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Review
. 2022 Oct 9;23(19):12010.
doi: 10.3390/ijms231912010.

Choroidal Vasculature Changes in Age-Related Macular Degeneration: From a Molecular to a Clinical Perspective

Serena Fragiotta  1 , Luca Scuderi  2 , Clemente Maria Iodice  1 , Daria Rullo  1 , Mariachiara Di Pippo  1 , Elisa Maugliani  1 , Solmaz Abdolrahimzadeh  2
Affiliations
Review

Choroidal Vasculature Changes in Age-Related Macular Degeneration: From a Molecular to a Clinical Perspective

Serena Fragiotta et al. Int J Mol Sci. .

Abstract

The contribution of choroidal vasculature to the pathogenesis of age-related macular degeneration (AMD) has been long debated. The present narrative review aims to discuss the primary molecular and choroidal structural changes occurring with aging and AMD with a brief overview of the principal multimodal imaging modalities and techniques that enable the optimal in vivo visualization of choroidal modifications. The molecular aspects that target the choroid in AMD mainly involve human leukocyte antigen (HLA) expression, complement dysregulation, leukocyte interaction at Bruch's membrane, and mast cell infiltration of the choroid. A mechanistic link between high-risk genetic loci for AMD and mast cell recruitment has also been recently demonstrated. Recent advances in multimodal imaging allow more detailed visualization of choroidal structure, identifying alterations that may expand our comprehension of aging and AMD development.

Keywords: age-related macular degeneration; aging; choroid; choroidal vascularity index; retina.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Enhanced depth imaging (EDI: (A) near-infrared reflectance; (B) spectral-domain optical coherence tomography (SD-OCT, Heidelberg Engineering, Germany) subfoveal B-scan acquired using EDI-mode. On magnification (inset), the choroid–scleral junction is clearly detectable (teal arrowheads) allowing the calculation of subfoveal choroidal thickness traced between the outer border of the retinal pigment epithelium and the inner surface of the choroid–scleral junction through a digital caliper.
Figure 2
Figure 2
Choroidal vascularity index (CVI): (A) spectral-domain optical coherence tomography (SD-OCT) subfoveal B-scan; (B) the same image after binarization using Niblack’s autolocal threshold technique; (C) the binarized image after applying color threshold into a polygonal selection traced between the retinal pigment epithelium and the choroid–scleral junction; the dark pixels represent the luminal areas, while the remaining light pixels represent the stroma.
Figure 3
Figure 3
Choriocapillaris flow voids: (A) a choriocapillaris slab obtained through optical coherence tomography angiography. The yellow circle represents a region of interest chosen for processing. (B) The region of interest is then cropped using a circular selection of 1 mm and (C) imported into Fiji software for binarization using autolocal threshold with Phansalkar method; (D) the binarized slab is analyzed using the “Analyze Particles” tool that automatically counts the flow deficits.
See this image and copyright information in PMC

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