PURPOSE\nTo measure macular choroidal thickness in normal eyes at different points using enhanced depth imaging (EDI) optical coherence tomography (OCT) and to evaluate the association of choroidal thickness and age.\n\n\nDESIGN\nRetrospective, observational case series.\n\n\nMETHODS\nEDI OCT images were obtained in patients without significant retinal or choroidal pathologic features. The images were obtained by positioning a spectral-domain OCT device close enough to the eye to acquire an inverted image. Seven sections were obtained within a 5 x 30-degree area centered at the fovea, with 100 scans averaged for each section. The choroid was measured from the outer border of the retinal pigment epithelium to the inner scleral border at 500-microm intervals of a horizontal section from 3 mm temporal to the fovea to 3 mm nasal to the fovea. Statistical analysis was performed to evaluate variations of choroidal thickness at each location and to correlate choroidal thickness and patient age.\n\n\nRESULTS\nThe mean age of the 30 patients (54 eyes) was 50.4 years (range, 19 to 85 years), and 14 patients (46.7%) were female. The choroid was thickest underneath the fovea (mean, 287 microm; standard deviation, +/- 76 microm). Choroidal thickness decreased rapidly in the nasal direction and averaged 145 microm (+/- 57 microm) at 3 mm nasal to the fovea. Increasing age was correlated significantly with decreasing choroidal thickness at all points measured. Regression analysis suggested that the subfoveal choroidal thickness decreased by 15.6 microm for each decade of life.\n\n\nCONCLUSIONS\nChoroidal thickness seems to vary topographically within the posterior pole. The thickness of the choroid showed a negative correlation with age. The decrease in the thickness of the choroid may play a role in the pathophysiologic features of various age-related ocular conditions.

Enhanced Depth Imaging Optical Coherence Tomography of the Choroid in Normal Eyes

Objective  To develop a practical evidence based list of clinical risk factors that can be assessed by a clinician at ≤16 weeks’ gestation to estimate a woman’s risk of pre-eclampsia. Design  Systematic review and meta-analysis of cohort studies. Data sources  PubMed and Embase databases, 2000-15. Eligibility criteria for selecting studies  Cohort studies with ≥1000 participants that evaluated the risk of pre-eclampsia in relation to a common and generally accepted clinical risk factor assessed at ≤16 weeks’ gestation. Data extraction  Two independent reviewers extracted data from included studies. A pooled event rate and pooled relative risk for pre-eclampsia were calculated for each of 14 risk factors. Results  There were 25 356 688 pregnancies among 92 studies. The pooled relative risk for each risk factor significantly exceeded 1.0, except for prior intrauterine growth restriction. Women with antiphospholipid antibody syndrome had the highest pooled rate of pre-eclampsia (17.3%, 95% confidence interval 6.8% to 31.4%). Those with prior pre-eclampsia had the greatest pooled relative risk (8.4, 7.1 to 9.9). Chronic hypertension ranked second, both in terms of its pooled rate (16.0%, 12.6% to 19.7%) and pooled relative risk (5.1, 4.0 to 6.5) of pre-eclampsia. Pregestational diabetes (pooled rate 11.0%, 8.4% to 13.8%; pooled relative risk 3.7, 3.1 to 4.3), prepregnancy body mass index (BMI) >30 (7.1%, 6.1% to 8.2%; 2.8, 2.6 to 3.1), and use of assisted reproductive technology (6.2%, 4.7% to 7.9%; 1.8, 1.6 to 2.1) were other prominent risk factors. Conclusions  There are several practical clinical risk factors that, either alone or in combination, might identify women in early pregnancy who are at “high risk” of pre-eclampsia. These data can inform the generation of a clinical prediction model for pre-eclampsia and the use of aspirin prophylaxis in pregnancy.

https://www.bmj.com/content/bmj/353/bmj.i1753.full.pdf

Clinical risk factors for pre-eclampsia determined in early pregnancy: systematic review and meta-analysis of large cohort studies

Earlier studies have reported the effectiveness of aspirin in preventing preeclampsia in women considered to be at moderate to high risk of developing this disorder. This current study was a meta-analysis of cohort studies examining risk factors for preeclampsia with the goal of estimating early in pregnancy (r16wk gestation) a woman’s risk of developing preeclampsia based on the presence of absence of various risk factors. Three practical estimates were generated: the absolute risk of developing preeclampsia in the presence or absence of a given risk factor; the relative risk in the presence or absence of a given risk factor, and the population attributable fraction (PAF) for preeclampsia in relation to each risk factor. On the basis of their analysis, the authors aimed to provide a list of risk factors that could be used to identify those women at high risk for developing preeclampsia. The PubMed and Embase databases were used to identify articles studying the association between preeclampsia and one or more risk factors in a previous pregnancy or in the current pregnancy. They specifically evaluated practical risk factors that were patient specific, easily remembered by the patient or found in previous medical records, and could be determined in the first trimester by the physician. Risk factors studied included: previous history of preeclampsia, placental abruption, intrauterine growth restriction (IUGR), or stillbirth; nulliparity; advanced maternal age; chronic hypertension; preexisting diabetes; high body mass index (BMI); kidney disease; lupus; antiphospholipid (aPL) antibody syndrome; multiple gestation, and assisted reproduction. The pooled preeclampsia event rate in the exposed and unexposed groups was calculated for each risk factor and pooled relative risk was calculated. Subsequently the PAF for each risk factor was calculated using the pooled relative risks. A total of 25,356,688 pregnancies from 92 studies were included in the meta-analysis. The mean pooled event rate for preeclampsia among all risk factors was 2.7% (SD=0.93%) for unexposed groups, while the mean pooled event rate for all exposed groups was 7.3% (SD= 4.6%). The highest pooled rate of preeclampsia was observed in women with aPL antibody syndrome [17.3%, 95% confidence Interval (CI), 6.8%-31.4%] while a previous history of preeclampsia had the highest pooled relative risk (8.4; 95% CI, 7.1-9.9). Chronic hypertension was the risk factor with the second highest pooled rate (16.0%; 95% CI, 12.6%-19.7%) and pooled relative risk (5.1%; 95% CI, 4.0%-6.5%) for preeclampsia. Preexisting diabetes, BMI >30, and pregnancy achieved by assisted reproduction were other risk factors with notably high pooled rates and relative risks. The presence of all but one of the risk factors evaluated (IUGR) was determined to significantly increase the risk of developing preeclampsia. Although aPL antibody syndrome was associated with the highest rate of preeclampsia it is a relatively uncommon disorder and therefore had one of the lowest PAFs for preeclampsia (0.18%; 95% CI, 0.08%-0.33%), whereas nulliparity, prepregnancy BMI >25, and prior preeclampsia were found to have the highest PAFs (32.3%; 95% CI, 27.4%-37.0%; 23.8%; 95% CI, 22.0%-25.6%; and 22.8%; 95% CI, 19.6%-26.3%, respectively). On the basis of their meta-analysis, the investigators identified multiple risk factors that could be used to identify early in pregnancy women who are at “high risk” of developing preeclampsia. They suggest this information could be used to develop a clinical prediction model that would be useful in determining those women who would benefit from aspirin prophylaxis during their pregnancies.

/pdf/clinical-risk-factors-for-preeclampsia-determined-in-early-seyf5wieqa.pdf

Clinical Risk Factors for Preeclampsia Determined in Early Pregnancy: Systematic Review and Meta-Analysis of Large Cohort Studies

PURPOSE
To measure macular choroidal thickness (CT) in highly myopic eyes using enhanced depth imaging optical coherence tomography (OCT).


DESIGN
Retrospective, observational case series.


METHODS
Enhanced depth imaging OCT images were obtained in highly myopic eyes (> or =6 diopters [D]). Images of CT were obtained by positioning a spectral-domain OCT device close enough to the eye to acquire an inverted image. CT was measured from the outer border of the retinal pigment epithelium to the inner scleral border at 1000-mum intervals of a horizontal section from 3 mm temporal to the fovea to 3 mm nasal to the fovea. Statistical analysis was performed to evaluate CT at each location and to correlate CT with age and refractive error.


RESULTS
The mean age of the 31 patients (55 eyes) was 59.7 years (+/- 17.6 years; range, 24 to 90 years), and the mean refractive error was -11.9 D (+/- 3.7 D). The mean subfoveal CT was 93.2 microm (+/- 62.5 microm) and was correlated negatively with age (P = .006), refractive error (P < .001), and history of choroidal neovascularization (P = .013). Regression analysis suggested that subfoveal CT decreased by 12.7 mum for each decade of life and by 8.7 microm for each D of myopia.


CONCLUSIONS
The choroid in highly myopic eyes is very thin and undergoes further thinning with increasing age and degree of myopia. Abnormalities of the choroid may play a role in the pathogenesis of myopic degeneration.

Enhanced Depth Imaging Optical Coherence Tomography of Choroid in Highly Myopic Eyes

State of science: Choroidal thickness and systemic health

Diabetes mellitus (DM) is a important health problem that induces ernestful complications and it causes significant morbidity owing to specific microvascular complications such as, retinopathy, nephropathy and neuropathy, and macrovascular complications such as, ischaemic heart disease, and peripheral vasculopathy. It can affect children, young people and adults and is becoming more common. Ocular complications associated with DM are progressive and rapidly becoming the world’s most significant cause of morbidity and are preventable with early detection and timely treatment. This review provides an overview of five main ocular complications associated with DM, diabetic retinopathy and papillopathy, cataract, glaucoma, and ocular surface diseases.

Ocular complications of diabetes mellitus.

Objective: To evaluate the effect of chronic cigarette smoking on dry eye parameters, endothelial cells, and corneal thickness.Design: Prospective cross-sectional case series.Methods: In this cross-sectional study, 49 eyes of 49 chronic smokers (smoker group) and 53 eyes of 53 age-matched, healthy non-smokers (non-smoker group) were enrolled. All participants underwent measurements of tear breakup time (TBUT), central corneal thickness (CCT) measurements with contact pachymeter and the Schirmer test with anesthesia. Corneal endothelial cells were evaluated by non-contact specular microscopy and photographed for analysis of cell density and hexagonality and the coefficient of variation in cell size.Results: The mean Schirmer score and TBUT value were significantly lower in the smoker group compared to the non-smoker group (p = 0.015) and p < 0.001, respectively). No statistically significant difference was found in the mean CCT, mean endothelial cell density, endothelial cell size, SD of size, and ...

Effects of chronic smoking on central corneal thickness, endothelial cell, and dry eye parameters

Purpose: To evaluate the subfoveal choroidal thickness (SFCT) measured by enhanced depth imaging optical coherence tomography (EDI-OCT) in pregnant women.Methods: In this prospective and cross-sectional study, 100 pregnant women and 100 age-matched nonpregnant women were enrolled. The SFCT was measured by EDI-OCT. The refractive error, intraocular pressure (IOP), axial length (AL), central corneal thickness (CCT), systolic and diastolic blood pressure, and ocular perfusion pressure (OPP) were also measured. Pregnancy-related factors including gestational age, maternal weight gain, and fetal weight were noted.Results: Mean SFCT was 371.1 ± 61.8 µm in the study group and 337.2 ± 62.4 µm in the control group (p < 0.001). No significant correlation was found between SFCT and spherical refraction, IOP, AL, CCT, OPP, gestational age, maternal weight gain, or fetal weight.Conclusion: Our results suggest that subfoveal choroidal thickness increases in pregnant women compared with age-matched nonpregnant w...

Evaluation of Subfoveal Choroidal Thickness in Pregnant Women Using Enhanced Depth Imaging Optical Coherence Tomography

BACKGROUND AND OBJECTIVE To evaluate the posterior segment of the eye using spectral-domain optical coherence tomography (SD-OCT) in patients with internal carotid artery (ICA) stenosis. PATIENTS AND METHODS Prospective study enrolling 25 patients with ICA stenosis (study group) and 25 age- and gender-matched healthy individuals (control group). Macular choroidal thickness (CT) was measured at the fovea; other CT measurements were taken 1,000 µm away from the fovea in the nasal, temporal, superior, and inferior regions by enhanced-depth imaging OCT (EDI-OCT). The thicknesses of the retinal nerve fiber layer (RNFL), macula, and ganglion cell complex (GCC) were measured with SD-OCT. Correlations between the CT values and the degree of ICA stenosis were also evaluated. RESULTS Mean macular CT values in the study group were significantly thinner than those of the control groups for all quadrants (P < .05). There was no significant correlation between the degree of ICA stenosis and the CT values. Moreover, the mean thicknesses of the RNFL, macula, and GCC did not differ between the two groups. CONCLUSION The results suggest that CT decreases in patients with ICA stenosis compared with age-matched healthy individuals, whereas the RNFL, macular, and GCC thicknesses are comparable.

A quantitative evaluation of the posterior segment of the eye using spectral-domain optical coherence tomography in carotid artery stenosis: a pilot study.

Purpose: To compare the subfoveal choroidal thickness (SFCT) in preeclampsia, normal pregnancy, and non-pregnant women using enhanced depth imaging optical coherence tomography (EDI-OCT). Methods: One hundred nineteen volunteers were enrolled in this prospective and comparative study. The participants were divided into three groups: group 1 (33 preeclamptic women), group 2 (46 normal pregnant), and group 3 (40 non-pregnant healthy women). The SFCT was measured by EDI-OCT. The refractive error, intraocular pressure (IOP), axial length (AL), central corneal thickness (CCT), systolic and diastolic blood pressure, and ocular perfusion pressure (OPP) were also measured. Medical records of pregnant women, including gestational age, maternal weight gain, weight, and proteinuria, were noted. Results: Mean SFCT of groups 1, 2, and 3 were 333.8 ± 55.3 μm (range 235-440 μm), 368.6 ± 67.6 μm (range 223-517 μm), and 334.8 ± 59.9 μm (range 197-432 μm), respectively. The mean SFCT was thicker in group 2 than tha...

Subfoveal choroidal thickness in preeclampsia: comparison with normal pregnant and nonpregnant women.

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