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Vujosevic, Stela MD*; Martini, Ferdinando MD; Cavarzeran, Fabiano SCD*; Pilotto, Elisabetta MD; Midena, Edoardo MD*,†

doi: 10.1097/IAE.0b013e31825db73d
Original Study

Purpose: To investigate macular and peripapillary choroidal thickness (CT) in diabetic patients with and without diabetic retinopathy (DR).

Methods: One hundred and fifty subjects were enrolled: 102 diabetic patients (102 eyes) and 48 normals, as controls. Exclusion criteria were previously treated DR, refractive error higher than ±3 diopters, and treated or untreated glaucoma. All patients underwent full ophthalmic examination, stereoscopic color fundus photography, and spectral domain optical coherence tomography (RS-3000; Nidek). Spectral domain optical coherence tomography examination consisted of linear scans, 6 mm in length, centered onto the fovea, and circle scan positioned around the optic disk (3.46 mm in diameter). Choroidal thickness was measured manually at the fovea and at 1, 2, and 3 mm distance along all scans in the macula. Peripapillary CT was measured at eight points along the circle scan. All measurements were performed independently by 2 masked graders.

Results: Mean age was not significantly different between patients with diabetes and controls. In the macular area, CT was significantly lower in the nasal quadrant versus all other quadrants (P < 0.0001), in both groups. In the peripapillary area, CT was significantly lower in the inferior quadrant versus all other quadrants (P < 0.05), in both groups. Mean macular and peripapillary CT progressively and significantly decreased with increasing level of DR (nonproliferative and proliferative DR vs. controls, P < 0.05). No significant CT difference was found between controls and diabetic eyes without detectable DR. Diabetic macular edema did not influence CT. Interobserver coefficient of repeatability was 28.8 (95% confidence interval, 24.8–32.8) for foveal measurements and 13.0 (95% confidence interval, 11.2–14.8) for peripapillary measurements. Pearson correlation coefficient was 0.99, and P <0.0001 for all measurements.

Conclusion: Choroidal thickness is reduced in diabetic eyes and parallels appearance and evolution of DR. Spectral domain optical coherence tomography clearly confirms in vivo previously reported histopathologic observations. The role of choroid in the pathophysiology of DR needs to be adequately investigated.

In patients with diabetes, choroidal thickness (both macular and peripapillary) progressively decreases with increasing level of diabetic retinopathy with specific patterns. Peripapillary choroidal thickness is significantly thinner than macular choroidal thickness. The role of choroid in the pathophysiology of diabetic retinopathy should be investigated using spectral domain optical coherence tomography.

*Fondazione G. B. Bietti, IRCCS, Roma, Italy

Department of Ophthalmology University of Padova, Padova, Italy.

Reprint requests: Edoardo Midena, MD, Department of Ophthalmology, University of Padova, 35128 Padova, Italy; e-mail:

There is no conflicting relationship and no conflict of interest.

© The Ophthalmic Communications Society, Inc.