0.383; P = 0.028), R2 (r = 0.409; P = 0.018) and the average of R1 + R2 (r = 0.419; P = 0.015).ConclusionsChoroidal thickness demonstrated a positive correlation with retinal function in the sample studied, so a thicker choroid is related to a better retinal function measured with mfERG and BCVA.

Incidence and risk factors of retreatment after three-monthly aflibercept therapy for exudative age-related macular degeneration

Though anti-vascular endothelial growth factor therapy has become the standard treatment for exudative age-related macular degeneration (AMD), retreatment after the initial loading injection is inevitable in most eyes with residual or recurrent exudative changes. In the present study, we studied 140 treatment naïve eyes with typical neovascular AMD (n = 71) or polypoidal choroidal vasculopathy (PCV) (n = 69) and investigated the incidence and risk factors of retreatment after 3-monthly intravitreal aflibercept injection for exudative AMD during the 12-month period. At 12 months, best-corrected visual acuity (BCVA) improved significantly from 0.45 ± 0.39 to 0.26 ± 0.33 (P = 4.1 × 10−11). Multiple regression analysis revealed that better baseline BCVA (P = 3.6 × 10−14) and thicker subfoveal choroidal thickness (P = 0.039) were associated with better BCVA at 12-months. Retreatment was required in 94 out of 140 (67.1%) eyes. Multivariate logistic regression analysis revealed that older age (P = 7.2 × 10−3) and T-allele of ARMS2 A69S (rs10490924) variants (P = 1.9 × 10−3) were associated with retreatment. Cox-regression analysis revealed that older age (P = 1.0 × 10−2) and T-allele of the ARMS2 gene (P = 6.0 × 10−3) were associated with retreatment-free period. The number of retreatment episodes was significantly different among the ARMS2 genotypes (P = 8.1 × 10−4). These findings might be helpful for physicians when considering the optimal treatment regimen for exudative AMD.

Choroidal Thickness Changes in Rheumatoid Arthritis and the Effects of Short-term Hydroxychloroquine Treatment

ABSTRACTPurpose: The objective of this study is to evaluate choroidal thickness (CT) in patients with rheumatoid artritis (RA) and the effects of short-term hydroxychloroquine (HCQ) treatment.Methods: Thirty RA patients (group 1) and 30 normal subjects (group 2) were enrolled in the study. Group 1 was further divided into two subgroups as follows: group 1A (Before HCQ treatment) and group 1B (1 year after HCQ treatment). The CTs were measured using optical coherence tomography (EDI-OCT).Results: The mean subfoveal choroidal thickness (SFCT) (µm) was 335.70 ± 64.58 in group 1A, 341.85 ± 63.95 in group 1B, and 358.51 ± 63.83 in group 2. SFCT was significantly lower in groups 1A and 1B than in group 2 (p = 0.020 and p = 0.028, respectively). Group 1B presented statistically significant thicker SFCT than group 1A (p = 0.033).Conclusions: CT was significantly lower in RA patients than in normal subjects. HCQ treatment may, however, cause a statistically significant increase in SFCT. This increase is clinically negligible.