Peripapillary and Macular Choroidal Thickness in Glaucoma

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Abstract

Purpose

To compare choroidal thickness (CT) between individuals with and without glaucomatous damage and to explore the association of peripapillary and submacular CT with glaucoma severity using spectral domain optical coherence tomography (SD-OCT).

Methods

Ninety-one eyes of 20 normal subjects and 43 glaucoma patients from the UCLA SD-OCT Imaging Study were enrolled. Imaging was performed using Cirrus HD-OCT. Choroidal thickness was measured at four predetermined points in the macular and peripapillary regions, and compared between glaucoma and control groups before and after adjusting for potential confounding variables.

Results

The average (± standard deviation) mean deviation (MD) on visual fields was −0.3 (±2.0) dB in controls and −3.5 (±3.5) dB in glaucoma patients. Age, axial length and their interaction were the most significant factors affecting CT on multivariate analysis. Adjusted average CT (corrected for age, axial length, their interaction, gender and lens status) however, was not different between glaucoma patients and the control group (P=0.083) except in the temporal parafoveal region (P=0.037); nor was choroidal thickness related to glaucoma severity (r=−0.187, P=0.176 for correlation with MD, r=−0.151, P=0.275 for correlation with average nerve fiber layer thickness).

Conclusions

Choroidal thickness of the macular and peripapillary regions is not decreased in glaucoma. Anatomical measurements with SD-OCT do not support the possible influence of the choroid on the pathophysiology of glaucoma.

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Most cited references 20

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A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes.

Ron Margolis, Richard Spaide (2009)

To measure macular choroidal thickness in normal eyes at different points using enhanced depth imaging (EDI) optical coherence tomography (OCT) and to evaluate the association of choroidal thickness and age. Retrospective, observational case series. EDI OCT images were obtained in patients without significant retinal or choroidal pathologic features. The images were obtained by positioning a spectral-domain OCT device close enough to the eye to acquire an inverted image. Seven sections were obtained within a 5 x 30-degree area centered at the fovea, with 100 scans averaged for each section. The choroid was measured from the outer border of the retinal pigment epithelium to the inner scleral border at 500-microm intervals of a horizontal section from 3 mm temporal to the fovea to 3 mm nasal to the fovea. Statistical analysis was performed to evaluate variations of choroidal thickness at each location and to correlate choroidal thickness and patient age. The mean age of the 30 patients (54 eyes) was 50.4 years (range, 19 to 85 years), and 14 patients (46.7%) were female. The choroid was thickest underneath the fovea (mean, 287 microm; standard deviation, +/- 76 microm). Choroidal thickness decreased rapidly in the nasal direction and averaged 145 microm (+/- 57 microm) at 3 mm nasal to the fovea. Increasing age was correlated significantly with decreasing choroidal thickness at all points measured. Regression analysis suggested that the subfoveal choroidal thickness decreased by 15.6 microm for each decade of life. Choroidal thickness seems to vary topographically within the posterior pole. The thickness of the choroid showed a negative correlation with age. The decrease in the thickness of the choroid may play a role in the pathophysiologic features of various age-related ocular conditions.

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Choroidal thickness measured by spectral domain optical coherence tomography: factors affecting thickness in glaucoma patients.

Eugenio A Maul, David Friedman, Dolly S Chang … (2011)

To measure choroidal thickness and to determine parameters associated with it. Cross-sectional study. Seventy-four glaucoma patients and glaucoma suspects. 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. Average macular and peripapillary choroidal thickness measured using SD-OCT. 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. 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. Proprietary or commercial disclosure may be found after the references. Copyright © 2011 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.

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Optical coherence tomography: a new tool for glaucoma diagnosis.

R. Hee, N Schuman, Paul E Swanson … (1995)

Optical coherence tomography (OCT) is a novel technique that allows cross-sectional imaging of the anterior and posterior eye. OCT has a resolution of approximately 10 microns, with extremely high sensitivity (approximately 10(-10) of incident light). OCT is analogous to computed tomography, which uses x-rays, magnetic resonance imaging, which uses spin resonance, or B-scan ultrasound, which uses sound waves, but OCT uses only light to derive its image. OCT is a noncontact, noninvasive system by which retinal substructure may be analyzed in vivo. OCT is useful in the evaluation of retinal pathologies and glaucoma. In retinal disease, entities such as macular holes, macular edema, central serous chorioretinopathy, retinal vascular occlusion and other factors have been examined. Separation between the posterior vitreous and retina, or lack thereof, are seen and quantitated. In glaucoma, retinal nerve fiber layer (NFL) thickness is measured at standardized locations around the optic nerve head. A circular scan produces a cylindrical cross-section of the retina, from which the NFL can be analyzed. In addition, radial scans through the optic nerve head are used to evaluate cupping and juxtapapillary NFL thickness. OCT, a new imaging technology by which the anterior and posterior segment are seen in cross-section, may permit the early diagnosis of glaucoma, and the early detection of glaucomatous progression.

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Author and article information

Journal

Journal ID (nlm-ta): J Ophthalmic Vis Res

Journal ID (iso-abbrev): J Ophthalmic Vis Res

Journal ID (publisher-id): JOVR

Title: Journal of Ophthalmic & Vision Research

Publisher: Ophthalmic Research Center

ISSN (Print): 2008-2010

ISSN (Electronic): 2008-322X

Publication date (Print): April 2014

Volume: 9

Issue: 2

Pages: 154-161

Affiliations

[1 ]Glaucoma Division, Jules Stein Eye Institute, UCLA, Los Angeles, CA, USA

[2 ]Eye Research Center, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran

[3 ]Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran

Author notes

Correspondence to: Kouros Nouri-Mahdavi, MD. Jules Stein Eye Institute, UCLA, 100 Stein Plaza, Los Angeles, CA 90095, USA; Tel:+1 310 794 1487, Fax: +1 310 794 6616; email: nouri-mahdavi@ 123456jsei.ucla.edu

Article

Publisher ID: JOVR-09-154

PMC ID: 4181196

PubMed ID: 25279115

SO-VID: 59c7235f-6890-4ae3-a81b-6b3c5a5d29a9

License:

This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.

Peripapillary and Macular Choroidal Thickness in Glaucoma

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Abstract

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Karger: Ophthalmology

Most cited references 20

A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes.

Choroidal thickness measured by spectral domain optical coherence tomography: factors affecting thickness in glaucoma patients.

Optical coherence tomography: a new tool for glaucoma diagnosis.

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