Enhanced Depth Imaging Optical Coherence Tomography of Choroidal Nevus in 104 Cases

doi:10.1016/j.ophtha.2011.11.001

Ophthalmology

Volume 119, Issue 5, May 2012, Pages 1066-1072

https://doi.org/10.1016/j.ophtha.2011.11.001 Get rights and content

Purpose

To describe the characteristics of choroidal nevus using the enhanced depth imaging (EDI) feature of spectral-domain optical coherence tomography (OCT).

Design

Retrospective, observational case series.

Participants

One hundred four eyes with choroidal nevus.

Methods

Spectral-domain EDI OCT was performed with a Heidelberg Spectralis HRA+OCT (Heidelberg Engineering, Heidelberg, Germany) using a custom scan acquisition protocol of up to 13 raster lines of 9-mm scan length with automatic real-time image averaging set at 100 images. The thickness of choroidal nevus was measured by combining Heidelberg's autosegmentation with manual segmentation.

Main Outcome Measures

Imaging features and thickness correlation of choroidal nevus by EDI OCT versus standard ultrasonography.

Results

Of 104 eyes with choroidal nevus imaged with EDI OCT, 51 (49%) displayed image detail suitable for study. The remaining 53 cases were suboptimal because of statistically identified factors of age older than 60 years (P = 0.027), female gender (P = 0.008), extramacular location of nevus (P<0.001), mean distance from foveola more than 3 mm (P = 0.002), mean distance from optic disc more than 4 mm (P<0.001), and mean maximal basal diameter more than 5 mm (P = 0.006). Of the 51 suitable cases, mean nevus thickness was 685 μm (median, 628 μm; range, 184–1643 μm) by EDI OCT compared with 1500 μm (median, 1500 μm; range, 1000–2700 μm) by ultrasonography. The most common EDI OCT imaging features included partial (59%) or complete (35%) choroidal shadowing deep to the nevus, choriocapillaris thinning overlying the nevus (94%), retinal pigment epithelial (RPE) atrophy (43%), RPE loss (14%), RPE nodularity (8%), photoreceptor loss (43%), inner segment–outer segment junction (IS–OS) irregularity (37%), IS–OS loss (6%), external limiting membrane irregularity (18%), outer nuclear and outer plexiform layer irregularity (8%), and inner nuclear layer irregularity (6%). Overlying subretinal fluid was identified by EDI OCT (16%), ophthalmoscopic examination (8%), and ultrasonographic evaluation (0%). A comparison of pigmented versus nonpigmented nevus showed only 1 significant difference of more intense choroidal shadowing with pigmented nevus (P = 0.046).

Conclusions

Imaging of choroidal nevus with EDI OCT enables precise measurement of tumor thickness with comparatively reduced thickness relative to ultrasonography. Using EDI OCT, 94% of choroidal nevi were found to have overlying choriocapillaris thinning.

Financial Disclosure(s)

The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Section snippets

Patients and Methods

This was a retrospective, observational study, approved by the institutional review board, designed to describe the characteristics of choroidal nevus (thickness ≤3 mm) using the EDI OCT technique. In addition to complete eye examination with dilated pupil, digital fundus photography, fundus autofluorescence, and ultrasonography, all patients diagnosed with choroidal nevus over a 6-month period from August 1, 2010, to January 31, 2011, at the Ocular Oncology Service, Wills Eye Institute,

Results

Of 104 choroidal nevi in 103 patients who underwent EDI OCT imaging over a 6-month period, the quality of the image was judged to be optimal in 51 (49%) and suboptimal in 53 (51%). The clinical factors responsible for image quality (optimal, suboptimal) were investigated statistically using the Student's t test and the chi-square test and are summarized in Table 1. Older age, female gender, extramacular location, greater distance of the margin of the nevus from the foveola and from the disc,

Discussion

Optical coherence tomography is a valuable tool for assessment of the status of the overlying retina and RPE with choroidal tumors.¹¹ Previous studies using time-domain (TD) OCT for evaluation of choroidal nevus have reported findings limited to the retina with little choroidal detail resulting from poor resolution of TD OCT for choroidal structures.12, 13 Schaudig et al¹⁴ recognized these limitations and suggested that OCT was of little value in the differential diagnosis of choroidal tumors.

References (20)

R.F. Spaide et al.
Enhanced depth imaging spectral-domain optical coherence tomography
Am J Ophthalmol
(2008)
R. Margolis et al.
A pilot study of enhanced depth imaging optical coherence tomography of the choroid in normal eyes
Am J Ophthalmol
(2009)
R.F. Spaide
Enhanced depth imaging optical coherence tomography of retinal pigment epithelial detachment in age-related macular degeneration
Am J Ophthalmol
(2009)
T. Fujiwara et al.
Enhanced depth imaging optical coherence tomography of the choroid in highly myopic eyes
Am J Ophthalmol
(2009)
Y. Imamura et al.
Enhanced depth imaging optical coherence tomography of the sclera in dome-shaped macula
Am J Ophthalmol
(2011)
S.E. Chung et al.
Choroidal thickness in polypoidal choroidal vasculopathy and exudative age-related macular degeneration
Ophthalmology
(2011)
G. Espinoza et al.
Optical coherence tomography in the evaluation of retinal changes associated with suspicious choroidal melanocytic tumors
Am J Ophthalmol
(2004)
L.M. Sakata et al.
Optical coherence tomography of the retina and optic nerve—a review
Clin Experiment Ophthalmol
(2009)
Y. Imamura et al.
Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy
Retina
(2009)
I. Maruko et al.
Subfoveal choroidal thickness after treatment of Vogt-Koyanagi-Harada disease
Retina
(2011)

There are more references available in the full text version of this article.

Cited by (91)

Choriocapillaris: Fundamentals and advancements
2022, Progress in Retinal and Eye Research
The choriocapillaris is the innermost structure of the choroid that directly nourishes the retinal pigment epithelium and photoreceptors. This article provides an overview of its hemovasculogenesis development to achieve its final architecture as a lobular vasculature, and also summarizes the current histological and molecular knowledge about choriocapillaris and its dysfunction. After describing the existing state-of-the-art tools to image the choriocapillaris, we report the findings in the choriocapillaris encountered in the most frequent retinochoroidal diseases including vascular diseases, inflammatory diseases, myopia, pachychoroid disease spectrum disorders, and glaucoma. The final section focuses on the development of imaging technology to optimize visualization of the choriocapillaris as well as current treatments of retinochoroidal disorders that specifically target the choriocapillaris. We conclude the article with pertinent unanswered questions and future directions in research for the choriocapillaris.
Retinal applications of swept source optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA)
2021, Progress in Retinal and Eye Research
The advent of optical coherence tomography (OCT) revolutionized both clinical assessment and research of vitreoretinal conditions. Since then, extraordinary advances have been made in this imaging technology, including the relatively recent development of swept-source OCT (SS-OCT). SS-OCT enables a fast scan rate and utilizes a tunable swept laser, thus enabling the incorporation of longer wavelengths than conventional spectral-domain devices. These features enable imaging of larger areas with reduced motion artifact, and a better visualization of the choroidal vasculature, respectively. Building on the principles of OCT, swept-source OCT has also been applied to OCT angiography (SS-OCTA), thus enabling a non-invasive in depth-resolved imaging of the retinal and choroidal microvasculature. Despite their advantages, the widespread use of SS-OCT and SS-OCTA remains relatively limited.
In this review, we summarize the technical details, advantages and limitations of SS-OCT and SS-OCTA, with a particular emphasis on their relevance for the study of retinal conditions. Additionally, we comprehensively review relevant studies performed to date to the study of retinal health and disease, and highlight current gaps in knowledge and opportunities to take advantage of swept source technology to improve our current understanding of many medical and surgical chorioretinal conditions. We anticipate that SS-OCT and SS-OCTA will continue to evolve rapidly, contributing to a paradigm shift to more widespread adoption of new imaging technology to clinical practice.
Choriocapillaris Compression Correlates with Choroidal Nevus–Associated Subretinal Fluid: OCT Analysis of 3431 Cases
2020, Ophthalmology
Polarization-Diversity Optical Coherence Tomography Assessment of Choroidal Nevi
2023, Investigative Ophthalmology and Visual Science
Is Tumour Thickness Measurement Required for MOLES Scoring of Melanocytic Choroidal Tumours?
2023, Ocular Oncology and Pathology
Ultrasound in ocular oncology: Technical advances, clinical applications, and limitations
2023, Experimental Biology and Medicine

View all citing articles on Scopus

: Manuscript no. 2011-1003.

: Financial Disclosure(s): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

: Supported by Eye Tumor Research Foundation, Philadelphia, Pennsylvania (CLS, JAS). The funders had no role in the design and conduct of the study; in the collection, analysis, or interpretation of the data; or in the preparation, review, or approval of the manuscript. Carol L. Shields, MD, has had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

View full text

Original articleEnhanced Depth Imaging Optical Coherence Tomography of Choroidal Nevus in 104 Cases

Purpose

Design

Participants

Methods

Main Outcome Measures

Results

Conclusions

Financial Disclosure(s)

Section snippets

Patients and Methods

Results

Discussion

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Am J Ophthalmol

Optical coherence tomography of the retina and optic nerve—a review

Clin Experiment Ophthalmol

Enhanced depth imaging optical coherence tomography of the choroid in central serous chorioretinopathy

Retina

Subfoveal choroidal thickness after treatment of Vogt-Koyanagi-Harada disease

Retina

Original article
Enhanced Depth Imaging Optical Coherence Tomography of Choroidal Nevus in 104 Cases