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Editors Selection IGR 9-1

Anatomical Structures: Peripapillary choroid and visual function

Comment by Jost Jonas on:

54682 Peripapillary choroidal thickness in both eyes of glaucoma patients with unilateral visual field loss, Li L; Bian A; Zhou Q et al., American Journal of Ophthalmology, 2013; 156: 1277-1284

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Since the landmark study by Spaide and colleagues on the possibility to image the choroid, assessment of the choroid and measurements of its thickness have markedly gained in importance in research and daily clinical practice. Previous investigations have shown that central serous choroidopathy, polypoidal choroidal vasculopathy and Vogt-Koyanaga Harada's diseases are associated with an abnormally thick subfoveal choroid, while geographic atrophy of the macula as late stage of age-related macular degeneration and in particular, myopic maculopathy, show a condensation or loss of the choriocapillaris and a thinning of the choroid. Other studies suggested that acute central retinal vein occlusion may be associated with a thickened subfoveal choroid, while eyes with previous retinal vein occlusions or eyes with diabetic reti- nopathy did not differ profoundly in choroidal thickness from normal eyes in population-based studies. Interestingly, it has been suggested that a thicker choroidal thickness is associated not only with shorter axial length and younger age, but also with a higher estimated cerebrospinal fluid pressure. With respect to glaucoma, investigations revealed that eyes after an acute angleclosure glaucoma attack showed an abnormally thick subfoveal choroid, while eyes with primary open-angle glaucoma tended to have a normal subfoveal choroidal thickness. The study by Li and colleagues measured the choroidal thickness in the parapapillary region and did not detect significant differences between eyes with primary open-angle glaucoma with visual field loss as compared with the contralateral eyes without perimetric defects and as compared with normal eyes. These results fit with the findings of previous studies measuring choroidal thickness in the subfoveal region. However, limitations of the study by Li et al., as also pointed out by the authors, may have to be taken into account. These limitations are: the relatively small sample size so that it may be difficult to conclude on the absence of an association; choroidal thickness strongly depends on axial length, and although the study groups showed a marginal difference in refractive error, axial length or refractive error were not intensively taken into account in the statistical analysis; and parapapillary beta zone may potentially be associated with a thinner choroid, so that presence and size of beta zone should additionally be included into the statistical analysis. In conclusion, the study by Li and coworkers fits with previous investigations on a normal subfoveal choroidal thickness in primary open-angle glaucoma and shows the interest in examining the deep tissue layers including Bruch's membrane in the parapapillary region of eyes with glaucoma.

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