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Peripapillary and Subfoveal Choroidal Thickness in Retinal Vein Occlusions [Response to Letter]
Authors Moleiro AF , Godinho G, Madeira C, Faria Pereira A, Brandão E, Falcão-Reis F, Beato JN , Penas S
Received 24 February 2023
Accepted for publication 7 March 2023
Published 10 March 2023 Volume 2023:17 Pages 817—818
Ana Filipa Moleiro,1,2 Gonçalo Godinho,3 Carolina Madeira,4 Ana Faria Pereira,1 Elisete Brandão,1 Fernando Falcão-Reis,1,2 João Nuno Beato,1,2 Susana Penas1,2
1Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Porto, Portugal; 2Department of Surgery and Physiology, Faculdade de Medicina da Universidade do Porto, Porto, Portugal; 3Department of Ophthalmology, Centro Hospitalar de Leiria, Leiria, Portugal; 4Department of Ophthalmology, Centro Hospitalar Gaia-Espinho, Gaia, Portugal
Correspondence: Ana Filipa Moleiro, Department of Ophthalmology, Centro Hospitalar e Universitário de São João, Alameda Hernani Monteiro, Porto, 4200-426, Portugal, Tel +351 915689259, Email [email protected]
View the original paper by Dr Moleiro and colleagues
This is in response to the Letter to the Editor
Dear editor
We appreciate the authors’ comment to our manuscript.1 Many studies have been performed to discover the most reliable method to measure choroidal thickness. Despite extensive research, a standardized choroidal thickness measurement technique remains undetermined.2–7 The authors chose to use manual segmentation method, a technique with drawbacks, but used by several authors.8 To reduce bias and error, choroidal thickness was performed independently by two trained OCT graders and measurements from the two graders were compared to assess intergrader reproducibility. Moreover, OCT scans in which the outer border of the choroid could not be correctly identified and scans without good-quality image were excluded. The authors understand the concerning’s regarding figure 1, since the shadow effect of hard exudates might make the identification of outer border of the choroid difficult.
It is known that choroidal thickness might be affected by several factors, such as axial length. A negative correlation between choroidal thickness and refractive error was described.9–11 The authors tried to mitigate this confounder by excluding patients with high refractive errors, defined by as a spherical equivalent superior to 6 diopters. In this paper, two types of analysis were performed: a longitudinal evaluation of choroidal thickness overtime and a comparison of choroidal thickness between patients with central and branch retinal vein occlusion. In the first analysis, a comparison was performed between eyes of the same patients. As none of the patients had significant anisometropia, the axial lengths bias is probably irrelevant in this analysis. In the second analysis, indeed the authors compared eyes with different axial lengths and, thus, they recognized that some confounders might be present.
Moreover, despite the scarce literature on the topic, our results are similar to results published by Kang et al that found a reduction in peripapillary and subfoveal choroidal thickness after retinal vein occlusion.2 Further studies are needed to assess the choroidal thickness in patients with this retinal vascular disease.
To date, there is no standard choroidal measurement technique (manual or automatic). We agree that a standardized and objective method for choroidal assessment is needed, because it has been proved that the choroidal thickness varies in ocular and systemic diseases and might be a key biomarker.
Disclosure
The authors report no conflicts of interest in this communication.
References
1. Moleiro AF, Godinho G, Madeira C, et al. Peripapillary and subfoveal choroidal thickness in retinal vein occlusions. Clin Ophthalmol. 2022;16:3775–3783. doi:10.2147/OPTH.S379373
2. Kang HM, Choi JH, Koh HJ, Lee SC, Kang SW. Changes in peripapillary and subfoveal choroidal thickness in patients with central retinal vein occlusion. PLoS One. 2021;16(8):e0255182. doi:10.1371/journal.pone.0255182
3. Cheong KX, Lim LW, Li KZ, Tan CS. A novel and faster method of manual grading to measure choroidal thickness using optical coherence tomography. Eye. 2018;32(2):433–438. doi:10.1038/eye.2017.210
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7. Ikuno Y, Maruko I, Yasuno Y, et al. Reproducibility of retinal and choroidal thickness measurements in enhanced depth imaging and high-penetration optical coherence tomography. Invest Ophthalmol Vis Sci. 2011;52(8):5536–5540. doi:10.1167/iovs.10-6811
8. Jiang R, Wang YX, Wei WB, Xu L, Jonas JB. Peripapillary choroidal thickness in adult Chinese: the Beijing eye study. Invest Ophthalmol Vis Sci. 2015;56(6):4045–4052. doi:10.1167/iovs.15-16521
9. Sanchez-Cano A, Orduna E, Segura F, et al. Choroidal thickness and volume in healthy young white adults and the relationships between them and axial length, ammetropy and sex. Am J Ophthalmol. 2014;158:3. doi:10.1016/j.ajo.2014.05.035
10. Flores-Moreno I, Lugo F, Duker JS, Ruiz-Moreno JM. The relationship between axial length and choroidal thickness in eyes with high myopia. Am J Ophthalmol. 2013;155(2):314–319.e1. doi:10.1016/j.ajo.2012.07.015
11. Li XQ, Larsen M, Munch IC. Subfoveal choroidal thickness in relation to sex and axial length in 93 Danish university students. Invest Ophthalmol Vis Sci. 2011;52(11):8438–8441. doi:10.1167/iovs.11-8108
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