Choroidal Thickness in Primary Open-Angle Glaucoma Using Spectral-Domain Optical Coherence Tomography

Ji Won Kim; Ji Young Rhew; Kyu Ryong Choi

doi:10.3341/jkos.2014.55.6.868

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Kim, Rhew, and Choi: Choroidal Thickness in Primary Open-Angle Glaucoma Using Spectral-Domain Optical Coherence Tomography

Original Article

J Korean Ophthalmol Soc 2014;55(6):868-876.

Published online: 30 August 2014

DOI: https://doi.org/10.3341/jkos.2014.55.6.868

Choroidal Thickness in Primary Open-Angle Glaucoma Using Spectral-Domain Optical Coherence Tomography

Ji Won Kim, MD, Ji Young Rhew, MD, Kyu Ryong Choi, MD, PhD

Ewha Institute of Ophthalmology and Optometry, Department of Ophthalmology, Ewha Womans University School of Medicine, Seoul, Korea

Address reprint requests to Kyu Ryong Choi, MD, PhD, Department of Ophthalmology, Ewha Womans University, Mokdong Hospital, #1071 Anyangcheon-ro, Yangcheon-gu, Seoul 158-710, Korea, Tel: 82-2-2650-5154, Fax: 82-2-2654-4334, E-mail: ckrey02@ewha.ac.kr

Received 3 January 2014 Revised 20 February 2014 Accepted 22 May 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the choroidal thickness in patients with primary open-angle glaucoma (POAG) and normal tension glauco-ma (NTG) using spectral-domain optical coherence tomography (SD-OCT), and to explore the relationship between the choroi-dal thickness and glaucoma.

Methods

A retrospective analysis was performed on patients who had been diagnosed with POAG or NTG at Ewha Womans University, Mokdong Hospital. SD-OCT scans were obtained to estimate retinal nerve fiber layer (RNFL) thickness, macular thickness, and subfoveal and peripapillary choroidal thickness in groups of POAG patients, NTG patients, and normal controls.

Results

A total of 21 patients with POAG, 53 patients with NTG, and 42 normal subjects were enrolled in this study. RNFL thick-ness and macular thickness were significantly thinner in the POAG and NTG groups compared to the normal subjects. In contrast, there were no significant differences in subfoveal and peripapillary choroidal thickness among the 3 groups. There was no significant correlations between the peripapillary choroidal thickness and retinal nerve fiber layer thickness.

Conclusions

Choroidal thickness does not seem to differ between glaucoma patients and normal subjects, and there were no significant correlations between the choroidal thickness and glaucomatous optic neuropathy.

Keywords: Choroidal thickness, Spectral-domain optical coherence tomography (SD-OCT)

References

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Figure 1.

Images from spectral-domain optical coherence tomography (SD-OCT) with enhanced-depth imaging (EDI). (A) Image from subfoveal SD-OCT scan. White line: line of measurements of the subfoveal choroidal thickness. (B) Image from 360-degree peripapillary SD-OCT scan. Examples of image depicting choroidal thickness and demonstrating manual delineation of choroidal vasculature lying between the outer border of the retinal pigment epithelium and the posterior choroidal vessels (white arrow with white dotted line, 0°: temporal, 45°: superotemporal, 90°: superior, 135°: superonasal, 180°: nasal, 225°: inferonasal, 270°: in-ferior, 315°: inferotemporal).

Figure 2.

Graph of choroidal thickness in nor-mal subjects and NTG, POAG patients. Subfoveal and peripapillary choroidal thickness did not change significantly between normal subjects and NTG, POAG patients. NTG = normal tension glaucoma; POAG = primary open angle glaucoma.

Table 1.

Dermographic characteristics of groups

	Normal (n = 42)	NTG (n = 53)		POAG (n = 21)		p-value^†	p-value^‡
	mean ± SD	mean ± SD	p-value^*	mean ± SD	p-value^*	p-value^†	p-value^‡
Age (years)	49.13 ± 17.09	52.75 ± 16.60	0.919	53.98 ± 11.23	0.892	0.865	0.794
Sex (M:F)	25:17	31:22	0.998	12:9	0.900	0.987	0.853
(percent of female)	(40.5%)	(41.5%)		(42.9%)
SE (diopter)	-1.83 ± 3.09	-2.31 ± 4.04	0.570	-2.15 ± 2.71	0.634	0.621	0.461
AL (mm)	24.70 ± 1.22	25.11 ± 1.43	0.744	24.93 ± 1.52	0.966	0.948	0.302
MD (dB)	1.16 ± 1.03	-2.21 ± 1.95	<0.001	-1.97 ± 1.24	<0.001	0.375	<0.001
PSD (dB)	1.37 ± 1.10	3.31 ± 1.18	<0.001	2.99 ± 1.63	0.001	0.284	<0.001

NTG = normal tension glaucoma; POAG = primary open angle glaucoma; SD = standard deviation; SE = spherical equivalent; AL= axial length; MD = visual field mean deviation; PSD = pattern standard deviation.

^* Values for comparison with normal group: Normal vs NTG: Student t-test, Chi-Square test (Sex): Normal vs POAG: Mann-whitney U-est, Chi-Square test (Sex);

^† Values for comparison with NTG and POAG: Mann-whitney U-test, Chi-Square test (Sex);

^‡ Values for comparison among Normal and NTG, POAG: Kruskal-Wallis H test, Chi-Square test (Sex).

Table 2.

Comparison of RNFL thickness in groups

Location	Normal (n = 42)	NTG (n = 53)		POAG (n = 21)		p-value^†	p-value^‡
Location	mean ± SD (μm)	mean ± SD (μm)	p-value^*	mean ± SD (μm)	p-value^*	p-value^†	p-value^‡
T sector	99.63 ± 28.08	78.08 ± 30.80	<0.001	83.01 ± 29.46	<0.001	0.366	<0.001
ST sector	108.67 ± 22.47	85.12 ± 24.49	0.001	87.15 ± 17.63	0.001	0.732	<0.001
SN sector	115.28 ± 18.15	82.83 ± 29.95	<0.001	89.99 ± 18.06	<0.001	0.277	<0.001
N sector	93.46 ± 15.36	68.75 ± 12.93	<0.001	69.29 ± 21.66	<0.001	0.959	<0.001
IN sector	112.19 ± 25.65	89.34 ± 20.09	<0.001	90.70 ± 19.85	<0.001	0.981	<0.001
IT sector	131.88 ± 23.17	91.58 ± 32.57	<0.001	93.95 ± 23.74	<0.001	0.904	<0.001
Average	110.19 ± 22.15	82.62 ± 25.14	<0.001	85.68 ± 21.73	<0.001	0.457	<0.001

RNFL = retinal nerve fiber layer; NTG = normal tension glaucoma; POAG = primary open angle glaucoma; SD = standard deviation; T = temporal; ST = superotemporal; SN = superonasal; N = nasal; IN = inferonasal; IT = inferotemporal.

^* Values for comparison with normal group: Normal vs NTG: Student t-test: Normal vs POAG: Mann-whitney U-test;

^† Values for comparison with NTG and POAG: Mann-whitney U-test;

^‡ Values for comparison among Normal and NTG, POAG: Kruskal-Wallis H test.

Table 3.

Comparison of macular thickness in groups

Location	Normal (n = 42)	NTG (n = 53)		POAG (n = 21)		p-value^†	p-value^‡
Location	mean ± SD (μm)	mean ± SD (μm)	p-value^*	mean ± SD (μm)	p-value^*	p-value^†	p-value^‡
Fovea centralis	266.58 ± 20.10	263.67 ± 18.69	0.767	268.15 ± 17.99	0.940	0.507	0.735
The inner sector of parafovea
Temporal	330.75 ± 10.87	317.42 ± 16.50	0.020	319.44 ± 15.54	0.028	0.899	0.001
Superior	343.88 ± 15.41	329.75 ± 17.29	0.017	328.37 ± 13.38	0.020	0.801	<0.001
Nasal	346.04 ± 14.15	333.04 ± 17.53	0.019	340.59 ± 17.11	0.025	0.893	<0.001
Inferior	336.67 ± 20.61	325.13 ± 16.99	0.022	322.96 ± 15.47	0.021	0.988	0.001
Average	339.34 ± 15.26	326.34 ± 17.08	0.021	327.09 ± 15.36	0.025	0.984	<0.001
The outer sector of parafovea
Temporal	299.28 ± 19.01	282.93 ± 16.87	0.011	283.31 ± 11.45	0.015	0.774	<0.001
Superior	307.63 ± 12.23	299.77 ± 17.68	0.035	296.62 ± 12.95	0.029	0.521	0.001
Nasal	321.45 ± 11.34	309.86 ± 14.16	0.010	310.23 ± 18.00	0.011	0.680	<0.001
Inferior	301.31 ± 18.42	289.21 ± 13.04	0.008	288.00 ± 11.34	0.010	0.789	<0.001
Average	307.42 ± 15.25	295.44 ± 15.44	0.024	294.54 ± 13.44	0.021	0.896	0.001

NTG = normal tension glaucoma; POAG = primary open angle glaucoma; SD = standard deviation.

^* Values for comparison with normal group: Normal vs NTG: Student t-test, Normal vs POAG: Mann-whitney U-test;

^† Values for comparison with NTG and POAG: Mann-whitney U-test;

^‡ Values for comparison among Normal and NTG, POAG: Kruskal-Wallis H test.

Table 4.

Comparison of choroidal thickness in groups

Location	Normal (n = 42)	NTG (n = 53)		POAG (n = 21)		p-value^†	p-value^‡
Location	mean ± SD (μm)	mean ± SD (μm)	p-value^*	mean ± SD (μm)	p-value^*	p-value^†	p-value^‡
Subfoveal CT	262.58 ± 49.53	253.79 ± 62.66	0.365	267.52 ± 60.31	0.451	0.143	0.584
Peripapillary CT
T	187.04 ± 21.03	185.16 ± 65.42	0.892	189.12 ± 41.61	0.803	0.738	0.831
ST	192.37 ± 46.25	172.63 ± 71.64	0.080	181.04 ± 59.56	0.119	0.351	0.609
S	203.54 ± 79.28	181.28 ± 69.61	0.073	178.79 ± 73.33	0.061	0.829	0.112
SN	163.38 ± 71.28	165.75 ± 69.70	0.904	170.15 ± 68.88	0.556	0.408	0.701
N	170.58 ± 51.36	155.00 ± 56.77	0.185	150.62 ± 55.41	0.080	0.777	0.126
IN	179.92 ± 60.46	154.42 ± 99.21	0.069	156.34 ± 67.89	0.072	0.818	0.141
I	151.63 ± 56.02	144.37 ± 72.77	0.387	152.40 ± 78.75	0.965	0.240	0.740
IT	168.81 ± 58.61	173.17 ± 66.54	0.594	160.46 ± 59.19	0.462	0.387	0.606
Average	177.16 ± 55.54	166.47 ± 71.46	0.213	167.37 ± 63.08	0.278	0.912	0.593

NTG = normal tension glaucoma; POAG = primary open angle glaucoma; SD = standard deviation; CT = choroidal thickness; T = temporal; ST = superotemporal; S = superior; SN = superonasal; N = nasal; IN = inferonasal; I = inferior; IT = inferotemporal.

^* Values for comparison with normal group: Normal vs NTG: Student t-test, Normal vs POAG: Mann-whitney U-test;

^† Values for comparison with NTG and POAG: Mann-whitney U-test;

^‡ Values for comparison among Normal and NTG, POAG: Kruskal-Wallis H test.

Table 5.

Pearson's correlation coefficient between retinal nerve fiber layer thickness and choroidal thickness by peripapillary location in open angle glaucoma patients

Location	Correlation coefficient (r)	p-value
Temporal	0.024	0.226
Superotemporal	0.071	0.509
Superonasal	-0.103	0.354
Nasal	-0.156	0.073
Inferonasal	0.261	0.635
Inferotemporal	-0.037	0.148

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