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Analysis of the pachychoroid phenotype in an Asian population: methodology and baseline study population characteristics
  1. Wendy Meihua Wong1,
  2. Wu Sun2,
  3. Chinmayi Vyas2,
  4. Angie Hon Chi Fong3,
  5. Caroline K Chee1,
  6. Xin Yi Su1,
  7. Kelvin YC Teo2,4,5,
  8. Chui Ming Gemmy Cheung2,4,5
  1. 1Ophthalmology, National University Hospital, Singapore
  2. 2Retina Research Group, Singapore Eye Research Institute, Singapore
  3. 3Ophthalmology, Hong Kong Eye Hospital, Hong Kong, Hong Kong
  4. 4Medical Retina, Singapore National Eye Centre, Singapore
  5. 5Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore
  1. Correspondence to Dr Chui Ming Gemmy Cheung, Singapore National Eye Centre, Singapore; gemmy.cheung.c.m{at}


Aim To describe the clinical characteristics in a cohort of patients with the pachychoroid phenotype and to evaluate the association of ocular and systemic factors with type of complications observed.

Methods We report baseline findings from a prospective observational study which recruited subjects with subfoveal choroidal thickness (SFCT) of ≥300 µm on spectral-domain optical coherence tomography (OCT). Multimodal imaging was used to classify eyes as uncomplicated pachychoroid (UP) or pachychoroid disease with pachychoroid pigment epitheliopathy (PPE), central serous chorioretinopathy (CSC) or pachychoroid neovasculopathy (PNV) subtypes.

Results Among 181 eyes of 109 participants (mean age 60.6 years, 33 (30.3%) female, 95 (7.2%) Chinese), 38 eyes (21.0%) had UP. Of 143 eyes (79.0%) with pachychoroid disease, 82 (45.3%), 41 (22.7%) and 20 (11.0%) had PPE, CSC and PNV, respectively. Addition of autofluorescence and OCT angiography to structural OCT led to reclassification of 31 eyes to a more severe category. Systemic and ocular factors evaluated, including SFCT, were not associated with disease severity. Comparison of PPE, CSC and PNV eyes showed no significant difference in OCT features of retinal pigment epithelial (RPE) dysfunction, but disruption of the ellipsoid zone (PPE 30.5% vs CSC 70.7% vs PNV 60%, p<0.001) and thinning of inner nuclear/inner plexiform layers (PPE 7.3% vs CSC 36.6% vs PNV 35%, p<0.001) were more frequent in CSC and PNV eyes.

Conclusions These cross-sectional associations suggest pachychoroid disease manifestations may reflect progressive decompensation from the choroid to the RPE then retinal layers. Planned follow-up of this cohort will be beneficial in clarifying the natural history of the pachychoroid phenotype.

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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  • Contributors Design of the study: CMGC, KYCT, CKC, XYS and WMW; collection of data: CMGC, KYCT, CKC, XYS, CV and WMW; analysis and interpretation of data: CMGC, KYCT, WS and WMW; writing the article: CMGC, KYCT, WMW, AHCF, WS and CV; critical revision of the article: CMGC and KYCT; final approval of the article: CMGC and KYCT. The Singapore Eye Research Institute accepts full responsibility for the finished work and/or the conduct of the study.

  • Funding This study was funded by National Medical Research Council Open Fund Large Collaborative Grant (NMRC/LCG/004/2018).

  • 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.