We read with interest the article “Assessment of Choroidal Topographic Changes by Swept-Source Optical Coherence Tomography After Intravitreal Ranibizumab for Exudative Age-Related Macular Degeneration” by Razavi and associates. The authors compare the effect of intravitreal ranibizumab on choroidal thickness in a cohort of treatment-naïve unilateral age-related macular degeneration (ARMD) patients. While the study is indeed interesting, there are certain points we wish to highlight.
The authors conclude that as the choroidal thickness of non-neovascular areas compared well with the changes in the neovascular areas, the change in choroidal thickness was due to the impact on hyperpermeability of the exudative choroid rather than shrinkage of the neovascular membrane itself. The choroidal thickness in patients of ARMD may be affected by exudation due to a leaky neovascular membrane or due to hyperpermeability of the choroid itself. We suggest analyzing changes in the sector of choroid diagonally opposite, furthest away, from the neovascular membrane separately vis-à-vis the rest of the sectors, as that sector is least likely to be affected by exudation from the neovascular membrane itself.
In this study, inferences have been drawn based on comparison of choroidal thickness between the 2 eyes. Recent investigations have highlighted the discrepancy in choroidal thickness values in a normal population. Therefore, comparing the choroidal thickness of 2 eyes may be error prone because of baseline differences.
Owing to the importance of the disease and its treatment, we wish the authors would share their valuable opinion.