Assessment of Choroidal Morphology and Vasculature in Healthy Young Saudi Adults

Research Article

Austin J Clin Ophthalmol. 2014;1(4): 1018.

Assessment of Choroidal Morphology and Vasculature in Healthy Young Saudi Adults

Haya Maatuoq Al Farhan*, Lulwah Ahmed Al Shibel and Mohammed Abdulmaboud

Department of Optometry and Vision Sciences, King Saud University, Saudi Arabia

*Corresponding author: Haya Maatuoq Al Farhan, Department of Optometry and Vision Sciences, College of Applied Medicine Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia

Received: February 14, 2014; Accepted: March 12, 2014; Published: March 21, 2014


Purpose: The aim of this prospective study was to assess choroidal morphology and vasculature in healthy young Saudi adults by spectraldomain optical coherence tomography imaging with confocal scanning laser ophthalmoscopy (OCT–SLO).

Methods: Eyes with the most visible choroid—sclera junction in 110 consecutive healthy subjects (mean age = 30 ± 6.20 years; range = 20—40 years; 53 women) were imaged by one examiner using an Optos OCT–SLO system. Choroidal morphologic and vascular parameters were subjectively assessed by one experienced rater.

Results: All the eyes had normal foveal contour and no retinal or choroidal abnormalities. The choroid was thicker sub foveally than 750 µm nasally and temporally in all cases. Regression analysis indicated strong negative correlation between age and subfoveal choroidal thickness (SFCT) (r= −0.81; P = 0.0001) and weak positive correlation between refractive error and SFCT (r = 0.10; P = 0.35). SFCT was greater in the female subjects (P = 0.04, paired t–test).

Conclusion: The subfoveal region is the thickest part of the choroid in healthy Saudi adults aged 20—40 years and is thicker in women. SFCT decreases by 5.54 µm per year of age and 1.58 µm per diopter increase in myopia.

Keywords: Subfoveal choroidal thickness; Choriocapillaris; Optical coherence tomography; Refractive error; age; Gender


OCT: Optical Coherence Tomography; SLO: Scanning Laser Ophthalmoscopy; CT: Choroidal Thickness; SFCT: Sub Foveal Choroidal Thickness; CVL: Choroidal Vessel Layer; CCT: Chorio Capillaris Thickness; RPE: Retinal Pigment Epithelium.


The choroid is a vascular pigmented tissue that extends from the ora serrata to the optic nerve. It plays an important role in most of the ocular blood supply and oxygen and nutrition distribution to the outer retinal layers [1]. Any disturbance in choroidal blood flow may lead to photoreceptor dysfunction and death. Several reports have described choroidal morphology of normal American [2,3], Japanese [4], Chinese [5], and Danish [6] populations. Assessment of the choroid in normal eyes would provide clinically relevant information on the effects of factors such as age and refractive error as well pathophysiologic conditions such as glaucoma, diabetic retinopathy, and age–related macular degeneration [7].

Indocyanine green angiography allows visualization of choroidal vessels and blood flow below the retinal pigment epithelium (RPE) from the posterior pole to the periphery as well as the vortex veins [8,9]. Laser Doppler flow metry is a noninvasive method for measuring hemodynamic parameters of the optic nerve head, iris, and subfoveal choroidal circulation [10,11]. However, these methods do not provide three–dimensional (3D) anatomic information on the RPE and choroid [2,12]. Recent reports have described examination and measurement of choroidal thickness in normal and pathologic states by spectral–domain optical coherence tomography (OCT), despite the choroid’s posterior location and presence of pigmented cells in the RPE that attenuate incident light [2,12]. The aim of this study was to assess choroidal morphology and vasculature in healthy young Saudi adults by spectral–domain OCT imaging with confocal canning laser ophthalmoscopy (SLO).

Subjects and Methods

Study design

This prospective study was conducted at Elite Medical & Surgical Centre in Riyadh, Saudi Arabia between September and December 2013. It adhered to the tenets of the 2008 Declaration of Helsinki, and the study protocol was approved by the research ethics review board of the College of Applied Medicine Sciences of King Saud University. Written consent was obtained from each participant after the purpose of the study was explained.

One hundred ten consecutive healthy adults (53 women) wererecruited. The exclusion criteria were existing ocular disease (e.g., corneal anomalies, cataract, glaucoma, retinopathy, or retinitis pigmentosa), prior intraocular surgery, intraocular pressure of ≥21 mmHg, and myopia or hyperopia with spherical equivalent more than 6.00 diopters [3]. Those with systemic disease (e.g., diabetes mellitus or hypertension) and taking any medication were also excluded. Comprehensive examinations were conducted by using a slit lamp. Spherical and cylindrical refractions and intraocular pressure were determined by auto refractometry (Auto Kerato–Refracto–Tonometer TRK–1P; Topcon Corporation, Tokyo, Japan).