Elsevier

Ophthalmology

Volume 118, Issue 10, October 2011, Pages 2001-2007
Ophthalmology

Original article
Analysis of Normal Peripapillary Choroidal Thickness via Spectral Domain Optical Coherence Tomography

https://doi.org/10.1016/j.ophtha.2011.02.049Get rights and content

Purpose

To analyze the normal peripapillary choroidal thickness utilizing a commercial spectral domain optical coherence tomography (OCT) device and determine the intergrader reproducibility of this method.

Design

Retrospective, noncomparative, noninterventional case series.

Participants

Thirty-six eyes of 36 normal patients seen at the New England Eye Center between April and September 2010.

Methods

All patients underwent high-definition scanning with the Cirrus HD-OCT. Two raster scans were obtained per eye, a horizontal and a vertical scan, both of which were centered at the optic nerve. Two independent graders individually measured the choroidal thickness. Choroidal thickness was measured from the posterior edge of the retinal pigment epithelium to the choroid–scleral junction at 500-μm intervals away from the optic nerve in the superior, inferior, nasal, and temporal quadrants. Statistical analysis was conducted to compare mean choroidal thicknesses. Intergrader reproducibility was assessed by intraclass correlation coefficient and Pearson's correlation coefficient. Average choroidal thickness in each quadrant was compared with retinal nerve fiber layer (RNFL) thickness in their respective quadrants.

Main Outcome Measures

Peripapillary choroidal thickness, intraclass coefficient, and Pearson's correlation coefficient.

Results

The peripapillary choroid in the inferior quadrant was significantly thinner compared with all other quadrants (P<0.001). None of the other quadrants were significantly different from each other in terms of thickness. The inferior peripapillary choroid was significantly thinner compared with all other quadrants at all distances measured away from the optic nerve (P<0.001). Generally, the peripapillary choroid increases in thickness the farther it was away from the optic nerve and eventually approaching a plateau. The intraclass correlation coefficient ranged from 0.62 to 0.93 and Pearson's correlation coefficient ranged from 0.74 to 0.95 (P<0.001). Neither RNFL thickness nor average age was significantly correlated with average choroidal thickness.

Conclusions

Manual segmentation of the peripapillary choroidal thickness is reproducible between graders, suggesting that this method is accurate. The inferior peripapillary choroid was significantly thinner than all other quadrants (P<0.001).

Financial Disclosure(s)

Proprietary or commercial disclosure may be found after the references.

Section snippets

Subjects and Optical Coherence Tomography Scan Protocol

A retrospective spectral domain OCT scan review was conducted for normal patients who underwent scanning of the optic nerve region with the Cirrus HD-OCT at the New England Eye Center, Tufts Medical Center, between April and September 2010. Patients' medical records were reviewed to exclude patients with glaucoma, retinal or choroidal pathologies. In addition, patients with refractive error of greater than −6.0 diopters were also excluded. This study was approved by the Tufts Medical Center

Results

Of the 36 patients recruited, 15 were male and 21 were female. We included 23 right and 13 left eyes. The average age of the patients was 48±16 years (range, 28–79). Twenty patients were Caucasian, 10 were African-American, and 6 patients were Asian. The choroid–scleral junction was clearly delineated in 36 of these 40 patients.

Discussion

The choroid is composed mainly of vessels and connective tissue.21 Investigations of the choroid in the past relied primarily on histologic sections. These studies had significant limitations, because it was difficult to accurately maintain the fidelity of the choroid during fixation because of its highly vascular nature and the numerous histologic processing artifacts that may arise.22 Recently, Rosen et al23 correlated OCT and indocyanine green angiography C-scan data to describe various

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    • Cited by (0)

    Financial Disclosures: The authors have made the following disclosures: James G. Fujimoto – Royalties – from intellectual property owned by M.I.T. and licensed to Carl Zeiss Meditech, Inc.; Stock Options – Optovue, Inc. Jay S. Duker – Research Support – Carl Zeiss Meditech, Inc., Optovue, Inc., and Topcon Medical Systems, Inc.

    Supported in part by a Research to Prevent Blindness Challenge grant to the New England Eye Center/Department of Ophthalmology -Tufts University School of Medicine, NIH contracts RO1-EY11289-24, R01-EY13178-10, R01-EY013516-07, Air Force Office of Scientific Research FA9550-07-1-0101 and FA9550-07-1-0014.

    Manuscript no. 2010-1337.

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    Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.