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Peripheral extent of the choroidal circulation by ultra-widefield indocyanine green angiography in healthy eyes
  1. Aditya Verma1,2,
  2. Jyotsna Maram1,
  3. Ahmed Roshdy Alagorie1,2,3,
  4. Jano van Hemert4,
  5. Darren J Bell6,
  6. Michael Singer5,
  7. Dana Keane4,
  8. Jessica Carnevale4,
  9. Muneeswar Nittala1,
  10. SriniVas Sadda1,2
  1. 1 Doheny Eye Institute, Los Angeles, California, USA
  2. 2 Ophthalmology, David Geffen School of Medicine, Los Angeles, California, USA
  3. 3 Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
  4. 4 Optos Plc, Dunfermline, UK
  5. 5 Ophthalmology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
  6. 6 Medical Center Ophthalmology Associates, San Antonio, Texas, USA
  1. Correspondence to SriniVas Sadda, 1355 San Pablo Street, Suite 211, Los Angeles, CA, USA, 90033;SSadda{at}


Aim To analyse the peripheral extent of choroidal circulation using ultra-widefield (UWF) indocyanine green angiography (ICGA) in healthy eyes.

Methods UWF ICGA images of 55 eyes of 36 healthy subjects were captured using the Optos California (Optos, Dunfermline, United Kingdom) in this prospective observational study. Images were analysed to locate the peripheral extent of the visible choroidal circulation, and the boundary was marked in ImageJ (v1.52). Each pixel annotated as the border of the choroidal circulation was projected individually to its anatomically correct location on the three-dimensional model eye, and spherical trigonometry was applied (using the Optos software) to calculate its respective radial distance from the centre of the optic disc in metric units (corrected by stereographic projection) for each quadrant.

Results The mean area of the peripheral extent was estimated to be 893.2 mm2 (95% CI: 844.2 to 942.3 mm2). The mean distance (range) of this boundary from optic nerve centre was 18.22 mm (95% CI: 14.0 to 23.14 mm). Multiple regression analysis with age, gender, axial length or ethnicity showed no relationship. There was excellent inter-grader reproducibility, with intraclass correlation coefficients of 0.95 (95% CI: 0.80 to 0.99, p<0.001) for distance and 0.99 (95% CI: 0.988 to 0.999, p<0.001) for area measurements.

Conclusions The peripheral choroidal boundary may be defined using UWF ICGA. Knowledge of the normal extent and its variability is essential to understand the impact of disease on the choroidal vasculature.

  • Imaging
  • Anatomy
  • Choroid

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  • A portion of this manuscript was presented as a poster in ARVO 2019.

  • Twitter Michael Singer.

  • Contributors All the authors have contributed equally and substantially to the following: conception or design of the work, the acquisition, analysis and interpretation of data; drafting the work and revisions required; final approval of the version published.

  • Funding Funding for this clinical study was provided by Optos. No conflicting relationship exists for any author.

  • Competing interests AV, JM, ARA: none; JvH: Optos (E); DB: Allegro, Apellis, Novartis, Allergan, Genentech, Regeneron, Optos, Santen, Senju, Clearside; MS: Allergan, Regeneron, Novartis, Optos, Spark, Allegro, Appellis, Santen, Clearside, Opthea, Kalvista, Kodiak, Aerie,Greybug; DK, JC: Optos (E); MNG: none; SRS: Allergan (C, F), Carl Zeiss Meditec (C,F), Centervue (C), Genentech (C, F), Heidelberg Engineering (C), Iconic (C), NightstarX (C), Novartis (C), Optos (C,F), Oxurion(C), Topcon (C).

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

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