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Quantitative OCT angiography of the retinal microvasculature and choriocapillaris in highly myopic eyes with myopic macular degeneration
  1. Feihui Zheng1,2,
  2. Jacqueline Chua1,2,3,
  3. Mengyuan Ke1,2,
  4. Bingyao Tan1,2,4,
  5. Marco Yu1,
  6. Qinglan Hu1,2,
  7. Chui Ming Gemmy Cheung1,3,
  8. Marcus Ang1,3,
  9. Shu Yen Lee1,3,
  10. Tien Yin Wong1,3,
  11. SNEC Retina Group1,3,
  12. Leopold Schmetterer1,2,4,5,6,7,
  13. Chee Wai Wong1,3,
  14. Quan V Hoang1,3,8
    1. 1 Singapore Eye Research Institute, Singapore National Eye Center, Singapore
    2. 2 SERI-NTU Advanced Ocular Engineering (STANCE), Singapore
    3. 3 Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, National University of Singapore, Singapore
    4. 4 Institute for Health Technologies, Nanyang Technological University, Singapore
    5. 5 Department of Clinical Pharmacology, Medical University Vienna, Vienna, Austria
    6. 6 Center for Medical Physics and Biomedical Engineering, Medical University Vienna, Vienna, Austria
    7. 7 Institute of Molecular and Clinical Ophthalmology, Basel, Switzerland
    8. 8 Department of Ophthalmology, Columbia University Medical Center, New York City, New York, USA
    1. Correspondence to Dr Chee Wai Wong, Singapore National Eye Centre, Singapore, Singapore; wong.chee.wai{at}


    Purpose To quantify retinal and choriocapillaris (CC) microvasculature in highly myopic (HM) eyes with myopic macular degeneration (MMD) using swept-source optical coherence tomography angiography (SS-OCTA).

    Methods 162 HM eyes (spherical equivalent ≤ −6.0 dioptres or axial length (AL) ≥26.5 mm) from 98 participants were enrolled, including 60 eyes (37.0%) with tessellated fundus, 54 eyes (33.3%) with peripapillary diffuse chorioretinal atrophy (PDCA), 27 eyes (16.7%) with macular diffuse chorioretinal atrophy (MDCA) and 21 eyes (13.0%) with patchy or macular atrophy. PLEX Elite 9000 SS-OCTA was performed to obtain perfusion densities (PD) of the superficial and deep retinal capillary plexus, and CC signal voids (number, area and density).

    Results Retinal PD decreased with increasing severity of MMD. Multivariable analysis showed that after adjustment of age and other factors, retinal PD decreased significantly in eyes with longer AL (β≤−0.51, p<0.001) and with an MMD severity of MDCA or worse (β≤−1.63, p<0.001). Reduced retinal PD were significantly associated with worse vision (β≤−0.01, p≤0.04). In terms of CC signal voids, multivariable analysis showed that longer AL (p<0.001), but not MMD severity (p≥0.12) was significantly associated with CC signal void changes in the earliest stage of MMD.

    Conclusion We demonstrate significant OCTA alterations in the retina and CC in HM eyes with varying severities of MMD. In eyes with early-stage PDCA, lower retinal PD and more extensive CC signal voids are predominantly associated with increasing AL. In contrast, in eyes with MDCA or worse, MMD itself was associated with sparser retinal and CC circulation.

    • choroid
    • degeneration
    • imaging
    • macula
    • retina

    Data availability statement

    Data are available on reasonable request. High-resolution digital photographs and OCTA imagings were stored on the Singapore Eye Research Institute server. The corresponding author has full access to all the data in the study.

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    Data availability statement

    Data are available on reasonable request. High-resolution digital photographs and OCTA imagings were stored on the Singapore Eye Research Institute server. The corresponding author has full access to all the data in the study.

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    • CWW and QVH contributed equally.

    • Presented at This work was presented, in part, at the 2020 Macula Society Annual Meeting, San Diego, California.

    • Correction notice This article has been corrected since it first published. The provenance and peer review statement has been included.

    • Contributors FZ is the first author doing data analysis and writing the manuscript; JC supervised research rationals and manuscript writing; BT and MK performed image processing; MY assisted in statistics; QH helped with image quality check and extraction; CMGC, MA, SYL and the Retinal Group of SNEC conducted patient recruitment; TYW gave guidance on the study; LS gave guidance on the study and kindly offered the OCTA machine from his research funding; CWW and QVH are the PI of the study and contributed equally. All coauthors contributed to the writing of the manuscript.

    • Funding This work was supported in part by the Singhealth-Duke-NUS Eye Academic Clinical Programme Nurturing Clinician Scientist Scheme (NCSS/R1364/50/2016, CWW, Singapore, CG/C010A/2017; OFIRG/0048/2017; OFLCG/004c/2018; and TA/MOH-000249-00/2018), National Eye Institute/NIH K08 Grant (1 K08 EY023595, QVH, USA) and the National Medical Research Council (grant CSA-MOH-000151, QVH, Singapore).

    • Disclaimer The funding organisations had no role in the design or conduct of this research.

    • Competing interests None declared.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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