Reproducibility of Choroidal Thickness in Normal Korean Eyes Using Two Spectral Domain Optical Coherence Tomography

Kwang Hyun Lee; Sung Chul Lee; Christopher Seungkyu Lee

doi:10.3341/jkos.2013.54.9.1365

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Lee, Lee, and Lee: Reproducibility of Choroidal Thickness in Normal Korean Eyes Using Two Spectral Domain Optical Coherence Tomography

Original Article

J Korean Ophthalmol Soc 2013;54(9):1365-1370.

Published online: 7 September 2013

DOI: https://doi.org/10.3341/jkos.2013.54.9.1365

Reproducibility of Choroidal Thickness in Normal Korean Eyes Using Two Spectral Domain Optical Coherence Tomography

Kwang Hyun Lee, MD, Sung Chul Lee, MD, Christopher Seungkyu Lee, MD

Department of Ophthalmology, Yonsei University College of Medicine, Seoul, Korea

Address reprint requests to Christopher Seungkyu Lee, MD Department of Ophthalmology, Severance Hospital, #50 Yonsei-ro, Seodaemun-gu, Seoul 120-749, Korea Tel: 82-2-2228-3570, Fax: 82-2-312-0541 E-mail: sklee219@yuhs.ac

∗ The Association for Research in Vision and Ophthalmology Annual Meeting, May, 6-10,2012, Fort Lauderdale, Florida.

Received 2 February 20133 May 2013 Accepted 23 July 2013

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 investigate the reproducibility of choroidal thickness measurements in healthy Koreans using two spectral do-main optical coherence tomography (SD-OCT) instruments: Zeiss Cirrus HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA, USA) and Heidelberg Spectralis (Heidelberg Engineering, Heidelberg, Germany).

Methods

Images were obtained in 60 eyes of 30 healthy undilated volunteers without ocular pathology in a clinical setting. The choroid was imaged in all subjects using Cirrus HD 1-line raster and Spectralis enhanced depth imaging (EDI). The choroid was measured subfoveally, 1500 µm temporal, and 1500 µm nasal to the fovea. All measurements were per-formed by two independent observers. One-way analysis of variance (ANOVA), Pearson correlation, and Bland–Altman analysis were used to compare measurements.

Results

The study group consisted of 15 males and 15 females. The mean age was 50.73 ± 15.09 years (range, 24-75 years). There was no significant difference in the mean choroidal thickness (p > 0.05) between systems for any location. The choroidal thickness measurements using two instruments (Cirrus vs. Spectralis) were also strongly correlated (p < 0.001).

Conclusions

In the present study of healthy Korean adults, good reproducibility was observed between choroidal thick-ness measurements of images obtained from Cirrus and Spectralis.

Keywords: Choroidal thickness, Optical coherence tomography, Reproducibility of results

References

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Figure 1.

Optical coherence tomography scans showing cho-roidal thicknesses of the same subject on Cirrus and Spectralis. (A) An OCT image of the subject on Cirrus (Carl Zeiss Meditec Inc., Dublin, CA). Image averaging is used for cho-roidal visualization. choroidal thickness measurements was taken perpendicularly from the outer edge of the hyper-re-flective retinal pigment epithelium to the inner sclera at the fo-vea, 1500 μ m temporal to the fovea, and 1500 μ m nasal to the fovea. (B) An OCT image of subject on Spectralis. Image averaging with the aid of the eye tracking and EDI are used for choroidal visualization. Choroidal thickness measurements was taken at the fovea, 1500 μ m temporal to the fovea, and 1500 μ m nasal to the fovea (CTN: choroidal thickness meas-ured at 1.5 mm nasal to the fovea, CTF subfoveal choroidal thickness, CTT choroidal thickness measured at 1.5 mm tem-poral to the fovea).

Figure 2.

Graph showing mean choroidal thickness measure-ment in normal eyes at the fovea, 1.5 mm nasal to the fovea, and 1.5 mm temporal to the fovea.

Figure 3.

Bland-Altman plots for Cirrus vs. Spectralis. (A) Bland-Altman plot for subfoveal choroidal thickness. Mean dif-ference is 2.425 (95% CI -0.174 to 5.024). The 95% limits of agreement for choroidal thickness measurements are -17.694 to 22.544. (B) Bland-Altman plot for choroidal thickness of the na-sal fovea. Mean difference is 0.733 (95% CI -1.489 to 2.956). The 95% limits of agreement are -16.476 to 17.942. (C) Bland- Altman plot forchoroidal thickness of the temporal fovea. Mean difference is 1.292 (95% CI -1.659 to 4.242). The 95% limits of agreement for choroidal thickness measurements between Cirrus and Spectralis are -21.549 to 24.133.

Table 1.

Inter-grader comparison of choroidal thickness measurements for cirrus and spectralis

Location	Spectralis		Cirrus
Location	Correlation coefficient	p-value	Correlation coefficient	p-value
CTN*	0.945	<0.001^§	0.919	<0.001^§
CTF^†	0.977	<0.001^§	0.966	<0.001^§
CTT^‡	0.953	<0.001^§	0.890	<0.001^§

^* Choroidal thickness measured at 1.5 mm nasal to the fovea;

^† Subfoveal choroidal thickness;

^‡ Choroidal thickness measured at 1.5 mm temporal to the fovea;

^§ p-value is significant at the 0.05 level (two-tailed).

Table 2.

Summary of previous studies on demographics and choroidal thickness measurements using various optical coherence to-mographies in normal subjects

Group	Number of eyes	Type of OCT	Choroidal thickness (μ m)	Age (years)	Refractive error (D)	AL (mm)	Race
Ikuno et al¹⁵	79	HP-OCT	354 ± 111	39.4 ± 16.0	-1.9 ± 2.3	24.40 ± 1.24	Asian (Japanese)
			(80~641)	(23~88)	(+4.0~-5.75)	(21.76~27.35)
Margolis and Spaide¹⁸	54	Spectralis	287 ± 76	50.4 (19~86)	-1.3 ± 2.1	N/A	N/A
Spaide⁴	17	Spectralis	318 (R), 335 (L	) 33.4 (19~54)	N/A	N/A	N/A
Xiaoyan Ding²¹	420	Spectralis	261.93 ± 88.42	2 49.73 ± 17.89	-0.87 ± 1.98	N/A	Asian (Chinese)
				(20~85)
Varsha Manjunath⁷	34	Cirrus OCT	272 ± 81	51.1 (22~78)	N/A	N/A	N/A
Li²²	93	Spectralis	342 ± 118	24.9 ± 2.6	-1.43	24.0	White (Danish)
			(73~691)	(19.6~33.4)	(-11.25~4.50)	(20.7~27.3)
Yamashita⁸	39	Spectralis	272.6 ± 63.0	30.5 ± 7.8	-3.1 ± 1.8	N/A	Asian (Japanese)
		Cirrus	272.8 ± 64.7	(19~40)
		Topcon	269.2 ± 61.0
Branchini⁵	27	Spectralis	347.46 ± 97.92	2 35.2 (23~64)	N/A	N/A	White, asian,
		Cirrus	347.51 ± 94.37	7			hispanic, african
		RTvue	337.67 ± 89.01	1			american
Our data	60	Spectralis	240.93 ± 55.13	3 50.73 ± 15.09	-0.74 ± 1.98	23.78 ± 1.00	Asian (Korean)
		Cirrus	238.50 ± 54.79	9(24~75)	(-6.00~+2.75)	(22.03~27.06)

Values are presented as mean ± SD.

AL = axial length; N/A = not applicable; HP-OCT = high-penetration optical coherence tomography.

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