Segregation of ophthalmoscopic characteristics according to choroidal thickness in patients with early age-related macular degeneration.
OBJECTIVE
To investigate the association of fundus features with choroidal thickness in eyes with early age-related macular degeneration.


METHODS
Consecutive patients with age-related macular degeneration were evaluated. Major exclusionary criteria included late age-related macular degeneration (central geographic atrophy or choroidal neovascularization), macular laser therapy, myopia greater than -6 diopters, past vitreoretinal surgery, or central serous chorioretinopathy. Charts and multimodal imaging were reviewed for refraction, cataract, hypertension, diabetes, open-angle glaucoma, β-zone peripapillary atrophy, fundus tessellation, pigmentary changes, drusen, subretinal drusenoid deposits (also known as reticular pseudodrusen). Data measured from enhanced-depth imaging spectral-domain optical coherence tomography included subfoveal choroidal thickness, central foveal thickness, outer nuclear layer thickness, inner segment to retinal pigment epithelium aggregate thickness, presence of subretinal drusenoid deposit, and outer retinal hyperreflective layers (including the band corresponding to overlap between retinal pigment epithelium apical processes and outer segments). Correlations were calculated among the measured variables, fundus features, open-angle glaucoma, and visual acuity.


RESULTS
In 90 eyes of 70 early age-related macular degeneration patients with mean visual acuity 20/31 (logarithm of the minimum angle of resolution 0.193), subfoveal choroidal thickness showed a significant inverse correlation with age (P = 0.004) and increasing myopic spherical equivalent refractive error (P = 0.023). Subfoveal choroidal thickness was thinner in eyes with fundus tessellation (P < 0.001), subretinal drusenoid deposit (P = 0.023), an absence of conventional drusen (P < 0.001), the presence of β-zone peripapillary atrophy (P < 0.001), and in eyes with a diagnosis of open-angle glaucoma (P = 0.003) or an absent band on optical coherence tomography corresponding to overlap between outer segment and retinal pigment epithelium apical processes (P = 0.022).


CONCLUSIONS
Major ocular manifestations in early age-related macular degeneration and open-angle glaucoma are associated with the choroid-the main blood supply in the eye. Theories concerning the pathogenesis of these two diseases should incorporate interactions involving the choroid.
Vitreous, Retina, Macula Consultants of New York and LuEsther T. Mertz Retinal Research Center, Manhattan Eye, Ear and Throat Hospital, New York, New York, USA.
David W
DW
Switzer
Luis S
LS
Mendonça
Masaaki
M
Saito
Sandrine A
SA
Zweifel
Richard F
RF
Spaide
D000368:Aged; D000369:Aged, 80 and over; D002829:Choroid / Q000098:blood supply / Q000473:pathology*; D004396:Coloring Agents; D005260:Female; D005451:Fluorescein Angiography; D005654:Fundus Oculi; D005902:Glaucoma, Open-Angle / Q000175:diagnosis; D006801:Humans; D007208:Indocyanine Green; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D009896:Optic Atrophy / Q000175:diagnosis; D012189:Retrospective Studies; D013997:Time Factors; D041623:Tomography, Optical Coherence; D014792:Visual Acuity / Q000502:physiology; D057135:Wet Macular Degeneration / Q000175:diagnosis* / Q000503:physiopathology
D004396:Coloring Agents; D007208:Indocyanine Green