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Choriocapillaris and progressive ganglion cell-inner plexiform layer loss in non-glaucomatous eyes
  1. Weijing Cheng1,
  2. Wei Wang1,
  3. Yunhe Song1,
  4. Fengbin Lin1,
  5. Yongbo Duan2,
  6. Liu Xie3,
  7. Kai Jin4,
  8. Robert N Weinreb5,
  9. Xiulan Zhang1
  1. 1 Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-Sen University, Guangzhou, China
  2. 2 Southern Medical University, Guangzhou, Guangdong, China
  3. 3 Yiyang Central Hospital, Yiyang, Hunan Province, China
  4. 4 Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China
  5. 5 University of California San Diego, La Jolla, California, USA
  1. Correspondence to Professor Xiulan Zhang, Sun Yat-Sen University, Guangzhou, China; zhangxl2{at}; Dr Robert N Weinreb, Hamilton Glaucoma Center, Shiley Eye Institute, Viterbi Family Department of Ophthalmology, University of California, San Diego, California, USA; rweinreb{at}


Aims To explore the relationship between choriocapillaris (CC) flow deficit percentage (FD%) and ganglion cell-inner plexiform layer (GCIPL) thickness in a population-based sample of non-glaucomatous eyes.

Methods This is a longitudinal cohort study and prospective cross-sectional study. Non-glaucoma Chinese subjects aged 18 years or older were enrolled. All participants underwent a detailed ophthalmic examination, including swept-source optical coherence tomography (SS-OCT) and SS-OCT angiography. Average, inner average, outer average and nine Early Treatment Diabetic Retinopathy Study sub-regions of GCIPL thickness and CC FD% were measured. The correlation between CC FD% and GCIPL was assessed using a linear regression model, and the relationship between the rate of change of GCIPL thickness and CC FD% was further validated in a 2year longitudinal study.

Results In the cross-sectional study including 3514 participants (3514 non-glaucoma eyes), a higher CC FD% was significantly associated with a thinner GCIPL (β=−0.32; 95% CI −0.43 to –0.21; p<0.001). Further, in a longitudinal study (453 eyes of 453 participants), a faster increase in CC FD% was found to be significantly associated with a faster decrease in GCIPL thickness (β=−0.10; 95% CI –0.17 to –0.03; p=0.004) after adjusting for age, sex, axial length and image quality score.

Conclusions This is the first time to show that CC FD% and GCIPL thickness were correlated in both cross-sectional and longitudinal studies of non-glaucomatous individuals, which may potentially provide further insights on the role of CC perfusion in glaucoma development and progression.

  • imaging
  • retina
  • choroid
  • glaucoma
  • macula

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • WC and WW are joint first authors.

  • WC and WW contributed equally.

  • Contributors Data collection: WC, YD, LX, KJ; study design: WW, WC; statistical analysis: WW; image analysis and quality control: WC, YS, FL; preparation of the manuscript: WC and WW; manuscript drafting and revision: XZ and RNW. XZ is responsible for the overall content as guarantor.

  • Funding This research was supported by the High-level Hospital Construction Project, Zhongshan Ophthalmic Center, Sun Yat-sen University (303020104), the National Natural Science Foundation of China (82070955 and 82000901) and the Science and Technology Programme of Guangzhou, China. RNW is supported in part by an unrestricted grant from Research to Prevent Blindness (New York, NY) and EY029058 from the National Eye Institute.

  • Competing interests RNW has received instruments for research from Centervue, Heidelberg Engineering, Optovue. Topcon, and Zeiss-Meditec. He is a consultant for Topcon.

  • 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.