Original article
Analysis of Choroidal Thickness in Age-Related Macular Degeneration Using Spectral-Domain Optical Coherence Tomography

https://doi.org/10.1016/j.ajo.2011.03.008Get rights and content

Purpose

To understand the relationship between choroidal thickness and various disease factors in patients with age-related macular degeneration (AMD) using spectral-domain optical coherence tomography.

Design

Cross-sectional, retrospective analysis.

Methods

Fifty-seven eyes of 47 patients with wet and dry AMD seen between November 2009 and January 2010 at the New England Eye Center, Boston, Massachusetts, were analyzed. Choroidal thickness was measured by 2 independent observers at 11 sites with high-definition horizontal 1-line raster scans through the foveal center. A retrospective chart review was performed to obtain data concerning duration of disease, number of intravitreal anti–vascular endothelial growth factor injections, visual acuity, lens status, and concomitant retinal pathologic features. The Pearson correlation and Student t test were used for statistical analysis for assessment of choroidal thickness changes in wet and dry AMD.

Results

The choroid in eyes with wet and dry AMD demonstrated a wide range of thicknesses above and below the normal mean (range, 77.5 to 399.5 μm; standard deviation [SD], 90.2). Nearly one third (33.3%) of the eyes with AMD measured less than 1 SD below the mean. Eyes with wet AMD demonstrated a mean subfoveal choroidal thickness of 194.6 μm (SD, 88.4; n = 40) compared with 213.4 μm (SD, 92.2; n = 17) in the dry AMD group. The choroidal thickness in eyes with dry AMD was correlated inversely with age (r = −0.703; P = .002); however, analysis of the number of intravitreal anti–vascular endothelial growth factor injections, number of years of disease, and visual acuity failed to demonstrate any significant correlations with choroidal thickness.

Conclusions

This study demonstrated that choroidal thickness can be measured by spectral-domain optical coherence tomography and that variable choroidal thickness exists among patients with the clinical diagnosis of wet and dry AMD. However, it is unclear at this time why in some eyes, choroidal thickness either increases or decreases with the disease. Further studies need to be carried out to understand the significance of choroidal thickness with respect to visual function and disease progression over time.

Section snippets

Methods

A retrospective review was performed on 57 eyes of 47 patients with the clinical diagnosis of either wet or dry AMD seen between November 2009 and January 2010 at the New England Eye Center, Tufts Medical Center, Boston, Massachusetts. All patients included in the study underwent a comprehensive ophthalmologic examination with fundus biomicroscopy, color fundus photography, best-corrected Snellen visual acuity, fluorescein angiography, and OCT. OCT imaging was performed using Cirrus-HD OCT

Results

The study group included 23 males (40%) and 34 females (60%). Forty eyes (70%) had the diagnosis of wet AMD with a mean age of 78.6 years (standard deviation [SD], 7.0 years). Seventeen eyes (30%) had dry AMD with a mean age of 78.2 years (SD, 7.9 years). AMD is defined as a chronic, progressive degenerative disorder of the macula that affects older individuals and features central visual loss as a result of drusen deposition, geographic atrophy, serous detachment of the retinal pigment

Discussion

The choroid is a highly vascular structure that varies in thickness with intraocular and perfusion pressure and is subject to regulation by various vasoactive factors, including nitric oxide, endothelins, and autonomic innervation.18, 19, 20, 21, 22, 23 The choroid provides nutrients to the photoreceptors and removes waste products from the retinal pigment epithelium. The macula is the region of highest metabolic demand in the retina, and this has been postulated to be the reason for the

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