Choroidal Thickening During Young Adulthood and Baseline Choroidal Thickness Predicts Refractive Error Change

Abstract

Purpose: The purpose of this study was to explore the age-related change in choroidal thickness (ChT) and test the hypothesis that baseline ChT is predictive of refractive error change in healthy young adults.

Methods: Participants underwent spectral-domain optical coherence tomography (SD-OCT) imaging and autorefraction at 20 (baseline) and 28 years old. The enhanced depth imaging mode on the SD-OCT was used to obtain images of the choroid. Scans were exported from the SD-OCT and analyzed with a custom software that automatically measures the central ChT. The longitudinal change in subfoveal ChT and association between baseline subfoveal ChT and 8-year change in refractive error (spherical equivalent) were determined using linear mixed models.

Results: In total, 395 eyes of 198 participants (44% men; 18-22 years at baseline) were included. Over 8 years, mean spherical equivalent decreased by 0.25 diopters (D) and axial length increased by 0.09 mm. Subfoveal choroid thickened by 1.3 µm/year (95% confidence interval [CI] = 0.6-2.0), but this was reduced by 0.9 µm/year (95% CI = 1.6-0.2) for every 1 mm increase in axial length. For every 10 µm increase in baseline ChT, average annual change in spherical equivalent and axial length reduced by 0.006 D/year and 0.003 mm/year, respectively.

Conclusions: In a community-based cohort of young adults, the choroid continued to change during early adulthood. Choroidal thickening was less in eyes that were longer at baseline, and the choroid thinned in eyes that showed myopia progression. The association between baseline ChT and longitudinal changes in spherical equivalent and axial length supports the hypothesis that ChT may be predictive of refractive error development and/or myopia progression.

Figure.

(a) Estimated change (and 95% confidence interval) in choroidal thickness (µm/year) at the 9 ETDRS regions. (b) Estimated difference (and 95% confidence interval) in rate of choroidal thickening (µm/year) per 1 mm increase in axial length. The nine regions shown are: subfovea (the innermost ring; 0.5 mm radius around the foveal center), and at the superior, inferior, temporal, and nasal aspects of the inner macular ring (between 0.5 and 1.5 mm radii around the foveal center), and outer macular ring (between 1.5 and 3.0 mm radii around the foveal center). Statistically significant changes (P < 0.05) shown in bold. Values in green represent a thickening, whereas those in red represents thinning or a decrease in rate of change.