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Subfoveal choroidal thickness as a prognostic factor in exudative age-related macular degeneration
  1. Jaya B Kumar1,
  2. Karen M Wai2,
  3. Justin P Ehlers1,
  4. Rishi P Singh1,
  5. Aleksandra V Rachitskaya1
  1. 1 Cleveland Clinic Department of Ophthalmology, Cole Eye Institute, Cleveland, Ohio, USA
  2. 2 Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
  1. Correspondence to Dr Aleksandra V Rachitskaya, Cole Eye Institute, Cleveland Clinic Foundation, Cleveland, OH 44195, USA; rachita{at}


Aims To investigate the relationship between subfoveal choroidal thickness (SFCT), visual acuity (VA), optical coherence tomography (OCT) features and total anti-vascular endothelial growth factor (VEGF) treatments to determine whether SFCT serves as a prognostic factor in age-related macular degeneration (AMD).

Methods This is a retrospective case series of 62 consecutive treatment-naive patients with exudative AMD followed for 1 year and treated with treat-and-extend or pro re nata anti-VEGF protocols. SFCT was measured at three locations using Cirrus HD-OCT (the foveal centre and 500 um nasal and temporal to the fovea) at presentation, 3, 6 and 12 months. Demographic characteristics, OCT imaging biomarkers and VA were recorded.

Results Mean SFCT at baseline was 187 µm (range: 70–361 µm). There was a trend of decreasing SFCT at 1 year (173 µm) compared with 3 months (175 µm) and baseline (188 µm) (p=0.2). There was no correlation between baseline SFCT and presence of subretinal fluid (p=0.2), intraretinal fluid (p=0.6) or subretinal hyper-reflective material (p=0.4) at baseline. The mean number of injections at 1 year was 6.6 (range: 2–12). Increased SFCT at baseline showed statistically significant correlation with a higher number of intravitreal injections at 1 year (p=0.004). Eyes with SFCT>1 SD above the mean required 50% more injections compared with others. There was no association between SFCT on presentation with baseline and 1 year VA (p=0.7 and p=0.2).

Conclusions SFCT in naïve patients with exudative AMD may be an important prognostic tool in determining treatment burden. Patients with thicker subfoveal choroid may require increased intravitreal injections.

  • choroid
  • treatment Medical
  • macula

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  • Contributors Conception and design: JBK, AVR. Data analysis and interpretation: JBK, AVR. Data collection: JBK, KMW, JPE, RPS. Manuscript preparation: JBK. Manuscript review: AVR, JPE, RPS, KMW. Overall responsibility: AVR.

  • Funding This study was supported in part by an Unrestricted Grant from The Research to Prevent Blindness, Inc, awarded to the Cole Eye Institute.

  • Competing interests JBK and KMW report no financial disclosures. JPE reports grants from National Institutes of Health/National Eye Institute, grants from Ohio Department of Development, grants from Research to Prevent Blindness, during the conduct of the study; other from Bioptigen, grants and personal fees from Thrombogenic, personal fees from Leica, personal fees from Zeiss, grants and personal fees from Alcon, grants and personal fees from Genentech, grants from Regeneron, personal fees from Allergan, personal fees from Santen, personal fees from Roche, outside the submitted work. RPS reports grants and personal fees from Regeneron, grants and personal fees from Genentech/Roche, grants and personal fees from Alcon/Novartis, grants from Apellis, personal fees from Optos, personal fees from Zeiss and personal fees from Biogen. AVR is a consultant for Allergan and Zeiss.

  • Patient consent Not required.

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

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