Elsevier

Ophthalmology

Volume 118, Issue 8, August 2011, Pages 1571-1579
Ophthalmology

Original article
Choroidal Thickness Measured by Spectral Domain Optical Coherence Tomography: Factors Affecting Thickness in Glaucoma Patients

Presented in part at: the Association for Vision and Research in Ophthalmology Annual Meeting, May 2010, Fort Lauderdale, Florida.
https://doi.org/10.1016/j.ophtha.2011.01.016Get rights and content

Purpose

To measure choroidal thickness and to determine parameters associated with it.

Design

Cross-sectional study.

Participants

Seventy-four glaucoma patients and glaucoma suspects.

Methods

Spectral domain optical coherence tomography (SD-OCT) scans were obtained to estimate average choroidal thickness in a group of glaucoma suspects and glaucoma patients. The average thickness was calculated from enhanced depth SD-OCT images and manually analyzed with Image J software. Open-angle glaucoma, open-angle glaucoma suspect, primary angle-closure glaucoma, primary angle closure, and primary angle-closure suspect were defined by published criteria. Glaucoma suspects had normal visual fields bilaterally. Glaucoma was defined by specific criteria for optic disc damage and visual field loss in ≥1 eye. The most affected eye was analyzed for comparisons across individuals, and right/left and upper half/lower half comparisons were made to compare thickness against degree of visual field damage.

Main Outcome Measures

Average macular and peripapillary choroidal thickness measured using SD-OCT.

Results

The choroidal–scleral interface was visualized in 86% and 96% of the macular and peripapillary scans, respectively. In multivariable linear regression analysis, the macular choroid was significantly thinner in association with 4 features: Longer eyes (22 μm per mm longer [95% confidence interval (CI), −33, −11]), older individuals (31 μm thinner per decade older [95% CI, −44, −17]), lower diastolic ocular perfusion pressure (26 μm thinner per 10 mmHg lower [95% CI, 8, 44]), and thicker central corneas (6 μm per 10 μm thicker cornea [95% CI, −10, 0]). The choroid was not significantly thinner in glaucoma patients than in suspects (14 μm [95% CI, −54, 26]; P = 0.5). Peripapillary choroidal thickness was not significantly different between glaucoma and suspect patients. Thickness was not associated with damage severity as estimated by visual field mean deviation or nerve fiber layer thickness, including comparisons of right with left eye or upper with lower values.

Conclusions

Age, axial length, CCT, and diastolic ocular perfusion pressure are significantly associated with choroidal thickness in glaucoma suspects and glaucoma patients. Degree of glaucoma damage was not consistently associated with choroidal thickness.

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Methods

Subjects were selected as a convenience sample of those from a tertiary referral practice of glaucoma who gave verbal informed consent and agreed to the additional testing at times when staff members were available to test them. The study followed the tenets of the Declaration of Helsinki and was approved by the Johns Hopkins Joint Committee for Clinical Investigation. Adherence to Health Insurance Portability and Accountability Act guidelines was maintained throughout the study. Eligible

Results

Seventy-four patients, 37 with glaucoma and 37 glaucoma suspects, met the eligibility criteria between October 2009 and February 2010. SD-OCT macular scans were obtained ≥1 eye in 73 of 74 subjects, and in ≥1 eye in 73 of 74 subjects for the peripapillary scans. Intraclass correlation coefficient (95% confidence interval [CI]) for the measures obtained by both graders in the 60 remeasured macular and peripapillary scans were 0.97 (0.95–0.98) and 0.98 (0.97–0.99), respectively. Images were

Discussion

Previous investigations of factors associated with choroidal thickness in normal or pseudophakic patients had determined that older persons and eyes with longer axial length or myopic refraction have a thinner choroid.20, 21, 22, 23, 24 Our study has found for the first time that a group of glaucoma suspect and glaucoma patients share these associations. Clearly, the aging process and axial length are closely related to choroidal thickness as well as being important risk factors for OAG

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    Manuscript no. 2010-1201.

    Financial Disclosure(s): The authors have made the following disclosures:

    Harry A. Quigley - financial (research) support - Alcon, Heidelberg Engineering, and the NIH-NEI.

    Supported in part by NIH research grant EY01765 (Core Facility Grant, Wilmer Institute), and by unrestricted gifts from the Leonard Wagner Trust, New York, NY, and Tom Forrester.

    David S. Friedman - financial (research) support - Carl Zeiss Meditec.

    Henry D. Jampel - paid consultant - Endo-Optics, Ivantis, Transcend, and Mobius; equity owner - Allergan.

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