Citation: Wong CW, Phua V, Lee SY, Wong TY, Cheung CMG. Is choroidal or scleral thickness related to myopic macular degeneration? Invest Ophthalmol Vis Sci. 2017;58:907-913. DOI:10.1167/iovs.16-20742 PURPOSE. The relative contribution of mechanical and vascular factors to the pathogenesis of myopic macular degeneration (MMD) is unclear. To address this gap, we examined the association of choroidal thickness (CT) and scleral thickness (ST) with MMD.METHODS. Prospective, clinic-based case series of 62 eyes of 41 patients with high myopia ( À6 diopters or axial length ‡26.5 mm). Swept-source optical coherence tomography (SSOCT) was performed to measure subfoveal CT and ST. Myopic macular degeneration was graded from fundus photographs according to the International Meta-Analysis for Pathologic Myopia (META-PM) classification. Presence of MMD was defined as META-PM category ‡ 2 and severe MMD was defined as category ‡ 3.RESULTS. The distribution of MMD severity was 15 (24.2%) in category 1, 28 (45.2%) in category 2, 10 (16.1%) in category 3, and 9 (14.5%) in category 4. Correlation of MMD severity was strong for subfoveal CT (r ¼ À0.70, P < 0.001) but weak for subfoveal ST (r ¼ À0.31, P ¼ 0.01). Subfoveal CT, but not ST, was independently associated with presence of MMD (age and gender adjusted odds ratio [OR] per 10 lm decrease in CT 1.41, P ¼ 0.002), and subfoveal CT, but not subfoveal ST, was significantly thinner in eyes with severe MMD ( ‡ category 3) than in eyes with mild MMD (CT: 31.5 6 40.5 lm versus 82.0 6 57.1 lm, P < 0.001; ST: 261.6 6 78.5 lm versus 297.0 6 73.8 lm, P ¼ 0.09). CONCLUSIONS.We demonstrated significant thinning of the choroid with increasing MMD severity. In contrast, ST was weakly correlated with MMD. These data suggest progressive loss of choroid may be important in the pathogenesis of MMD.

Diabetic retinopathy (DR), a leading cause of acquired vision loss, is a microvascular complication of diabetes. While traditional risk factors for diabetic retinopathy including longer duration of diabetes, poor blood glucose control, and dyslipidemia are helpful in stratifying patient's risk for developing retinopathy, many patients without these traditional risk factors develop DR; furthermore, there are persons with long diabetes duration who do not develop DR. Thus, identifying biomarkers to predict DR or to determine therapeutic response is important. A biomarker can be defined as a characteristic that is objectively measured and evaluated as an indicator of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. Incorporation of biomarkers into risk stratification of persons with diabetes would likely aid in early diagnosis and guide treatment methods for those with DR or with worsening DR. Systemic biomarkers of DR include serum measures including genomic, proteomic, and metabolomics biomarkers. Ocular biomarkers including tears and vitreous and retinal vascular structural changes have also been studied extensively to prognosticate the risk of DR development. The current studies on biomarkers are limited by the need for larger sample sizes, cross-validation in different populations and ethnic groups, and time-efficient and cost-effective analytical techniques. Future research is important to explore novel DR biomarkers that are non-invasive, rapid, economical, and accurate to help reduce the incidence and progression of DR in people with diabetes.

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