Analysis of Choroidal Thickness Measured Using RTVue and Associated Factors in Open-Angle Glaucoma

Sang Wook Jin; Woo Seok Choi; Hong Ryung Seo; Seung Soo Rho; Sae Heun Rho

doi:10.3341/jkos.2015.56.7.1065

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Jin, Choi, Seo, Rho, and Rho: Analysis of Choroidal Thickness Measured Using RTVue and Associated Factors in Open-Angle Glaucoma

Original Article

J Korean Ophthalmol Soc 2015;56(7):1065-1074.

Published online: 27 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.7.1065

Analysis of Choroidal Thickness Measured Using RTVue and Associated Factors in Open-Angle Glaucoma

Sang Wook Jin, M.D¹, Woo Seok Choi, M.D¹, Hong Ryung Seo, M.D, PhD², Seung Soo Rho, M.D, PhD³, Sae Heun Rho, M.D, PhD^1,

Department of Ophthalmology, Dong-A University College of Medicine, Busan, Korea

Department of Ophthalmology, Wallace Memorial Baptist Hospital, Busan, Korea

Department of Ophthalmology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea

Address reprint requests to Sae Heun Rho, MD, PhD Department of Ophthalmology, Dong-A University Hospital, #26 Daesingongwon-ro, Seo-gu, Busan 602-715, Korea Tel: 82-51-240-5227, Fax: 82-51-254-1987 E-mail: shrho@dau.ac.kr

∗This study was presented as a narration at the 110th Annual Meeting of the Korean Ophthalmological Society 2013.

∗This article has been supported by the Research Fund of the Dong-A University.

Received 28 November 201416 February 2015 Accepted 4 June 2015

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 compare the macular choroidal thickness, ganglion cell complex thickness, peripapillary choroidal thickness and retinal nerve fiber layer thickness among normal, primary open angle glaucoma (POAG) and normal tension glaucoma (NTG) patients using RTVue (Fourier-domain optical coherence tomography; Optovue, Fremont, CA, USA).

Methods:

A retrospective analysis of 32 normal controls, 32 POAG and 52 NTG patients was performed. Choroidal thickness, ganglion cell complex thickness and retinal nerve fiber layer thickness were compared among normal controls, POAG and NTG subjects. Additionally, the factors influencing choroidal thickness (age, axial length, spherical equivalent, central corneal thick-ness, mean deviation, nocturnal dip, blood pressure variability) were analyzed.

Results:

A total of 32 normal controls, 32 POAG and 52 NTG patients were enrolled in this study. Macular and peripapillary cho-roidal thicknesses were significantly thinner in the NTG patients. In NTG subjects, the significant influencing factors associated with macular and peripapillary choroidal thicknesses were age, axial length, nocturnal dip (diastolic blood pressure), diastolic blood pressure variability and ganglion cell complex thickness. In POAG patients, significant influencing factors associated with macular and peripapillary choroidal thicknesses were age and axial length.

Conclusions:

Choroidal thickness was significantly thinner in NTG patients compared with normal controls and POAG patients. Factors influencing choroidal thickness in NTG patients were age, axial length, nocturnal dip (diastolic blood pressure), diastolic blood pressure variability and ganglion cell complex thickness. In POAG patients, significant factors influencing choroidal thick-ness were age and axial length.

Keywords: Blood pressure variability, Choroidal thickness, Nocturnal dip, RTVue

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Figure 1

. Choroidal thickness of the macula. The image was acquired using the RTVue FD-OCT. The macular thickness is meas-ured horizontally at 3 points: fovea, 750 μ m nasal from the fovea, 750 μ m temporal from the fovea (double headed white arrow: measurements line between the retinal pigment epithelium and sclera at the fovea). FD-OCT = Fourier domain-optical coherence tomography.

Figure 2.

Choroidal thickness of the peripapillary area. The image was acquired using the RTVue FD-OCT. The peripapillary thick-ness is measured at 8 points around the optic disc. FD-OCT = Fourier domain-optical coherence tomography.

Figure 3.

24-hour ambulatory blood pressure monitoring (24-hr ABPM). (A) 24-hr ABPM (TONOPORT V. GM Medical System, Freiburg, Germany). (B) A picture of patient who is undergoing 24-hr ABPM. (C) Printouts from the commercially available 24-hr ABPM. syst. = systolic blood pressure; diast = diastolic blood pressure.

Table 1.

Patient characteristics in each group

	Control	POAG	NTG	p-value
Age (years)	60.28 ± 4.28	59.32 ± 3.35	58.64 ± 2.64	0.255^∗
Male:female	14:18	15:17	24:28	0.586^†
SE (diopter)	-1.13 ± 1.83	-1.22 ± 1.77	-1.23 ± 1.65	0.976^∗
Axial length (mm)	23.99 ± 1.04	23.78 ± 1.02	24.01 ± 1.14	0.701^∗
IOP (mm Hg)	11.67 ± 1.49	14.55 ± 2.54^§	13.84 ± 2.03^‡	0.000^∗
MD (dB)	-0.28 ± 0.11	-4.22 ± 2.47^§	-4.11 ± 1.85^‡	0.000^∗
CCT (μ m)	532.15 ± 21.98	535.19 ± 19.15	533.27 ± 20.51	0.872^∗

Values are presented as mean ± SD unless otherwise indicated.

POAG = primary open angle glaucoma; NTG = normal tension glaucoma; SE = spherical equivalent; IOP = intraocular pressure; MD = mean deviation; CCT = central corneal thickness.

^∗ Comparison between 3 groups by one-way analysis of variance; ^† Comparison between 3 groups by chi-square test;

^‡ Significantly different compared with control by post hoc multiple comparison;

^§ Significantly different compared with control by post hoc multiple comparison.

Table 2.

Comparison of the macular and peripapillary choroidal thickness between groups

	Control	POAG	NTG	p-value^∗
Macular choroidal thickness (μ m)
Average	240.29 ± 10.17	221.77 ± 16.65^§	210.15 ± 10.30^†‡	0.000
Center	256.07 ± 35.12	232.12 ± 29.17^§	219.13 ± 25.21^†	0.000
Temporal	226.66 ± 20.31	211.10 ± 24.34^§	201.21 ± 22.20^†	0.001
Nasal	238.15 ± 26.76	222.11 ± 21.13	210.13 ± 27.06^†	0.001
Peripapillary choroidal thickness (μ m)
Average	178.32 ± 24.88	161.68 ± 19.86^§	144.18 ± 24.11^†‡	0.000
Superior	202.54 ± 34.64	185.37 ± 25.89	169.18 ± 32.27^†	0.001
Superonasal	200.71 ± 34.48	188.38 ± 22.12	172.28 ± 24.25^†	0.002
Nasal	201.35 ± 28.06	183.08 ± 23.50^§	170.54 ± 26.86^†	0.000
Inferonasal	193.13 ± 23.15	166.21 ± 22.93^§	152.48 ± 21.06^†	0.000
Inferior	165.05 ± 35.10	153.84 ± 25.82	137.18 ± 31.78^†	0.008
Inferotemporal	216.42 ± 24.89	186.16 ± 21.78^§	154.31 ± 30.12^†‡	0.000
Temporal	217.96 ± 32.74	189.96 ± 37.43^§	166.92 ± 42.46^†	0.000
Superotemporal	222.50 ± 38.50	206.68 ± 32.57	183.06 ± 35.12^†	0.001

Values are presented as mean ± SD.

POAG = primary open angle glaucoma; NTG = normal tension glaucoma.

^∗ Comparison between 3 groups by one-way analysis of variance;

^† Significantly different compared with control by post hoc multiple comparison;

^‡ Significantly different compared with POAG by post hoc multiple comparison;

^§ Significantly different compared with control by post hoc multiple comparison.

Table 3.

Comparison of average macular and peripapillary choroidal thickness among non-dip, dip, and over-dip groups in POAG

	Macular choroidal thickness (μ m)	Peripapillary choroidal thickness (μ m)
Non-dip (systolic) (n = 13)	221.46 ± 12.59	163.51 ± 12.71
Dip (systolic) (n = 15)	224.60 ± 15.53	165.85 ± 9.56
Over-dip (systolic) (n = 4)	215.75 ± 4.5	163.83 ± 10.79
p-value^∗	0.502	0.981
Non-dip (diastolic) (n = 11)	222.73 ± 13.36	162.51 ± 13.44
Dip (diastolic) (n = 17)	223.41 ± 14.92	164.46 ± 9.19^†
Over-dip (diastolic) (n = 4)	215.82 ± 13.44	164.75 ± 10.84
p-value^∗	0.599	0.889

Values are presented as mean ± SD unless otherwise indicated. POAG = primary open-angle glaucoma.

^∗ Comparison between 3 groups by one-way analysis of variance;

^† Significantly different compared with non-dip by post hoc multiple comparison.

Table 4.

Comparison of average macular and peripapillary choroidal thickness among non-dip, dip, and over-dip groups in NTG

	Macular choroidal thickness (μ m)	Peripapillary choroidal thickness (μ m)
Non-dip (systolic) (n = 24)	213.18 ± 11.70	155.50 ± 9.67
Dip (systolic) (n = 23)	206.78 ± 14.65	145.30 ± 17.24
Over-dip (systolic) (n = 5)	202.91 ± 12.59	135.41 ± 9.35^†
p-value^∗	0.044	0.029
Non-dip (diastolic) (n = 21)	213.62 ± 9.80	156.70 ± 10.91
Dip (diastolic) (n = 26)	207.44 ± 12.17	145.72 ± 16.19
Over-dip (diastolic) (n = 5)	201.57 ± 13.15	148.05 ± 14.95^†
p-value^∗	0.047	0.018

Values are presented as mean ± SD unless otherwise indicated. NTG = normal tension glaucoma.

^∗ Comparison between 3 groups by one-way analysis of variance;

^† Significantly different compared with non-dip by post hoc multiple comparison.

Table 5.

Association of choroidal thickness with demographic factor, ocular factors and 24-hr ABPM variables by multivariate line-ar regression analysis in POAG

POAG	Macular choroidal thickness ^∗		Peripapillary choroidal thickness ^∗
POAG	β ± SE	p-value^∗	β ± SE	p-value^∗
Age	-2.024 ± 0.620	0.000	-2.674 ± 1.921	0.000
Axial length	-0.407 ± 0.895	0.029	-0.912 ± 0.563	0.001
MAP	3.385 ± 1.006	0.003	3.447 ± 1.011	0.003

Values are presented as mean ± SD unless otherwise indicated.24-hr ABPM = 24-hour ambulatory blood pressure monitoring; POAG = primary open angle glaucoma; SE = spherical equivalent; MAP = mean arterial pressure.

^∗ Multivariate linear regression analysis.

Table 6.

Association of choroidal thickness with demographic factor, ocular factors and 24-hr ABPM variables by multivariate linear regression analysis in NTG

NTG	Macular choroidal thickness		Peripapillary choroidal thickness
NTG	β ± SE	p-value^∗	β ± SE	p-value^∗
Age	-3.621 ± 0.668	0.000	-3.463 ± 0.501	0.000
Axial length	-0.618 ± 2.878	0.057	-0.165 ± 2.140	0.126
MAP	2.422 ± 2.957	0.148	2.950 ± 3.012	0.203
Diastolic nocturnal dip	-2.605 ± 2.957	0.148	-2.073 ± 1.248	0.111
Diastolic wSD	-3.020 ± 0.753	0.001	-2.663 ± 2.093	0.216
Average GCC thickness	0.092 ± 0.991	0.107	1.013 ± 0.678	0.106

Values are presented as mean ± SD unless otherwise indicated.

24-hr ABPM = 24-hour ambulatory blood pressure monitoring; NTG = normal tension glaucoma; SE = spherical equivalent; MAP = mean arterial pressure; wSD = weighted standard deviation; GCC = ganglion cell complex.

^∗ Multivariate linear regression analysis.

Table 7.

Comparison of choroidal thickness measurement value’s reliability which was measured by 2 examiners

	Choroidal thickness
ICC (95% CI, p-value)	0.904 (0.712 to 0.964, p = 0.000)

ICC = intra-class correlation coefficients; CI = confidence interval.

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