Choroidal thickness in diabetic retinopathy

Article

A better clinical understanding of choroidal damage might be important

Clinical and experimental findings suggested that choroidal vasculopathy in diabetes may play a role in the pathogenesis of diabetic retinopathy.1–3 It has been proposed that the hypofluorescent spots observed in the indocyanine green angiography (ICG) result from ischaemic changes of the choroidal vessels and represent either a dye filling delay or a defect of the choriocapillaris.4

However, hyperfluorescent spots may be secondary to the presence of choroidal neovascularization, intrachoroidal microvasculature abnormalities or nodules at the level of the choriocapillaris or underlying stroma. Additionally, studies assessing the choroidal blood flow beneath the fovea with the use of laser doppler flowmetry indicate a reduction of choroidal blood flow and volume in patients with non-proliferative and proliferative diabetic retinopathy.5

A better clinical understanding of choroidal damage might be important for an accurate assessment of diabetic eye disease. Until recently, the choroid could only be evaluated by ICG, laser doppler flowmetry and ultrasoungraphy. Currently, it is possible to successfully evaluate and measure the choroidal thickness and choroidal morphology in normal and pathologic states using spectral domain-optical coherence tomography (SD-OCT) instruments.

Our group studied the choroidal thickness of 65 patients with different stages of diabetic retinopathy, using a SD-OCT. We showed that eyes with diabetic macular oedema (63.3 μm, 27.2%) and proliferative diabetic retinopathy (69.6 μm, 30.0%) had a significant reduction on the choroidal thickness when compared to age - matched normal subjects. However, eyes with no proliferative diabetic retinopathy did not present a significant thinning of the choroid.

Additionally, Dr Esmaeelpour reported a central choroid thinning in all type 2 diabetic eyes regardless of disease stage.6 Sixty-three eyes were studied and the choroidal thickness mapping of all diabetic patients demonstrated central and inferior thinning compared to healthy eyes. Subfoveal choroidal thickness for healthy eyes was 327 ± 74 μm which was found to be significantly thicker than all diabetic eyes: eyes with microaneurysm 208 ± 49 μm, eyes with exudates 205 ± 54 μm, and eyes with clinically-significant-macula-oedema 211 ± 76 μm (ANOVA P < 0.001, Tukey P < 0.001).

Speculation and conclusions

We can speculate that the thinner choroid may indicate an overall reduction of choroidal blood flow in diabetic patients, as was previously demonstrated with laser doppler flowmetry and ICG angiography. Therefore, it is likely that the decreased choroidal thickness may be related to retinal tissue hypoxia, as the choroid is the major source of nutrition for the retinal pigment epithelium and outer retinal layers.

A structurally and functionally normal choroidal vasculature is essential for the function of the retina: abnormal choroidal blood volume and/or compromised flow can result in photoreceptor dysfunction and death. The diabetic choroidopathy may develop before the diabetic retinopathy in a subset of patients. Using the new OCT technologies we might be able to identify patients with higher risk of developing diabetic retinopathy examining the choroid.

References

1. A.A. Hidayat and B.S. Fine, Ophthalmology, 1985;92:512–522.

2. D. Weinberger et al., Am. J. Ophthalmol., 1998;126:238–247.

3. C. Shiragami et al., Graefes Arch. Clin. Exp. Ophthalmol., 2002;240:436–442.

4. K. Shiraki et al., Int. Ophthalmol., 1999;23:105–109.

5. L.S. Schocket et al., Int. Ophthalmol., 2004;25:89–94.

6. M. Esmaeelpour et al., Invest. Ophthalmol. Vis. Sci., 2011;52:5311–5316.

Newsletter

Join ophthalmologists across Europe—sign up for exclusive updates and innovations in surgical techniques and clinical care.

Recent Videos
Alfredo Sadun, MD, PhD, chief of Ophthalmology at the Doheny Eye Institute, University of California Los Angeles, shared exciting new research with the Eye Care Network during the Association for Research in Vision and Ophthalmology (ARVO) meeting on the subject of Leber hereditary optic neuropathy (LHON).
At this year's Association for Research in Vision and Ophthalmology (ARVO) meeting in Salt Lake City, Utah, Nitish Mehta, MD, shared highlights from his research documenting real-world results of aflibercept 8 mg for patients with diabetic macular oedema.
ARVO 2025: Anat Loewenstein, MD, shares data from herself and her colleagues on meeting needs of patients with diabetic retinopathy
At the American Society of Cataract and Refractive Surgeons annual meeting, Sheng Lim, MD, FRCOphth discusses the benefit of endoscopic cyclophotocoagulation for patients with primary open angle glaucoma and cataracts in the CONCEPT study
A photo of Seville, Spain, with the Congress on Controversies in Ophthalmology logo superimposed on it. Image credit: ©francovolpato – stock.adobe.com; logo courtesy COPHy
Anat Loewenstein, MD, Professor and Director, Department of Ophthalmology, Tel Aviv Medical Center, discusses the Congress on Controversies in Ophthalmology (COPHy)
(Image credit: Ophthalmology Times Europe) AGS 2025: Clemens Strohmaier, PhD, on improving aqueous humour outflow following excimer laser trabeculostomy
3 experts are featured in this series.
Anat Loewenstein, MD, speaks about the 22nd Annual Angiogenesis, Exudation, and Degeneration Meeting in February 2025 and shares her global forecast for AI-driven home OCT
3 experts are featured in this series.
© 2025 MJH Life Sciences

All rights reserved.