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Wide-field swept-source optical coherence tomography angiography in the assessment of retinal microvasculature and choroidal thickness in patients with myopia
  1. Jade Y. Moon1,2,
  2. Itika Garg1,2,
  3. Ying Cui2,3,
  4. Raviv Katz1,2,
  5. Ying Zhu2,4,
  6. Rongrong Le2,5,
  7. Yifan Lu1,2,
  8. Edward S. Lu1,2,
  9. Cassie A. Ludwig1,
  10. Tobias Elze6,
  11. David M. Wu1,
  12. Dean Eliott1,
  13. Joan W. Miller1,
  14. Leo A. Kim1,6,
  15. Deeba Husain1,
  16. Demetrios G. Vavvas1,
  17. John B. Miller1,2
  1. 1 Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
  2. 2 Harvard Retinal Imaging Lab, Boston, Massachusetts, USA
  3. 3 Guangdong Eye Institute, Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China
  4. 4 Eye Center of Xiangya Hospital, Central South University, Changsha, Hunan, People's Republic of China
  5. 5 Wenzhou Medical University affiliated Eye Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, People's Republic of China
  6. 6 Schepens Eye Research Institute of Massachusetts Eye and Ear, Boston, MA, USA
  1. Correspondence to Dr. John B. Miller, Harvard Medical School, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA; john_miller{at}


Background/aims Pathological myopia (PM) is a leading cause of blindness worldwide. We aimed to evaluate microvascular and chorioretinal changes in different stages of myopia with wide-field (WF) swept-source (SS) optical coherence tomography angiography (OCTA).

Methods This prospective cross-sectional observational study included 186 eyes of 122 patients who had undergone imaging between November 2018 and October 2020. Vessel density (VD) and vessel skeletonised density (VSD) of superficial capillary plexus, deep capillary plexus and whole retina, as well as foveal avascular zone parameters, retinal thickness (RT) and choroidal thickness (CT), were calculated.

Results This study evaluated 75 eyes of 48 patients with high myopia (HM), 43 eyes of 31 patients with mild to moderate myopia and 68 eyes of 53 age-matched controls. Controlling for age and the presence of systemic hypertension, we found that HM was associated with decrease in VD and VSD in all layers on 12×12 mm² scans. Furthermore, HM was associated with a VD and VSD decrease in every Early Treatment Diabetic Retinopathy Study grid, with a larger decrease temporally (βVD=−0.39, βVSD=−10.25, p<0.01). HM was associated with decreased RT and CT. Reduction in RT was outside the macular region, while reduction in CT was in the macular region.

Conclusion Using WF SS-OCTA, we identified reduction in microvasculature and structural changes associated with myopia. Decrease in VD and VSD was greater in the temporal quadrant, and reductions in RT and CT were uneven across the retina. Further work may help identify risk factors for the progression of PM and associated vision-threatening complications.

  • retina
  • imaging
  • optics and refraction

Data availability statement

Data are available upon reasonable request. Deidentified participant data used in this study could be shared upon reasonable request sent to the corresponding author.

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Data availability statement

Data are available upon reasonable request. Deidentified participant data used in this study could be shared upon reasonable request sent to the corresponding author.

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  • JYM and IG are joint first authors.

  • Twitter @itikagarg, @

  • JYM and IG contributed equally.

  • Presented at The work from this manuscript has been presented (paper) at The Association for Research in Vision and Ophthalmology (ARVO) Meeting,1–7 May 2021, and accepted for an on-demand presentation at the American Society of Retina Specialists (ASRS) Meeting, 8-12 October 2021.

  • Contributors Concept and design: JBM, IG, JYM, and YC; acquisition, analysis or interpretation of data: JYM, IG, YC, RK, YZ, RL, YL, EL and TE; drafting of the manuscript: JYM and IG; critical revision of the manuscript for important intellectual content: YC, EL, CAL, DW, DE, JWM, LK, DH, DV and JBM; statistical analysis: IG and JYM; obtained funding: JBM; supervision: JBM.

  • Funding This research was funded by the Lions International Fund (Grant 530125 and 530869). The funding organization had no role in design or conduct of this research.

  • Competing interests DMW holds a patent through Massachusetts Eye and Ear (MEE). DE is a consultant for Alcon, Allergan, Dutch Ophthalmic, Glaukos and Alderya Therapeutics. He has a financial relationship with Alderya Therapeutics and Pykus Therapeutics and has received financial support from Neurotech Pharmaceuticals. JWM is a consultant for Heidelberg Engineering, Genetech/Roche, Sunovion, KalVista Pharmaceuticals and ONL Therapeutics. She holds a patent through and has received financial support from ONL, Valeant Pharmaceuticals/MEE and has received financial support from Lowy Medical Research Institute, Ltd. She holds a non-remunerative position at Drusolv Therapeutics. LAK has received financial support from National Eye Institute and CureVac AG and has financial arrangement with Pykus Therapeutics. DH is a consultant for Allergan, Genetech and Omeicos Ophthalmics. She has received financial support from Lions VisionGift, Commonwealth Grant and the Macular Society. DGV is a consultant for Valitor, Olix Pharmaceuticals and has received financial support from National Eye Institute, Research to Prevent Blindness, Loefflers Family Foundation, Yeatts Family Foundation and Alcon Research Institute. JBM is a consultant for Alcon, Allergan, Carl Zeiss, Sunovion and Genentech.

  • 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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