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. 2008 Jan;49(1):358-63.
doi: 10.1167/iovs.07-0526.

Foveolar choroidal circulation and choroidal neovascularization in age-related macular degeneration

Tatyana I Metelitsina  1 , Juan E Grunwald, Joan C DuPont, Gui-Shuang Ying, Alexander J Brucker, Joshua L Dunaief
Affiliations

Foveolar choroidal circulation and choroidal neovascularization in age-related macular degeneration

Tatyana I Metelitsina et al. Invest Ophthalmol Vis Sci. 2008 Jan.

Abstract

Purpose: To investigate in a longitudinal study whether foveolar choroidal blood flow changes are associated with the development of choroidal neovascularization (CNV) in AMD.

Methods: Relative foveolar choroidal blood velocity (ChBVel), volume (ChBVol), and flow (ChBFlow) were assessed in 135 patients with AMD, at baseline and then annually with laser Doppler flowmetry. All study eyes had visual acuity of 20/40 or better and no CNV at the time of enrollment. Comparison of foveolar choroidal circulatory measurements at baseline and their change before the development of CNV was made between eyes that had CNV and those that did not.

Results: CNV developed in 28 eyes during the study. Baseline average foveolar ChBVol and ChBFlow in these eyes were 24% (P < 0.0001) and 20% (P = 0.0007) lower than that observed in the 165 eyes in which CNV did not develop. In the eyes with CNV, foveolar ChBVol and ChBFlow decreased by 9.6% and 11.5% before the formation of CNV, whereas in the eyes that did not, they increased by 6.7% (P = 0.006) and 2.8% (P = 0.004), respectively. Eyes with lower baseline foveolar ChBFlow were more likely (risk ratio = 3.47, 95% CI: 1.24-8.70) to show visual loss of three or more lines than were eyes with a higher baseline ChBFlow (P = 0.005).

Conclusions: The development of CNV and visual loss are associated with lower choroidal circulatory parameters at baseline. In addition, the results suggest that decreases in the foveolar choroidal circulation precede the development of CNV in AMD and may play some role in its development.

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Figures

FIGURE 1
FIGURE 1
Comparison of baseline foveolar ChBVol between eyes with or without newly developing CNV. Results were shown in arbitrary units (AU). Error bar, SE. Student’s t-test showed a statistically significant difference between the two groups (P < 0.0001).
FIGURE 2
FIGURE 2
Comparison of baseline foveolar ChBFlow between eyes with and without newly developing CNV. Results are shown in arbitrary units (AU). Error bars, SE. Student’s t-test showed a statistically significant difference between the two groups (P = 0.0007).
FIGURE 3
FIGURE 3
Comparison of baseline foveolar ChBVel between eyes with and without newly developing CNV. Results are shown in arbitrary units (AU). Error bars, SE. Student’s t-test showed a statistically significant difference between the two groups (P = 0.27).
FIGURE 4
FIGURE 4
Comparison of percentage of change in foveolar ChBFlow during two annual visits before CNV appeared in AMD eyes and yearly percentage of change in ChBFlow in eyes in which CNV it did not develop. Student’s t-test shows a statistically significant difference between the two groups (P = 0.004). Each box plot includes the upper extreme (whisker, excluding outliers indicated as circles outside the box), upper quartile (top portion of box), median (horizontal line in box), lower quartile (bottom portion of box), and lower extreme (whisker).
FIGURE 5
FIGURE 5
All eyes in the study were divided into two groups according to the baseline foveolar ChBFlow. One group included all eyes with ChBFlow below or equal to the median (n = 92 eyes) and the other group included all patients with ChBFlow above the median (n = 91 eyes). The graph shows for each follow-up visit a comparison of the percentage of eyes with loss of visual acuity of three or more lines between the eyes with baseline ChBFlow below (solid line) and above (dotted line) the median. The numerator represents the number of eyes with visual acuity loss of three or more lines, and the denominator represents the number of eyes that completed the specific follow-up visit. Patients with ChBFlow below or equal to the median were three times more likely to have three or more lines of visual acuity loss within the study follow-up.
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