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Editors Selection IGR 13-1
Optical Coherence Tomography: PP choroidal thickness and glaucoma
Comment by Joel Schuman on:
27868 Peripapillary choroidal thickness in glaucoma measured with optical coherence tomography, Ehrlich JR; Peterson J; Parlitsis G et al., Experimental Eye Research, 2011; 92: 189-194
Ehrlich et al. (37) studied peripapillary choroidal thickness (PPCT) in exploring the hypothesis that choroidal thickness (CT) is related to glaucoma and/or glaucoma damage. In a carefully performed and well thought out study, the authors convincingly demonstrate that they find no relationship between PPCT and either glaucoma or retinal nerve fiber layer thickness. They do find a relationship between PPCT and age, which may in fact be a confounder that contributed to the hypothesis initially.
The authors use optical coherence tomography to study PPCT. This technology allowed discrimination of the anterior and posterior borders of the peripapillary choroid. The authors show that agreement between observers in measurement of PPCT is acceptable; however, measurement reproducibility is not reported. It would be useful to know this parameter in evaluating the results of this study.
This investigation and the evidence to date suggest that there is not a relationship between choroidal thickness and glaucoma
Yin in 19971 (based on pathology specimens) and Spaide in 20092 (based on OCT findings) each proposed a link between CT and glaucoma. The current paper was e-published in January, 2011. Subsequent to this there have been other papers reporting the investigation of an association between CT and glaucoma, and these studies have similarly found no such relationship.3,4 In addition, Ehrlich and co-authors looked for the possibility of a connection between peripapillary atrophy and PPCT, but found none.
It is very difficult to prove a negative hypothesis, and neither the current study nor those with similar findings have done so; however, this investigation and the evidence to date suggest that there is not a relationship between choroidal thickness and glaucoma, or that if there is such an association it is very weak indeed.
References
- Yin ZQ, Vaegan, Millar TJ, Beaumont P, Sarks S: Widespread choroidal insufficiency in primary open-angle glaucoma. J Glaucoma. 1997 Feb;6(1):23-32.
- Spaide, RF: Age-related choroidal atrophy. Am J Ophthalmol 2009. 147:801-810.
- Mwanza JC, Hochberg JT, Banitt MR, Feuer WJ, Budenz DL: Lack of Association between Glaucoma and Macular Choroidal Thickness Measured with Enhanced Depth Imaging Optical Coherence Tomography. Invest Ophthalmol Vis Sci. 2011 Feb 25. [Epub ahead of print]
- Maul EA, Friedman DS, Chang DS, Boland MV, Ramulu PY, Jampel HD, Quigley H: Choroidal Thickness Measured by Spectral Domain Optical Coherence Tomography Factors Affecting Thickness in Glaucoma Patients. Ophthalmology. 2011 Apr 12. [Epub ahead of print]
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