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A Longitudinal Analysis of Peripapillary Choroidal Thinning in Healthy and Glaucoma Subjects.

ABSTRACT: PURPOSE:To evaluate the rate of peripapillary choroidal thinning in glaucoma patients and healthy controls using spectral domain optical coherence tomography. DESIGN:Cohort study. METHODS:Participants from the multicenter African Descent and Glaucoma Evaluation Study and Diagnostic Innovations in Glaucoma Study were included. The San Diego Automated Segmentation Algorithm was used to automatically segment and measure peripapillary choroidal thickness (PCT) from circle scans centered on the optic nerve head. The rate of PCT thinning was calculated using mixed effects models. RESULTS:Two hundred ninety-seven eyes with a median follow-up of 2.6 years were included. At baseline, the global mean PCT was significantly thinner in glaucoma patients than healthy control subjects (141.7 ± 66.3 ?m vs 155.7 ± 64.8 ?m, respectively; P < .001). However, when age was included in the model, this difference was no longer significant (P = .38). Both healthy controls and glaucoma patients had a significant decrease in mean (95% confidence interval) PCT change over time (-2.18 [-2.97 to -1.40 ?m/year] and -1.88 [-3.08 to -0.67 ?m/year], respectively) and mean PCT percent change over time (-3.32% [-4.36 to -2.27 ?m/year] and -2.85% [-4.64 to -0.99 ?m/year], respectively). No significant difference was found between healthy control subjects and glaucoma patients in the mean rate of PCT change (P = .28) or PCT percentage change over time (P = .23). CONCLUSIONS:The rate of peripapillary choroidal thinning was not significantly different between healthy and glaucoma eyes during this relatively short follow-up period. Longer follow-up is needed to determine whether monitoring the rate of PCT change has a role in glaucoma management.

SUBMITTER: Mundae RS

PROVIDER: S-EPMC5805594 | biostudies-literature | 2018 Feb

REPOSITORIES: biostudies-literature

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A Longitudinal Analysis of Peripapillary Choroidal Thinning in Healthy and Glaucoma Subjects.

Mundae Rusdeep S RS Zangwill Linda M LM Kabbara Sami W SW Hammel Naama N Bowd Christopher C Medeiros Felipe A FA Girkin Christopher A CA Liebmann Jeffrey M JM Weinreb Robert N RN Belghith Akram A

American journal of ophthalmology 20171219

<h4>Purpose</h4>To evaluate the rate of peripapillary choroidal thinning in glaucoma patients and healthy controls using spectral domain optical coherence tomography.<h4>Design</h4>Cohort study.<h4>Methods</h4>Participants from the multicenter African Descent and Glaucoma Evaluation Study and Diagnostic Innovations in Glaucoma Study were included. The San Diego Automated Segmentation Algorithm was used to automatically segment and measure peripapillary choroidal thickness (PCT) from circle scans ...[more]

PMID: 29103960

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Project description:ObjectiveTo compare peripapillary and macular choroidal thickness (PCT and MCT) between open-angle glaucoma (OAG) and normal controls using swept-source optical coherence tomography (SS-OCT), and to evaluate global and localized relationships between choroidal thickness and various factors in OAG, also using SS-OCT.MethodsIn this cross-sectional comparative study, 134 OAG patients and 73 normal controls were examined. PCT (global, 12 clock-hour sectors), MCT (global, six sectors) were measured by SS-OCT. The difference in choroidal thickness between the OAG patients and the normal controls was analyzed. The relationships between choroidal thickness and various factors including age, sex, spherical equivalent (SE), axial length (AXL), central corneal thickness (CCT), intraocular pressure (IOP), peripapillary retinal nerve fiber layer thickness (pRNFLT), visual field mean deviation (MD), ganglion cell-inner plexiform layer thickness (GCIPLT), and disc area were analyzed by univariate and multivariate linear regression. Global and regional analyses were performed in 12 segments of the peripapillary circle and in six sectors of the macula.ResultsThere were significant differences in global PCT and MCT between the OAG patients and the normal controls (115.22±41.17 vs. 138.89±44.70, P<0.001), (184.36±57.15 vs. 209.25±61.11, P = 0.004). The difference in global PCT remained, both after adjusting for age, AXL (117.08±3.45 vs. 135.47±4.70, P = 0.002) and also after adjusting for age, AXL, disc area (117.46±3.46 vs. 135.67±4.67, P = 0.002). But the difference in global MCT did not remain after adjusting for age, AXL, SE (188.18±4.46 vs. 202.25±6.08, P = 0.066). PCT showed significant differences between the groups in all of the 12 clock-hour sectors. These differences remained after adjusting for age, AXL and for age, AXL, disc area, with the exception of the 10 o'clock (o/c) sector. MCT in six sectors showed differences between the two groups, but they did not remain after adjusting for age, AXL, SE. In a multivariate regression analysis of the OAG patients, global PCT showed correlations with age (? = -1.18, P = 0.001), AXL (? = -14.01, P<0.001), and disc area (? = -16.67, P = 0.026). Global MCT, meanwhile, showed a significant correlation with age (? = -1.92, P<0.001), AXL. (? = -21.97, P<0.001). Choroidal thickness did not show any global or localized relationship with glaucoma severity in the OAG patients.ConclusionsThe global and all 12 clock-hour PCT, with the exception of the 10 o/c sector, were thinner in OAG; however, they did not show any correlation with glaucoma severity. Possible roles of PCT in glaucoma pathogenesis should be investigated further.

Project description:Importance:Parapapillary choroidal microvasculature dropout (MvD) is considered one of pathophysiological manifestations of glaucomatous damage. Objective:To evaluate the longitudinal change in the parapapillary choroidal MvD in patients with primary open-angle glaucoma (POAG), and to determine whether this change is associated with progressive retinal nerve fiber layer (RNFL) thinning. Design, Setting, and Participants:This prospective observational case series was conducted at a tertiary referral center in Korea and included 68 patients with POAG who exhibited parapapillary choroidal MvD in en face optical coherence tomography (OCT) angiography (OCTA) images who were enrolled from the ongoing Investigating Glaucoma Progression Study from January 1, 2016, through July 31, 2018. The mean (SD) follow-up period was 2.5 (0.2) years and observers were masked to the clinical characteristics of the participants for measurements. The OCTA images were obtained twice at an interval of at least 2 years, during which the RNFL thickness was measured at least 4 times in serial OCT examinations. Microvasculature dropout was defined as a focal sectoral capillary dropout with no visible microvascular network identified in the choroidal layer. The MvD area was measured in the OCTA images obtained at the baseline and the final follow-up. The significance of changes in the MvD area was defined using the 95% Bland-Altman limits of agreement. The rate of RNFL thinning was determined by linear regression of the serial OCT RNFL thickness measurements. Main Outcomes and Measures:The association between the change in the MvD area and the rate of RNFL thinning. Results:Of 68 Korean participants, 37 (54.5%) were women, and the mean (SD) age was 54.3 (13.1) years. Among 68 eyes, 22 (32.4%) showed increases in the MvD area during the follow-up. Faster global RNFL thinning was associated with a larger baseline parapapillary atrophy β-zone (β = -0.55; 95% CI, -0.96 to -0.14; P = .01), disc hemorrhage detection during the follow-up period (β = -0.75; 95% CI, -1.67 to -0.34; P = .001), and a larger increase in the MvD area (β = -4.74; 95% CI, -7.72 to -1.75; P = .002). The MvD area was not associated with the rate of RNFL thinning at baseline or the final follow-up. Conclusions and Relevance:Microvasculature dropout enlargement was associated with progressive RNFL thinning in POAG.

Dataset Information

A Longitudinal Analysis of Peripapillary Choroidal Thinning in Healthy and Glaucoma Subjects.

Publications

A Longitudinal Analysis of Peripapillary Choroidal Thinning in Healthy and Glaucoma Subjects.

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