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Optical coherence tomography angiography for the assessment of choroidal vasculature in high myopia
  1. Kavya Devarajan1,
  2. Ralene Sim2,
  3. Jacqueline Chua1,3,
  4. Chee Wai Wong1,3,
  5. Saiko Matsumura1,
  6. Hla M Htoon1,3,
  7. Leopold Schmetterer1,3,4,5,6,
  8. Seang Mei Saw1,3,6,
  9. Marcus Ang1,3
  1. 1 Singapore Eye Research Institute, Singapore
  2. 2 Yong Loo Lin School of Medicine, National University of Singapore, Singapore
  3. 3 Department of Ophthalmology and Visual Sciences, Duke-National University of Singapore, Singapore
  4. 4 Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria
  5. 5 Nanyang Technological University, Singapore
  6. 6 Saw Swee Hock School of Public Health, NUS, Singapore
  1. Correspondence to Dr Marcus Ang, Singapore National Eye Centre, Singapore 168751, Singapore; marcus.ang{at}


Aims To assess specific layers of the choroid in highly myopic young adults and to examine their associations with levels of myopia.

Methods We recruited 51 young myopes (n=91 eyes) from the Singapore Cohort of Risk Factors for Myopia cohort. We performed standardised optical coherence tomography (OCT) and OCT angiography imaging and developed a novel segmentation technique assessing choroidal layers’ thickness (overall choroidal thickness (CT), medium-vessel choroidal layer (MVCL) thickness, large-vessel choroidal layer (LVCL)) and vasculature (choroidal vessel density (%), choroidal branch area (CBA, %) and mean choroidal vessel width (MCVW, mm)).

Results We found that eyes with extreme myopia (EM) had thinner vascular layers compared with high myopia (HM), that is, LVCL (36.0±1.5 vs 39.2±1.2 µm, p=0.002) and MVCL (185.5±5.7 vs 198.2±4.6 µm, p=0.014). Overall CT was thinnest in the nasal and inferior quadrants in EM (nasal: 157.1±9.6 vs 187.2±8.3 µm, p<0.001; superior: 236.6±11.1 vs 257.0±9.5 µm, p=0.02; temporal: 228.0±10.6 vs 254.3±8.8 µm, p=0.012; and inferior quadrant: 198.7±10.0 vs 239.8±8.3 µm, p=<0.001) when compared with HM. We also observed significantly more vessel branching in eyes with EM as compared with eyes with HM (CBA, 10.2%±0.7% vs 9.95%±0.8%, p=0.018).

Conclusions The novel segmentation technique and introduced choroidal parameters may serve as new biomarkers to study disease conditions in myopia.

  • imaging
  • choroid
  • diagnostic tests/investigation
  • vision
  • epidemiology

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  • Contributors MA, KD and RS performed and validated the method of segmentation. KD performed the image processing. KD and RS analysed the results. HMH performed the statistical analysis. MA and SMS coordinated the project and handled the funding. KD drafted the main manuscript text and prepared all figures.

  • Funding This study was supported in part by Singapore National Eye Centre Health Research Endowment Fund grants JX0071, JX0072 and JX0073.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Approval given from the ethics committee of the Singapore Eye Research Institute.

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

  • Data availability statement Data are available upon request.

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