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Characterisation of choroidal morphological and vascular features in diabetes and diabetic retinopathy
  1. Preeti Gupta1,2,
  2. Sri Gowtham Thakku1,2,
  3. Charumathi Sabanayagam1,2,3,
  4. Gavin Tan1,2,3,
  5. Rupesh Agrawal1,4,5,
  6. Chui Ming Gemmy Cheung1,2,3,
  7. Ecosse L Lamoureux1,2,3,
  8. Tien-Yin Wong1,2,3,
  9. Ching-Yu Cheng1,2,3
  1. 1Singapore Eye Research Institute and Singapore National Eye Centre, Singapore, Singapore
  2. 2Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
  3. 3Duke-NUS Medical School, Singapore, Singapore
  4. 4Tan Tock Seng Hospital, Singapore
  5. 5School of Material Science and Engineering, Nanyang Technological University, Singapore
  1. Correspondence to Dr Cheng-Yu Cheng, Academic Medicine Research Institute, Duke-NUS Medical School, Head, Ocular Epidemiology Research Group & Statistics Unit, Singapore Eye Research Institute, 20 College Road, The Academia, Level 6, Discovery Tower, Singapore 169856, Singapore; chingyu.cheng{at}


Aim We aimed to characterise specific morphological and vascular features of the choroid in Indian adults with diabetes and diabetic retinopathy (DR).

Methods Consecutive participants from the Singapore Indian Eye Study's 6-year follow-up examination underwent choroidal imaging using spectral domain optical coherence tomography (OCT) with enhanced depth imaging. Raw OCT images were loaded on a custom-written application on MATLAB that enabled delineation for detailed morphological and vascular analyses. Multiple linear regression analyses were performed to assess differences in choroidal characteristics by diabetes DR.

Results Of the 462 recruited participants, 273 had no diabetes (mean age was 60.1±6.8 years), 100 had diabetes but no DR (61.8±7.4 years) and 89 had DR (62.4±6.0 years). In multiple regression analysis, after accounting for relevant confounders, compared with those without diabetes, participants with diabetes had significantly thinner mean choroidal thickness (CT; mean difference (MD)=−25.19 µm, p=0.001), smaller choroidal volume (MD=−0.23 mm3, p=0.003), more inflection points (MD=1.78, p<0.001) and lesser choroidal vascular area within the foveal (MD=−0.024 mm2, p=0.001) and macular (MD=−0.095 mm2, p<0.001) regions. Among the diabetic group, subjects with DR had significantly thicker mean CT (MD=25.91 µm, p=0.001), greater choroidal volume (MD=0.24 mm3, p=0.009), lesser inflection points (MD=−0.478, p=0.045) and greater choroidal vascular area at foveal (MD=0.016 mm2, p=0.019) and macular (MD=0.057 mm2, p=0.016) regions, compared with those without DR.

Conclusions Choroidal morphology and vasculature were altered in Indian adults with diabetes and DR. These findings may provide insights into choroidal changes in diabetes and DR.

  • Choroid
  • Epidemiology
  • Imaging
  • Diagnostic tests/Investigation

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  • Correction notice This article has been corrected since it was published Online First. Rupesh Agrawal has been added to the author list and his affiliations and Contributions have been added to the paper.

  • Contributors PG and C-YC had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. CS and C-YC: study concept and design. All authors: acquisition, analysis or interpretation of data; critical revision of the manuscript for important intellectual content; and administrative, technical, or material support. PG, SGT and C-YC: drafting of the manuscript. PG and C-YC: statistical analysis. CS, T-YW and C-YC: obtained funding. C-YC: study supervision. RA: analysis of data and technical support.

  • Funding This study was supported by a grant from National Medical Research Council, Singapore [grant number NMRC/CIRG/1371/2013]. The sponsor or funding organisation had no role in the design or conduct of this research.

  • Competing interests CMGC: independent consultant for Bayer and Novartis; T-YW: received grant support from National Medical Research Council (NMRC) and Biomedical Research Council, Singapore directed to Singapore Eye Research Institute, Advisory Board member for Abbot, Novartis, Pfizer, Allergan, and Bayer, independent consultant for Abbot, Novartis, Pfizer, Allergan and Bayer; C-YC: received grant support from NMRC and Biomedical Research Council, Singapore directed to Singapore Eye Research Institute.

  • Patient consent Obtained.

  • Ethics approval SingHealth Centralised Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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