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Evaluation of choroidal lesions with swept-source optical coherence tomography
  1. Cindy Ung1,
  2. Inês Laíns1,2,
  3. Rebecca F Silverman1,
  4. Russell Woods3,
  5. Anne Marie Lane1,
  6. Thanos D Papakostas1,
  7. Deeba Husain1,
  8. Joan W Miller1,
  9. Evangelos S Gragoudas1,
  10. Ivana K Kim1,
  11. John B Miller1
  1. 1 Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts, USA
  2. 2 Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  3. 3 Department of Ophthalmology, Harvard Medical School, Schepens Eye Research Institute, Boston, Massachusetts, USA
  1. Correspondence to Dr John B Miller, Retina Service, Massachusetts Eye and Ear, Department of Ophthalmology, Harvard Medical School, Boston, MA 02114, USA; john_miller{at}


Aims The aim of our study was to image choroidal lesions with swept-source optical coherence tomography (SS-OCT) and to identify the morphological characteristics associated with optimal visualisation.

Methods This was a prospective, cross-sectional study. Patients with choroidal melanocytic lesions <3 mm in thickness on B-scan ultrasonography were recruited. All participants underwent SS-OCT. On SS-OCT we evaluated qualitative (eg, lesion outline, detection of scleral-choroidal interface and quality of the image) and quantitative (measurement of maximum lesion thickness and the largest basal diameter) parameters. Probability of optimal image quality was examined using ordered logistic regression models. The main outcome measure was quality of the choroidal lesion images on SS-OCT, defined as: optimal, suboptimal or poor.

Results We included 85 choroidal lesions of 82 patients. There were 24 choroidal lesions (29%) for which image quality was classified as optimal, 31 lesions (37%) as suboptimal and 30 lesions (36%) as poor. The factors associated with optimal image quality were distance closer to the fovea (OR 0.76, p<0.001), posterior pole location (OR 3.87, p=0.05), lower ultrasonography thickness (OR 0.44, p=0.04), lighter lesion pigmentation (OR 0.12, p=0.003) and smaller lesion diameter (OR 0.73, p<0.001). In the multivariable analysis, closer distance to the fovea (OR 0.81, p=0.005), lighter lesion pigmentation (OR 0.11, p=0.01) and smaller lesion diameter (OR 0.76, p=0.006) remained statistically significant.

Conclusion SS-OCT is useful in imaging most choroidal melanocytic lesions. Image quality is best when the choroidal lesion is closer to the fovea, has a smaller diameter and a lighter choroidal pigmentation.

  • imaging
  • choroid
  • retina
  • neoplasia

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  • CU and IL contributed equally.

  • Contributors IL, A-ML, DH, JWM, EG, IKK and JBM were responsible for the conception and design of this research project, as well as for obtaining the required institutional review board approval. CU, IL, RFS, A-ML, TDP, DH, JWM, EG, IKK and JBM were responsible for data collection. CU, IL, RFS, RW, TDP, JBM were responsible for images and data analysis. CU and IL drafted the manuscript, and all authors critically commented on and approved the final submitted version of the paper.

  • Funding The Miller Retina Research Fund (Mass. Eye and Ear); the Miller Champalimaud Vision Award (Mass. Eye and Ear) (to JWM); Portuguese Foundation for Science and Technology/Harvard Medical School Portugal Programme (HMSP-ICJ/006/2013) (to IL); Ronald G. Michels Foundation (to TDP).

  • Competing interests IL receives travel expenses from Allergan. IKK: Consultant to Allergan, Alcon, Genentech and Iconic Therapeutics. JWM: Consultant to Alcon Research Institute, KalVista Pharmaceuticals Ltd, Maculogix Inc; Patent with ONL Therapeutics LLC, Royalties from Valeant Pharmaceuticals. JBM: Consultant to Allergan. The following authors have no financial disclosures: CU, RFS, RW, AML, TDP, DH, ESG.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval The protocol adhered to the tenets of the declaration of Helsinki, complied with the Health Insurance Portability and Accountability Act, and was approved by the Massachusetts Eye and Ear Institutional Review Board.

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

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