To subsegment the choroid in patients with polypoidal choroidal vasculopathy and to determine whether the ratio of choriocapillaris/Sattler layer thickness to total choroidal thickness is decreased at sites of polypoidal pathology. Retrospective, observational, cross-sectional study. A total of 320 eyes of 305 patients with polypoidal choroidal vasculopathy were studied with optical coherence tomography and dye angiography. The ratio of choriocapillaris/Sattler layer thickness to total choroidal thickness was calculated at polypoidal lesion sites in eyes with subfoveal choroidal thickness (SFCT) ≤200 μm. Mean SFCT was 267.7 ± 118.5 μm for the entire cohort. Mean SFCT was 151.2 ± 35.0 μm in eyes with SFCT ≤200 μm (n = 124, 39%). In this subgroup, dilated Haller vessels (pachyvessels) were identified under the site of neovascular ingrowth in 117 eyes (94%). Choroidal thickness in the pachyvessel zone was greater (213.3 ± 52.2 μm) than SFCT (P < 0.001) with a significantly lower choriocapillaris/Sattler layer to total thickness ratio (P < 0.001). Qualitative alterations of the retinal pigment epithelium were observed in 60 eyes (51%). Eyes with normal or subnormal SFCT exhibited extrafoveal choroidal thickening at sites of polypoidal disease. The choriocapillaris and Sattler layers were attenuated at these locations, but Haller vessels were markedly dilated. These changes were topographically associated with sites of neovascular ingrowth and support the classification of polypoidal choroidal vasculopathy as a pachychoroid disorder.

To study the repeatability and reproducibility of tear meniscus height (TMH) measurements obtained with a keratograph and Fourier domain optical coherence tomography (FD-OCT) and to assess their agreement in patients with dry eye. Sixty-four eyes with dry eye were analyzed by the Schirmer test, tear breakup time test, and fluorescein corneal staining. The TMH was measured 3 times using both devices by 2 different examiners. The repeatability and reproducibility of measurements were assessed by within-subject standard deviation (Sw), repeatability (2.77 Sw), coefficient of variation (CoV), and intraclass correlation coefficient. The TMH measured with the keratograph and FD-OCT was 0.232 ± 0.074 mm and 0.308 ± 0.129 mm, respectively (P < 0.01). A close correlation was found between the TMH measured with the keratograph and FD-OCT (r = 0.343). There was a negative correlation between the mean TMH and differences in the TMH measured with the keratograph and FD-OCT (r = 0.359). Both measurements correlated with the Schirmer test score, tear breakup time, and corneal staining score with P < 0.01. Intraexaminer CoV, 2.77 Sw, and intraclass correlation coefficient of the TMH were 0.986, respectively, and interexaminer CoV and 2.77 Sw were 5.58% and 0.039 mm, respectively. Although the TMH measured with the keratograph tended to be lower than that measured with FD-OCT, the TMH measured with the keratograph closely correlated with the TMH measured with FD-OCT and conventional tests and had good repeatability and reliability.

Aims Automatic identification of pachychoroid maybe used as an adjunctive method to confirm the condition and be of help in treatment for macular diseases. This study investigated the feasibility of classifying pachychoroid disease on ultra-widefield indocyanine green angiography (UWF ICGA) images using an automated machine-learning platform. Methods Two models were trained with a set including 783 UWF ICGA images of patients with pachychoroid (n=376) and non-pachychoroid (n=349) diseases using the AutoML Vision (Google). Pachychoroid was confirmed using quantitative and qualitative choroidal morphology on multimodal imaging by two retina specialists. Model 1 used the original and Model 2 used images of the left eye horizontally flipped to the orientation of the right eye to increase accuracy by equalising the mirror image of the right eye and left eye. The performances were compared with those of human experts. Results In total, 284, 279 and 220 images of central serous chorioretinopathy, polypoidal choroidal vasculopathy and neovascular age-related maculopathy were included. The precision and recall were 87.84% and 87.84% for Model 1 and 89.19% and 89.19% for Model 2, which were comparable to the results of the retinal specialists (90.91% and 95.24%) and superior to those of ophthalmic residents (68.18% and 92.50%). Conclusions Auto machine-learning platform can be used in the classification of pachychoroid on UWF ICGA images after careful consideration for pachychoroid definition and limitation of the platform including unstable performance on the medical image.

Purpose: To investigate the association between geographic atrophy (GA) and neovascular activity in retinal angiomatous proliferation (RAP) during anti-VEGF treatment. Methods: Ninety-one RAP eyes (74 patients) treated with anti-VEGF on an as-needed basis for at least 3 years were evaluated. Development of GA, area of GA, and injection numbers were assessed. Results: Eighteen eyes that developed fibrous scar or massive hemorrhage were excluded. Forty-four eyes (60%) developed GA (GA group), and 29 eyes (40%) did not develop GA (non-GA group) at year 3. The mean injection number continuously decreased in the GA group (5.1, 3.1, and 1.9 at years 1, 2, and 3, respectively, P < 0.01, < 0.01), but did not decrease at year 3 in the non-GA group (4.6, 3.5, and 3.3 at years 1, 2, and 3, respectively, P < 0.01, = 0.64). In both groups, best-corrected visual acuity improved significantly at year 1 and declined to baseline level at year 3. During the entire follow-up (mean of 48.5 months), 57 eyes developed GA. In those eyes, number of injections per year before and after the development of GA was 4.5 and 2.1 (P < 0.01), and showed continuous decline after GA development as the area of GA progressed at a rate of 1.85 mm² per year. Conclusions: The activity of RAP lesion requiring anti-VEGF treatment diminished as GA developed and progressed. Identification of GA and its progression provides further information to tailor anti-VEGF treatment for each patient.