Subfoveal Choroidal Thickness: The Beijing Eye Study

doi:10.1016/j.ophtha.2012.07.048

Ophthalmology

Volume 120, Issue 1, January 2013, Pages 175-180

https://doi.org/10.1016/j.ophtha.2012.07.048 Get rights and content

Purpose

To study subfoveal choroidal thickness (SFCT) in adult Chinese subjects and its correlation with ocular biometric parameters, refractive error, and age.

Design

Population-based longitudinal study.

Participants

The population-based Beijing Eye Study 2011 included 3468 individuals with a mean age of 64.6±9.8 years (range, 50–93 years).

Methods

A detailed ophthalmic examination was performed, including spectral-domain optical coherence tomography (SD-OCT) with enhanced depth imaging for measurement of SFCT.

Main Outcome Measures

Subfoveal choroidal thickness.

Results

The SFCT measurements were available for 3233 subjects (93.2%). Mean SFCT was 253.8±107.4 μm (range, 8–854 μm). In multivariate analysis, SFCT increased with younger age (P<0.001; correlation coefficient r = 4.12; beta coefficient = 0.37), shorter axial length (P<0.001; r = 44.7; beta coefficient = 0.46), male gender (P<0.001; r = 28.5; beta coefficient = −0.13), deeper anterior chamber depth (P<0.001; r = 39.3; beta coefficient = 0.13), thicker lens (P<0.001; r = 26.8; beta coefficient = 0.08), flatter cornea (P<0.001; r = 46.0; beta coefficient = 0.11), and better best-corrected visual acuity (BCVA) (logarithm of minimal angle of resolution; P = 0.001; r = 48.4; beta coefficient = 0.06). In multivariate analysis, SFCT was not significantly associated with blood pressure, ocular perfusion pressure, intraocular pressure, cigarette smoking, alcohol consumption, serum concentrations of lipids and glucose, diabetes mellitus, and arterial hypertension. In the myopic refractive error range of more than −1 diopter (D), SFCT decreased by 15 μm (95% confidence interval [CI], 11.9–18.5) for every increase in myopic refractive error of 1 D, or by 32 μm (95% CI, 37.1–26.0) for every increase in axial length of 1 mm. For each year increase in age, the SFCT decreased by 4.1 μm (95% CI, 4.6–3.7) (multivariate analysis).

Conclusions

Subfoveal choroidal thickness with a mean of 254±107 μm in elderly subjects with a mean age of 65 years decreased with age (4 μm per year of age) and myopia (15 μm per diopter [D] of myopia). It was also associated with male gender and the ocular biometric parameters of a deeper anterior chamber and thicker lens. The association between SFCT and BCVA indicates a functional aspect of SFCT.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Materials and Methods

The Beijing Eye Study 2011 is a population-based, cross-sectional study in Northern China.16, 17 The Medical Ethics Committee of the Beijing Tongren Hospital approved the study protocol, and all participants gave informed consent. The study was carried out in 5 communities in the urban district of Haidian in the North of Central Beijing and in 3 communities in the village area of Yufa of the Daxing District south of Beijing. The only eligibility criterion for inclusion in the study was an age

Results

Of the 3468 participants, SFCT measurements were available for 3233 (93.2%) (1818 female, 56.2%). The mean age was 64.3±9.6 years (median, 63 years; range, 50–93 years), the mean refractive error (spherical equivalent) was −0.18±1.98 D (median, 0.25 D; range, −20.0 to +7.00 D). The group of subjects without SFCT measurements compared with the group of subjects with SFCT measurements was significantly (P<0.001) older (69.6±10.9 years vs. 64.3±9.6 years) and more myopic (−1.44±4.75 D vs.

Discussion

In our population-based study on a relatively large study population, we found that that mean SFCT was 253.8±107.4 μm, ranging from 8 to 854 μm. In multivariate analysis, SFCT was associated with younger age (P<0.001; beta coefficient = 0.37), shorter axial length (P<0.001; beta = 0.46), male gender (P<0.001; beta = −0.13), deeper anterior chamber depth (P<0.001; beta = 0.13), thicker lens (P<0.001; beta = 0.08), flatter cornea (P<0.001; beta = 0.11), and better BCVA (P = 0.001; beta = 0.06).

References (26)

R.F. Spaide et al.
Enhanced depth imaging spectral-domain optical coherence tomography
Am J Ophthalmol
(2008)
T. Fujiwara et al.
Enhanced depth imaging optical coherence tomography of the choroid in highly myopic eyes
Am J Ophthalmol
(2009)
S. Grover et al.
Normative data for macular thickness by high-definition spectral-domain optical coherence tomography (Spectralis)
Am J Ophthalmol
(2009)
L. Branchini et al.
Reproducibility of choroidal thickness measurements across three spectral domain optical coherence tomography systems
Ophthalmology
(2012)
R. Margolis et al.
A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes
Am J Ophthalmol
(2009)
M. Elagouz et al.
Uveal effusion syndrome
Surv Ophthalmol
(2010)
S.S. Hayreh
Segmental nature of the choroidal vasculature
Br J Ophthalmol
(1975)
C. Flügel et al.
Species differences in choroidal vasodilative innervation: evidence for specific intrinsic nitrergic and VIP-positive neurons in the human eye
Invest Ophthalmol Vis Sci
(1994)
T. Kubota et al.
Decreased choroidal thickness in eyes with secondary angle-closure glaucoma: an aetiological factor for deep retinal changes in glaucoma?
Br J Ophthalmol
(1993)
Y. Imamura et al.
Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy
Retina
(2009)

Y. Ikuno et al.

Retinal and choroidal biometry in highly myopic eyes with spectral-domain optical coherence tomography

Invest Ophthalmol Vis Sci

(2009)

Y. Ikuno et al.

Choroidal thickness in healthy Japanese subjects

Invest Ophthalmol Vis Sci

(2010)

J.C. Mwanza et al.

Lack of association between glaucoma and macular choroidal thickness measured with enhanced depth-imaging optical coherence tomography

Invest Ophthalmol Vis Sci

(2011)

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: Manuscript no. 2012-500.

: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

: Supported by state natural sciences fund (81041018) and natural sciences fund of Beijing government (7092021;7112031).

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Original articleSubfoveal Choroidal Thickness: The Beijing Eye Study

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Materials and Methods

Results

Discussion

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Surv Ophthalmol

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Br J Ophthalmol

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Invest Ophthalmol Vis Sci

Decreased choroidal thickness in eyes with secondary angle-closure glaucoma: an aetiological factor for deep retinal changes in glaucoma?

Br J Ophthalmol

Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy

Retina

Retinal and choroidal biometry in highly myopic eyes with spectral-domain optical coherence tomography

Invest Ophthalmol Vis Sci

Choroidal thickness in healthy Japanese subjects

Invest Ophthalmol Vis Sci

Lack of association between glaucoma and macular choroidal thickness measured with enhanced depth-imaging optical coherence tomography

Invest Ophthalmol Vis Sci

Original article
Subfoveal Choroidal Thickness: The Beijing Eye Study