Macular Fluid Reduces Reproducibility of Choroidal Thickness Measurements on Enhanced Depth Optical Coherence Tomography

Abstract

Purpose To determine if different types of retinal fluid in the central macula affect the reproducibility of choroidal thickness (CT) measurements on enhanced depth imaging optical coherence tomography (EDI-OCT) Design retrospective, reliability analysis Methods EDI-OCT images were obtained and the choroidal-scleral junction was analyzed through semi-automated segmentation. CT was measured at the fovea and averaged across the central 3 mm horizontal segment. Demographic data, central macular thickness and type of fluid present were recorded. Intragrader and intergrader repeatability were assessed using the intraclass correlation coefficient (ICC) and coefficient of repeatability (CR). Results Of 124 eyes analyzed, 60 (48.4%) had diabetic macular edema, 32 (25.8%) had neovascular age-related macular degeneration, and 32 (25.8%) had other causes of fluid. Intergrader ICC (CR) were 0.95 (74.1 μm) and 0.96 (63.9 μm) for subfoveal and average CT, respectively. CR were similar across various causes of retinal fluid, but were worst for subretinal fluid compared to intraretinal or sub-retinal pigment epithelial fluid. CR also worsened with increasing choroidal thickness, but was not affected by retinal thickness. Intragrader repeatability was generally greater than intergrader values, and followed the same trend. Conclusions The presence of macular fluid reduces CT measurement reproducibility, particularly in eyes with subretinal fluid and greater choroidal thickness. A difference of 74.1 μm in subfoveal CT or 63.9 μm in average CT may be necessary to detect true clinical change in eyes with macular fluid.

Alteration of layer thickness in the choroid of diabetic patients

“…It is mandatory to ensure reproducibility of data among raters. Since Wong et al reported that the thickened choroid, and the presence of subretinal fluids could involve the reproducibility, 28 these factors might also involve choroidal layer thickness in this study. Third, choroidal layer thickness was only available in the central choroid in this study.…”

Comparison of chorioretinal layers in rhesus macaques using spectral-domain optical coherence tomography and high-resolution histological sections

“…Total retinal thickness was measured from the internal limiting membrane (ILM) to the outer border of Bruch’s membrane (BM). Total choroidal thickness was measured from the outer border of BM to the choroidal-scleral junction as described previously (Vuong et al, 2016; Willoughby et al, 2017; Wong et al, 2017; Yiu et al, 2014).…”

Relationship between diabetic macular edema and choroidal layer thickness

“…It is indisputable to ensure data reproducibility between evaluators. Since Wong et al have reported that the presence of thickened choroid and subretinal fluid may affect the reproducibility [37], these factors may involve measurements of the thickness of the choroidal layer in this study. Second, the thickness of the choroid layer was evaluated only in the central choroid in this study.…”