Choriocapillary Flow Correlation with Axial Length in High Myopia – An Angiography Study with Optical Coherence Tomography

Abstract

Purpose To investigate parameters of retinal and choroidal microcirculation quantitatively with optical coherence tomography angiography (OCTA) in high myopic children, and to explore potential correlations with age, axial length (AL), spherical equivalent (SE), and central retinal thickness (CRT).

Methods En face angiograms were generated with an OCTA device and evaluated with automated density and flow analyzer algorithms. Perfusion parameters were correlated with age, AL, SE, and CRT using Spearmanʼs rank correlation analysis. Repeatability and reproducibility of perfusion parameter measurements were calculated in a high myopic cohort.

Results Repeatability and reproducibility of OCTA measurements were good, ranging from 3.6 – 6.5%. Strong positive correlation was identified between age and CRT (rho = 0.673, p = 0.00) as well as between AL and SE (rho = 0.844, p = 0.00). There was a strong negative correlation between AL and choriocapillary flow density (CCFD) (rho = − 0.612, p = 0.00), and a moderate negative correlation between age and superficial parafoveal retinal vessel density (SPRVD) as well as CCFD (rho = − 0.497, p = 0.013 and rho = − 0.483, p = 0.023, respectively).

Conclusion OCTA appears to be a reliable tool for the quantitative investigation of retinal and choroidal microcirculation in a high myopic pediatric cohort. CCFD reduction was associated with increasing AL in this cohort.

Zusammenfassung

Ziel Quantitative Untersuchung retinaler und choroidaler Mikrozirkulationsparameter mittels optischer Kohärenztomografie-Angiografie (OCTA) in Augen hochmyoper Kinder sowie Korrelationen mit Alter, axialer Bulbuslänge (AL), sphärischem Äquivalent (SE) und zentraler retinaler Dicke (CRT).

Methoden En-face-Angiogramme wurden mit dem RTVue AngioVue OCTA (Software V.2018.01) erstellt und mit automatischen Dichte- und Flussanalysealgorithmen ausgewertet. Die Perfusionsparameter wurden mit Alter, AL, SE und CRT mithilfe von Spearmans Rangkorrelationskoeffizienten korreliert. Die Wiederholbarkeit und Reproduzierbarkeit von Messungen der Perfusionsparameter wurden in hochmyopen Augen berechnet.

Ergebnisse Die Wiederholbarkeit und Reproduzierbarkeit der OCTA-Messungen waren sehr gut und reichten von 3,6% bis 6,5%. Eine starke positive Korrelation wurde zwischen Alter und CRT (rho = 0,678; p = 0,00) und zwischen AL und SE (rho = 0,844; p = 0,00) gefunden. Eine starke negative Korrelation zeigte sich zwischen AL und choriokapillärer Flussdichte (CCFD) (rho = − 0,612; p = 0,00), und es gab eine negative Korrelation zwischen Alter und oberflächlicher parafovealer retinaler Gefäßdichte sowie CCFD (rho = − 0,497; p = 0,013 bzw. rho = − 0,483; p = 0,023).

Schlussfolgerung Die OCTA erwies sich als ein zuverlässiges Verfahren zur quantitativen Untersuchung der retinalen und choroidalen Mikrozirkulation – erstmals gemessen in einer pädiatrischen Kohorte mit hoher Myopie. Eine Reduktion der CCFD korreliert mit der zunehmenden axialen Bulbuslänge bei hoher Myopie.

Conclusion Box

Already known:

• Retinal and choroidal microcirculation play a primary role in maintaining normal retinal function but could not be investigated in a detailed noninvasive way before the advent of OCTA.

• Choroidal thinning has been known to occur along with axial elongation in progressive high myopic eyes, and accordingly, the density of the choriocapillaris has been expected to become reduced in a similar way.

Has not been known and needs to be clarified:

• This association, however, has only been shown in morphometrical studies, but has not been confirmed in human eyes so far. For these reasons, our primary goal in this OCTA study was to explore correlations between parameters of retinal and choroidal microcirculation and myopia progression (axial elongation and myopic shift of SE) for high myopic eyes.

Newly described:

• This is the first OCTA study to confirm the findings of previous studies with non-OCTA techniques, that choroidal vascular changes are correlated with the degree of high myopia, i.e., a statistically significant negative correlation has been identified between CCFD and AL in a high myopic pediatric cohort for the first time.

• This is the second OCTA study to report on the repeatability and reproducibility of retinal and CCFD measurements in children, and the first to do it in a high myopic cohort.

Key words

OCT angiography - choriocapillaris - axial length - high myopia - pathological myopia

Schlüsselwörter

optische Kohärenztomografie-Angiografie - Choriokapillaris - axiale Bulbuslänge - hohe Myopie - pathologische Myopie

Publication History

Received: 12 December 2021

Accepted: 29 November 2022

Accepted Manuscript online:
02 December 2022

Article published online:
16 February 2023

• References

• 1 Choi W, Mohler KJ, Potsaid B. et al. Choriocapillaris and choroidal microvasculature imaging with ultrahigh speed OCT angiography. PLoS One 2013; 8: e81499
• 2 Ohno-Matsui K. Pathologic myopia. Ann Eye Sci 2018; 3: 8
• 3 Milani P, Montesano G, Rossetti L. et al. Vessel density, retinal thickness, and choriocapillaris vascular flow in myopic eyes on OCT angiography. Graefes Arch Clin Exp Ophthalmol 2018; 256: 1419-1427
• 4 Shimada N, Ohno-Matsui K, Harino S. et al. Reduction of retinal blood flow in high myopia. Graefes Arch Clin Exp Ophthalmol 2014; 242: 284-288
• 5 Benavente-Pérez A, Hosking SL, Logan NS. et al. Ocular blood flow measurements in healthy human myopic eyes. Graefes Arch Clin Exp Ophthalmol 2010; 248: 1587-1594
• 6 Akyol N, Kükner AS, Ozdemir T. et al. Choroidal and retinal blood flow changes in degenerative myopia. Can J Ophthalmol 1996; 31: 113-119
• 7 Quaranta M, Arnold J, Coscas G. et al. Indocyanine green angiographic features of pathologic myopia. Am J Ophthalmol 1996; 122: 663-671
• 8 Wang X, Kong X, Jiang C. et al. Is the peripapillary retinal perfusion related to myopia in healthy eyes? A prospective comparative study. BMJ Open 2016; 6: e010791
• 9 Jia Y, Wei E, Wang X. et al. Optical coherence tomography angiography of optic disc perfusion in glaucoma. Ophthalmology 2014; 121: 1322-1332
• 10 Wang X, Jiang C, Ko T. et al. Correlation between optic disc perfusion and glaucomatous severity in patients with open-angle glaucoma: an optical coherence tomography angiography study. Graefes Arch Clin Exp Ophthalmol 2015; 253: 1557-1564
• 11 Wei E, Jia Y, Tan O. et al. Parafoveal retinal vascular response to pattern visual stimulation assessed with OCT angiography. PLoS One 2013; 8: e81343
• 12 Yu J, Jiang C, Wang X. et al. Macular perfusion in healthy Chinese: an optical coherence tomography angiogram study. Invest Ophthalmol Vis Sci 2015; 56: 3212-3217
• 13 Al-Sheikh M, Phasukkijwatana N, Dolz-Marco R. et al. Quantitative OCT Angiography of the Retinal Microvasculature and the Choriocapillaris in Myopic Eyes. Invest Ophthalmol Vis Sci 2017; 58: 2063-2069
• 14 Mo J, Duan A, Chan S. et al. Vascular flow density in pathological myopia: an optical coherence tomography angiography study. BMJ Open 2017; 7: e013571
• 15 Scherm P, Pettenkofer M, Maier M. et al. Choriocapillary Blood Flow in Myopic Subjects Measured With OCT Angiography. Ophthalmic Surg Lasers Imaging Retina 2019; 50: e133-e139
• 16 James CB, Trew DR, Clark K. et al. Factors influencing the ocular pulse–axial length. Graefes Arch Clin Exp Ophthalmol 1991; 229: 341-344
• 17 Flores-Moreno I, Lugo F, Duker JS. et al. The relationship between axial length and choroidal thickness in eyes with high myopia. Am J Ophthalmol 2013; 155: 314-319.e1
• 18 Liu B, Wang Y, Li T. et al. Correlation of subfoveal choroidal thickness with axial length, refractive error, and age in adult highly myopic eyes. BMC Ophthalmol 2018; 18: 127
• 19 Hirata A, Negi A. Morphological changes of choriocapillaris in experimentally induced chick myopia. Graefes Arch Clin Exp Ophthalmol 1998; 236: 132-137
• 20 Su L, Ji Y, Tong N. et al. Quantitative assessment of the retinal microvasculature and choriocapillaris in myopic patients using swept-source optical coherence tomography angiography. Graefes Arch Clin Exp Ophthalmol 2020; 258: 1173-1180
• 21 Lauermann JL, Eter N, Alten F. Optical Coherence Tomography Angiography Offers New Insights into Choriocapillaris Perfusion. Ophthalmologica 2018; 239: 74-84
• 22 Maruko I, Spaide RF, Koizumi H. et al. Choroidal blood visualization in high myopia using a projection artifact method in optical coherence tomography angiography. Retina 2017; 37: 460-465
• 23 Lee H, Purohit R, Patel A. et al. In Vivo Foveal Development Using Optical Coherence Tomography. Invest Ophthalmol Vis Sci 2015; 56: 4537-4545
• 24 Read SA, Collins MJ, Vincent SJ. et al. Macular retinal layer thickness in childhood. Retina 2015; 35: 1223-1233
• 25 Scott A, Read SA, Alonso-Caneiro D. et al. Longitudinal changes in macular retinal layer thickness in European populations: Myopic vs. non-myopic eyes. PLoS One 2017; 12: e0180462
• 26 Shi Y, Ye L, Chen Q. et al. Macular Vessel Density Changes in Young Adults With High Myopia: A Longitudinal Study. Front Med (Lausanne) 2021; 8: 648644
• 27 Venkatesh R, Sinha S, Gangadharaiah D. et al. Retinal structural-vascular-functional relationship using optical coherence tomography and optical coherence tomography – angiography in myopia. Eye Vis (Lond) 2019; 6: 8