title: Characterization of the choroid-scleral junction and suprachoroidal layer in healthy individuals on enhanced-depth imaging optical coherence tomography.
abstract: OBJECTIVE
  Accurate measurements of choroidal thickness (CT) using enhanced-depth imaging optical coherence tomography (EDI-OCT) require a well-defined choroid-scleral junction (CSJ), which may appear in some eyes as a hyporeflective band corresponding to the suprachoroidal layer (SCL).
  
  
  OBJECTIVE
  To identify factors associated with the presence and thickness of the SCL in healthy participants and determine how different CSJ boundary definitions impact CT measurements.
  
  
  METHODS
  Secondary analysis of EDI-OCT images obtained prospectively from 74 eyes of 74 controls (mean age, 68.6 years) from the Age-Related Eye Disease Study 2 Ancillary SDOCT Study.
  
  
  METHODS
  The CSJ appearances were categorized as either having no visible SCL or a hyporeflective band corresponding to the SCL. Ocular parameters associated with the presence and thickness of the SCL were identified. Subfoveal CT was measured using 3 different posterior boundaries: (1) the posterior vessel border (vascular CT [VCT]), (2) inner border of the SCL (stromal CT [StCT]), and (3) inner border of the sclera (total CT [TCT]). Manual segmentation using custom software was used to compare VCT, StCT, and TCT across the macula. RESULTS The SCL was visible in 33 eyes (44.6%). Factors associated with SCL presence and thickness included hyperopic refractive error (R2 = 0.123; P = .045) and increased TCT (R2 = 0.215; P = .004), but not age, visual acuity, intraocular pressure, retinal foveal thickness, VCT, or StCT. In eyes where the SCL was not visible, mean [SD] subfoveal VCT was 222.3 [101.5] μm and StCT and TCT were 240.0 [99.0] μm, with a difference of 17.7 [16.0] μm (P < .001). In eyes where the SCL was visible, mean [SD] subfoveal VCT, StCT, and TCT were 221.9 [83.1] μm, 257.7 [97.3] μm, and 294.1 [104.8] μm, respectively, with the greatest difference of 72.2 [30.4] μm between VCT and TCT (P < .001). All 3 CT measurements were significantly different along all points up to 3.0 mm nasal and temporal to the fovea.
  
  
  CONCLUSIONS
  A hyporeflective SCL is visible at the CSJ on EDI-OCT in nearly half of healthy individuals, and its presence correlates with hyperopia. Different posterior boundary definitions may result in significant differences in CT measurements and should be explicitly identified in future choroidal studies and segmentation algorithms.
authors: Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
authors: Glenn
authors: G
authors: Yiu
authors: Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
authors: Paula
authors: P
authors: Pecen
authors: Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
authors: Neeru
authors: N
authors: Sarin
authors: Department of Biomedical Engineering, Duke University, Durham, North Carolina.
authors: Stephanie J
authors: SJ
authors: Chiu
authors: Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina2Department of Biomedical Engineering, Duke University, Durham, North Carolina.
authors: Sina
authors: S
authors: Farsiu
authors: Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina.
authors: Prithvi
authors: P
authors: Mruthyunjaya
authors: Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina2Department of Biomedical Engineering, Duke University, Durham, North Carolina.
authors: Cynthia A
authors: CA
authors: Toth
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002829:Choroid / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012590:Sclera / Q000033:anatomy & histology*; D041623:Tomography, Optical Coherence