The choroid is the richly vascular layer of the eye located between the sclera and Bruch's membrane. Early studies in animals, as well as more recent studies in humans, have demonstrated that the choroid is a dynamic, multifunctional structure, with its thickness directly and indirectly subject to modulation by a variety of physiologic and visual stimuli. In this review, the anatomy and function of the choroid are summarized and links between the choroid, eye growth regulation, and myopia, as demonstrated in animal models, discussed. Methods for quantifying choroidal thickness in the human eye and associated challenges are described, the literature examining choroidal changes in response to various visual stimuli and refractive error-related differences are summarized, and the potential implications of the latter for myopia are considered. This review also allowed for the reexamination of the hypothesis that short-term changes in choroidal thickness induced by pharmacologic, optical, or environmental stimuli are predictive of future long-term changes in axial elongation, and the speculation that short-term choroidal thickening can be used as a biomarker of treatment efficacy for myopia control therapies, with the general conclusion that current evidence is not sufficient.

Purpose: To investigate diurnal variations in anterior and posterior segment biometry and assess differences between emmetropic and myopic adults. Methods: Healthy subjects (n = 42, 23–41 years old) underwent biometry and spectral-domain optical coherence tomography imaging (SD-OCT) every 4 hours for 24 hours. Subjects were in darkness from 11:00 PM to 7:00 AM. Central corneal thickness, corneal power, anterior chamber depth, lens thickness, vitreous chamber depth, and axial length were measured. Thicknesses of the total retina, photoreceptor outer segments + RPE, photoreceptor inner segments, and choroid over a 6-mm annulus were determined. Results: All parameters except anterior chamber depth demonstrated significant diurnal variations, with no refractive error differences. Amplitude of choroid diurnal variation correlated with axial length (P = 0.05). Amplitude of axial length variation (35.71 ± 19.40 μm) was in antiphase to choroid variation (25.65 ± 2.01 μm, P < 0.001). The central 1-mm retina underwent variation of 5.03 ± 0.23 μm with a peak at 12 hours (P < 0.001), whereas photoreceptor outer segment + RPE thickness peaked at 4 hours and inner segment thickness peaked at 16 hours. Diurnal variations in retina and choroid were observed in the 3- and 6-mm annuli. Conclusions: Diurnal rhythms in anterior and posterior segment biometry were observed over 24 hours in adults. Differences in baseline parameters were found between refractive error groups, and choroid diurnal variation correlated with axial length. The retina and choroid exhibited diurnal thickness variations in foveal and parafoveal regions.

Purpose: To investigate ocular and systemic diurnal rhythms in emmetropic and myopic adults and examine relationships with light exposure. Methods: Adult subjects (n = 42, 22–41 years) underwent measurements every 4 hours for 24 hours, including blood pressure, heart rate, body temperature, intraocular pressure (IOP), ocular biometry, and optical coherence tomography imaging. Mean ocular perfusion pressure (MOPP) was calculated. Saliva was collected for melatonin and cortisol analysis. Acrophase and amplitude for each parameter were compared between refractive error groups. Subjects wore a light, sleep, and activity monitor for 1 week before measurements. Results: All parameters exhibited significant diurnal rhythm (ANOVA, P < 0.05 for all). Choroidal thickness peaked at 2.42 hours, with a diurnal variation of 25.8 ± 13.44 μm. Axial length peaked at 12.96 hours, with a variation of 35.71 ± 6.6 μm. Melatonin peaked at 3.19 hours during the dark period, while cortisol peaked after light onset at 8.86 hours. IOP peaked at 11.24 hours, with a variation of 4.92 ± 1.57 mm Hg, in antiphase with MOPP, which peaked at 22.02 hours. Amplitudes of daily variations were not correlated with light exposure, and rhythms were not significantly different between emmetropes and myopes, except for body temperature and MOPP. Conclusions: Diurnal variations in ocular and systemic parameters were observed in young adults; however, these variations were not associated with habitual light exposure. Emmetropic and myopic refractive error groups showed small but significant differences in body temperature and MOPP, while other ocular and systemic patterns were similar.