Choroidal Thickness in Thyroid-associated Ophthalmopathy between Normal Tension Glaucoma Using Optical Coherence Tomography

Young Lee Bo; Yoon La Tae; A Choi Jin

doi:10.3341/jkos.2017.58.8.960

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Bo, Tae, and Jin: Choroidal Thickness in Thyroid-associated Ophthalmopathy between Normal Tension Glaucoma Using Optical Coherence Tomography

Original Article

J Korean Ophthalmol Soc 2017;58(8):960-967.

Published online: 8 September 2017

DOI: https://doi.org/10.3341/jkos.2017.58.8.960

Choroidal Thickness in Thyroid-associated Ophthalmopathy between Normal Tension Glaucoma Using Optical Coherence Tomography

Young Lee Bo, M.D., Yoon La Tae, M.D., PhD, A Choi Jin, M.D., PhD

Department of Ophthalmology and Visual Science, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea

Address reprint requests to Jin A Choi, MD, PhD Department of Ophthalmology, The Catholic University of Korea St. Vincent's Hospital, #93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea Tel: 82-31-259-7343, Fax: 82-31-251-6225 E-mail: jinah616@hanmail.net

* The authors acknowledge the financial support of the National Research Foundation of Korea (NRF) grant, funded by the Korean government (MSIP; No. NRF-2016R1C1B1011287).

* Conflicts of Interest: The authors have no conflicts to disclose.

Received 9 March 201713 June 2017 Accepted 24 July 2017

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 in patients with thyroid-associated ophthalmopathy (TAO) with those with normal tension glaucoma (NTG).

Methods

A total of 70 normal eyes, 74 eyes with TAO and 60 eyes with NTG were enrolled in this study. All patients underwent spectral-domain optical coherence tomography (SD-OCT) (Cirrus HD-OCT, Carl Zeiss Meditec Inc., Dublin, CA, USA). Macular choroidal thickness was assessed using enhanced depth imaging. The average macular choroidal thickness was defined as the average value of three measurements: at the fovea and at the points located 1.5 mm in the nasal and temporal directions from the fovea. Generalized estimating equations were used to uncover factors affecting the average macular choroidal thickness.

Results

The average, superior and inferior quadrant retinal nerve fiber layer thicknesses were significantly thinner in the NTG group compared with the TAO and control groups (p < 0.001). The average macular choroidal thickness of the TAO group, NTG group and controls was 281.01 ± 60.06 μ m, 241.66 ± 55.00 μ m and 252.07 ± 55.05 μ m, respectively, which were significantly dif-ferent (p = 0.013). The subfoveal, nasal and temporal side choroidal thicknesses were significantly thinner in the NTG group compared with the TAO group (p = 0.014, 0.012 and 0.034, respectively). Subjects with TAO were associated with a thicker aver-age macular choroidal thickness compared with the NTG group after adjusting for age, sex, spherical equivalent and intraocular pressure (β = 32.61, p = 0.017).

Conclusions

Macular choroidal thickness was significantly thicker in patients with TAO compared with those with NTG. Further evaluation is required to determine if a thick choroid in subjects with TAO has any role in glaucomatous optic neuropathy.

Keywords: Macular choroidal thickness, Normal tension glaucoma, Thyroid-associated ophthalmopathy

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Figure 1.

Representative cases showing the different subchoroidal thicknesses in control, thyroid associated ophthalmopathy (TAO) and normal tension glaucoma (NTG) patients. Choroidal thick-nesses were measured perpendicularly from the outer edge of the hyper-reflective retinal pigment epithelium to the inner sclera at the fovea, 1,500 μ m temporal from the fovea, and 1,500 μ m nasal from the fovea. (A) Normal. (B) TAO. (C) NTG patients.

Table 1.

Demographics of the control patients, TAO patients and NTG patients

	Normal	TAO	NTG	p-value^*	Post-hoc test
Number of eyes (n)	70	74	60
Age (years)	51.4 ± 12.9	40.5 ± 18.6	54.7 ± 16.3	<0.001^*	<0.001^‡/0.767^§/<0.001^Π
SE (diopters)	-1.3 ± 2.8	-1.7 ± 1.9	-1.8 ± 4.2	0.686^*
Phakic eye (n, %)	100.0	97.3	100.0	0.119^†
Baseline IOP (mmHg)	14.9 ± 3.8	17.6 ± 4.5	16.2 ± 2.5	<0.001^*	<0.001^‡/0.019^§/0.113^Π
Treated IOP (mmHg)	14.9 ± 3.8	16.1 ± 4.3	12.4 ± 2.6	<0.001^*	0.009^‡/0.004^§/<0.001^Π
Number of anti-glaucoma medications (n)	0.0 ± 0.0	0.5 ± 0.6	1.3 ± 0.5	<0.001^*	<0.001^‡/<0.001^§/<0.001^Π
History of diabetes (%)	20.7	11.5	24.0	0.244^†
History of hypertension (%)	26.9	20.0	24.0	0.712^†

Values are presented as mean ± SD unless otherwise indicated.

TAO = thyroid associated ophthalmopathy; NTG = normal tension glaucoma; SE = spherical equivalent; IOP = intraocular pressure.

^* p-value by One-way analysis of variance (ANOVA).

^† p-value by χ² test.

^‡ Values for comparison with Normal and TAO group: Post-hoc test.

^§ Values for comparison with Normal and NTG group: Post-hoc test.

^Π Values for comparison with TAO and NTG group: Post-hoc test.

Table 2.

The comparisons of the optic nerve head and peripapillary RNFL thickness parameters among control patients, TAO patients and NTG patients

Location	Normal	TAO	NTG	p-value^*	Post-hoc test
Average RNFL thickness (μ m)	94.4 ± 9.9	94.1 ± 13.0	80.3 ± 11.3	<0.001	0.900^†/<0.001^‡/<0.001^§
Superior quadrant (μ m)	115.7 ± 15.1	115.9 ± 21.6	100.2 ± 18.2	<0.001	0.900^†/<0.001^‡/<0.001^§
Inferior quadrant (μ m)	120.9 ± 15.1	119.8 ± 21.5	90.0 ± 24.7	<0.001	0.900^†/<0.001^‡/<0.001^§
Temporal quadrant (μ m)	74.9 ± 14.2	73.3 ± 12.2	67.7 ± 12.0	0.006	0.900^†/<0.001^‡/0.007^§
Nasal quadrant (μ m)	66.2 ± 11.9	67.5 ± 12.0	63.4 ± 10.1	0.124	0.900^†/<0.001^‡/0.498^§

Values are presented as mean ± SD unless otherwise indicated.

RNFL = retinal nerve fiber layer; TAO = thyroid associated ophthalmopathy; NTG = normal tension glaucoma.

^* One-way analysis of covariance (ANCOVA) between all groups.

^† Values for comparison with Normal and TAO group: Post-hoc test.

^‡ Values for comparison with Normal and NTG group: Post-hoc test.

^§ Values for comparison with TAO and NTG group: Post-hoc test.

Table 3.

The comparisons of choroidal thickness parameters among control patients, TAO patients and NTG patients

Location	Normal	TAO	NTG	p-value
Average macular choroidal thickness (μ m)	252.07 ± 55.05	281.01 ± 60.06	241.66 ± 55.00	0.013^*/0.022^†/0.426^‡/0.004^§
Nasal side macular choroidal thickness (μ m)	244.56 ± 61.30	269.50 ± 65.93	233.40 ± 50.37	0.040^*/0.068^†/0.381^‡/0.012^§
Subfoveal choroidal thickness (μ m)	257.01 ± 60.38	288.25 ± 64.93	245.94 ± 65.17	0.014^*/0.076^†/0.900^‡/0.014^§
Temporal side macular choroidal thickness (μ m)	253.44 ± 58.72	285.29 ± 59.34	245.61 ± 68.28	0.028^*/0.083^†/0.900^‡/0.034^§

Values are presented as mean ± SD unless otherwise indicated.

TAO = thyroid associated ophthalmopathy; NTG = normal tension glaucoma.

^* One-way analysis of covariance (ANCOVA) between all groups.

^† Values for comparison with Normal and TAO group: Post-hoc test.

^‡ Values for comparison with Normal and NTG group: Post-hoc test.

^§ Values for comparison with TAO and NTG group: Post-hoc test.

Table 4.

Generalized estimating equation of factors affecting the average macular choroidal thickness

	Univariate			Multivariate
Regression coefficient (95% CI)	Standard error	p-value	Regression coefficient (95% CI)	Standard error	p-value
Group^*
TAO	38.72 (11.38, 66.05)	13.94	0.006	32.61 (5.93, 59.29)	13.61	0.017
Normal	9.50 (-13.72, 32.72)	11.84	0.423	7.56 (-16.21, 31.32)	12.13	0.533
NTG	1
Age	-0.78 (-1.55, -0.02)	-0.39	0.046	-0.57 (-1.28, 0.15)	0.37	0.123
Sex	-9.57 (-32.00, 12.85)	1.44	0.403
SE	-0.20 (-3.500, -3.11)	1.67	0.908
Treated IOP	-0.253 (-2.75, 2.24)	1.28	0.843

CI = confidence interval; TAO = thyroid associated ophthalmopathy; NTG = normal tension glaucoma; SE = spherical equivalent; IOP = intraocular pressure.

^* NTG eyes were used as the reference group. Model 1 and 2: adjusted for cluster sampling effects.

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