Objective To examine peripapillary choroidal thickness in healthy controls and in patients with glaucoma who have focal, diffuse, and sclerotic optic disc damage.
Methods Healthy controls (n = 92) and patients with glaucoma who have focal (n = 34), diffuse (n = 35), and sclerotic (n = 34) optic disc damage were imaged with spectral-domain optical coherence tomography (12° circular scan protocol centered on optic nerve head). Peripapillary choroidal thickness was measured as the distance between the automatically segmented retinal pigment epithelium/Bruch's membrane and the manually outlined interface between the posterior choroid and the anterior border of the sclera in eyes in which the anterior scleral border was visible over more than 85% of the scan circumference.
Results The anterior scleral border was visible in 76 controls (83%) and 89 patients (86%). Peripapillary choroidal thickness in healthy controls decreased linearly with age (−11 μm/decade; P < .001; r2 = 0.16), with a predicted value of 137 μm at age 70 years (95% prediction interval, 62-212 μm). While this value was similar in patients with focal and diffuse optic disc damage (126 and 130 μm, respectively; P = .22 compared with controls), it was approximately 30% lower in patients with sclerotic optic disc damage (96 μm; P < .001 compared with controls).
Conclusions The peripapillary choroid of patients with glaucoma who have sclerotic optic disc damage was approximately 25% to 30% thinner compared with that in patients with focal and diffuse optic disc damage and with that in healthy controls. The role of the choroid in the pathophysiology of sclerotic glaucomatous optic disc damage needs further investigation.
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Figure 1. Typical examples of distinct morphological patterns of glaucomatous optic disc damage. A, Focal damage with localized inferior rim loss. B, Diffuse damage with concentric enlargement of the cup. C, Sclerotic damage with a shallow cup and a ring of surrounding peripapillary atrophy.
Figure 2. Peripapillary choroidal thickness (PCT) in healthy controls and patients with glaucoma. The relationship between age and PCT was similar in healthy controls and patients with glaucoma except for a constant difference of 18 μm.
Figure 3. Peripapillary choroidal thickness (PCT) in patients with focal, diffuse, and sclerotic optic disc damage.
Figure 4. Profile of peripapillary choroidal thickness (PCT). A, Lines show the mean PCT profiles of healthy controls and patients with focal, diffuse, and sclerotic optic disc damage. T indicates temporal; TS, temporal-superior; S, superior; NS, nasal-superior; N, nasal; NI, nasal-inferior; I, inferior; and TI, temporal-inferior. B, Box plots show the variation of mean PCT in the 4 groups. Error bars indicate the 5th and 95th percentiles; boxes, interquartile ranges; horizontal white lines, medians; and dots, means.
Figure 5. Example of a patient with focal optic disc damage in the left eye. The mean peripapillary choroidal thickness was 155 μm. The retinal nerve fiber layer was thin (mean, 62 μm) with complete absence inferior-temporally. A, An optical coherence tomographic image shows the software-derived segmentation of the internal limiting membrane (dashed white line) and Bruch's membrane (dashed blue line) as well as the manual segmentation of the anterior scleral border (blue dots). B, A scanning laser ophthalmoscopic image shows the location of the scanning circle. I indicates inferior; N, nasal; S, superior; and T, temporal. C, A color photograph shows the optic disc, which is notched inferiorly with a hemorrhage at the 6-o’clock position. D, The visual field shows extensive damage of the superior hemifield (mean deviation, −10.4 dB).
Figure 6. Example of a patient with diffuse optic disc damage in the left eye. The mean peripapillary choroidal thickness was 104 μm, and the mean retinal nerve fiber layer thickness was 77 μm. A, An optical coherence tomographic image shows the software-derived segmentation of the internal limiting membrane (dashed white line) and Bruch's membrane (dashed blue line) as well as the manual segmentation of the anterior scleral border (blue dots). B, A scanning laser ophthalmoscopic image shows the location of the scanning circle. I indicates inferior; N, nasal; S, superior; and T, temporal. C, A color photograph shows deep concentric cupping of the optic disc. D, The visual field shows mainly diffuse damage with a mean deviation of −5.9 dB.
Figure 7. Example of a patient with sclerotic optic disc damage in the right eye. The mean thickness of the peripapillary choroid was 67 μm, and the mean retinal nerve fiber layer thickness was 65 μm. A, An optical coherence tomographic image shows the software-derived segmentation of the internal limiting membrane (dashed white line) and Bruch's membrane (dashed blue line) as well as the manual segmentation of the anterior scleral border (blue dots). B, A scanning laser ophthalmoscopic image shows the location of the scanning circle. I indicates inferior; N, nasal; S, superior; and T, temporal. C, A color photograph shows the optic disc, with extensive peripapillary atrophy. D, The visual field shows a mean deviation of −3.9 dB.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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