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Choroidal thickness and vascular density in macular telangiectasia type 2 using en face swept-source optical coherence tomography
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  • Published on: 23 October 2019
    Re: Choroidal Thickness in Macular Telangiectasia Type 2
    • Jay C Wang, Vitreoretinal Fellow Massachusetts Eye and Ear
    • Other Contributors:
      • Inês Laíns, Research Fellow
      • Patrick Oellers, Vitreoretinal Fellow
      • Ivana K Kim, Vitreoretinal Staff
      • Joan W Miller, Chair of Department of Ophthalmology
      • John B Miller, Vitreoretinal Staff

    Dear Editor,

    We appreciate the interest in our paper by Kumawat and Kumar, and the opportunity to address their comments. With regards to axial length, it is certainly known to be correlated with choroidal thickness. However, this information was not routinely obtained in our retina clinic and was not available for most patients in the study. We were able to account for spherical equivalent in our multivariate model, which may serve as a proxy for axial length. We agree that accounting for at least one of these variables is required for studies on choroidal thickness. We appreciate the Kumawat and Kumar’s suggestion to categorize patients based on stage of disease (proliferative vs nonproliferative). We had considered this approach, however the small number of patients with proliferative disease (only 4) made this less ideal from a statistical standpoint. Subretinal neovascularization was included in our univariate analysis but was not found to be statistically significant with regard to choroidal thickness, so it was not further considered in our multivariate assessments. Lastly, while inter-ocular asymmetry in choroidal thickness may exist, eye laterality was not found to be a significant variable affecting choroidal thickness in our univariate analysis (p = 0.87) and thus was also not included in multivariate models. We once again thank Dr. Kumawat and Dr. Kumar for their interest in our work.

    Conflict of Interest:
    None declared.
  • Published on: 23 October 2019
    Choroidal Thickness in Macular Telangiectasia Type 2
    • Devesh Kumawat, Senior Resident, Ophthalmology Dr Rajendra Prasad Centre for Ophthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
    • Other Contributors:
      • Vinod Kumar, Assistant Professor, Ophthalmology

    Editor,
    We read with great interest the article titled “Choroidal thickness and vascular density in macular telangiectasia type 2 using en face swept-source optical coherence tomography” by Wang et al.[1] This is an interesting study in which the authors performed multimodal imaging for the diagnosis of macular telangiectasia (MacTel) type 2 and reported similar choroidal thickness (CT) between MacTel type 2 and control eyes using swept-source optical coherence tomography (SS-OCT).[1]
    There are a few concerns that we would like to highlight. Although the authors control for confounders like age and spherical equivalent, axial length is another important confounder that has not been evaluated in this prospectively conducted study. The subfoveal CT has been reported to decrease by up to 58µm per one mm increase in the axial length after adjusting for age and sex.[2] Ignoring the axial length in choroidal thickness analysis may have untoward consequences.
    Although the number of cases was small (n=39 eyes), the stagewise distribution of CT may be of help. A recent study by Kumar et al. using SS-OCT reported different subfoveal CT in non-proliferative and proliferative stages of the disease, although the results were not statistically significant.[3] If a varied distribution is observed between different stages, this may support the role of the choroid in the pathophysiology of this disease.
    Inter-ocular asymmetry does exist in CT[4] as well as in the pr...

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    Conflict of Interest:
    None declared.