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Original Investigation | Clinical Sciences

Characterization of the Choroid-Scleral Junction and Suprachoroidal Layer in Healthy Individuals on Enhanced-Depth Imaging Optical Coherence Tomography

Glenn Yiu, MD, PhD1; Paula Pecen, MD1; Neeru Sarin, MD1; Stephanie J. Chiu, BSE2; Sina Farsiu, PhD1,2; Prithvi Mruthyunjaya, MD1; Cynthia A. Toth, MD1,2
[+] Author Affiliations
1Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina
2Department of Biomedical Engineering, Duke University, Durham, North Carolina
JAMA Ophthalmol. 2014;132(2):174-181. doi:10.1001/jamaophthalmol.2013.7288.
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Importance  Accurate measurements of choroidal thickness (CT) using enhanced-depth imaging optical coherence tomography (EDI-OCT) require a well-defined choroid-scleral junction (CSJ), which may appear in some eyes as a hyporeflective band corresponding to the suprachoroidal layer (SCL).

Objective  To identify factors associated with the presence and thickness of the SCL in healthy participants and determine how different CSJ boundary definitions impact CT measurements.

Design, Setting, and Participants  Secondary analysis of EDI-OCT images obtained prospectively from 74 eyes of 74 controls (mean age, 68.6 years) from the Age-Related Eye Disease Study 2 Ancillary SDOCT Study.

Main Outcomes and Measures  The CSJ appearances were categorized as either having no visible SCL or a hyporeflective band corresponding to the SCL. Ocular parameters associated with the presence and thickness of the SCL were identified. Subfoveal CT was measured using 3 different posterior boundaries: (1) the posterior vessel border (vascular CT [VCT]), (2) inner border of the SCL (stromal CT [StCT]), and (3) inner border of the sclera (total CT [TCT]). Manual segmentation using custom software was used to compare VCT, StCT, and TCT across the macula.

Results  The SCL was visible in 33 eyes (44.6%). Factors associated with SCL presence and thickness included hyperopic refractive error (R2 = 0.123; P = .045) and increased TCT (R2 = 0.215; P = .004), but not age, visual acuity, intraocular pressure, retinal foveal thickness, VCT, or StCT. In eyes where the SCL was not visible, mean [SD] subfoveal VCT was 222.3 [101.5] μm and StCT and TCT were 240.0 [99.0] μm, with a difference of 17.7 [16.0] μm (P < .001). In eyes where the SCL was visible, mean [SD] subfoveal VCT, StCT, and TCT were 221.9 [83.1] μm, 257.7 [97.3] μm, and 294.1 [104.8] μm, respectively, with the greatest difference of 72.2 [30.4] μm between VCT and TCT (P < .001). All 3 CT measurements were significantly different along all points up to 3.0 mm nasal and temporal to the fovea.

Conclusions and Relevance  A hyporeflective SCL is visible at the CSJ on EDI-OCT in nearly half of healthy individuals, and its presence correlates with hyperopia. Different posterior boundary definitions may result in significant differences in CT measurements and should be explicitly identified in future choroidal studies and segmentation algorithms.

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Figure 1.
Different Appearances of the Choroid-Scleral Junction in Healthy Participants

A, Enhanced-depth imaging optical coherence tomography image of the macula from a participant shows a distinct choroid-scleral junction (arrowhead) with no visible suprachoroidal layer (SCL). B, Enhanced-depth imaging optical coherence tomography image from another participant demonstrates a hyporeflective band (arrowhead) across the entire posterior pole. C, Magnified view of the parafoveal region from panel B (box) shows the layers of the outer retina and choroid, as well as different posterior boundaries for measuring choroidal thickness. D, Histological section from a nonstudy adult postmortem eye shows the corresponding choroidal layers and boundaries (hematoxylin-eosin, original magnification ×10). ELM indicates external limiting membrane; EZ, ellipsoid zone; ISe, inner segment ellipsoid band; IZ, interdigitation zone; RPE, retinal pigment epithelium/Bruch’s complex; StCT, stromal choroidal thickness; TCT, total choroidal thickness; and VCT, vascular choroidal thickness.

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Figure 2.
Factors Associated With Suprachoroidal Layer (SCL) Thickness in Healthy Participants

A, The SCL thickness across the macula in participants where the SCL is visible. B and C, Subfoveal SCL thickness vs refractive error (B) and total choroidal thickness (TCT) (C). The curved lines are the 95% confidence intervals for the trend line (straight). D indicates diopter.

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Figure 3.
Choroidal Thickness Measurements Are Affected by the Definition of the Posterior Boundary

A, Comparison of vascular choroidal thickness (VCT), stromal choroidal thickness (StCT), and total choroidal thickness (TCT) in eyes with and without a visible suprachoroidal layer (SCL). Error bars represent ±2 SD. B, Comparison of VCT, StCT, and TCT across the macula in participants where the SCL is visible.

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