We read with interest the article “Optical Coherence Tomography Angiography of Shallow Irregular Pigment Epithelial Detachments in Pachychoroid Spectrum Disease” by Dansingani and associates. The study compares multimodal imaging data with optical coherence tomography angiography (OCTA) findings in a series of 22 eyes with shallow irregular pigment epithelial detachments falling under the pachychoroid spectrum. The authors found OCTA findings to be more sensitive for detecting type 1 choroidal new vessels in these patients as compared to conventional dye angiography.

The authors explain that their findings could either be due to the variable time difference between acquisition of dye and OCTA images or possibly be due to the quiescent nature of these new vessels resulting in their undetected status. In the optical coherence tomography image of the left eye (Figure 1), there appear to be hyporeflective extravascular spaces, which could be areas of posteriorly loculated fluid, as recently described in patients of central serous chorioretinopathy. These areas could be representative of early exudation from these new vessels and may help partly in resolving the query over sensitivity of OCTA.

Also, as one of the inclusion criteria for diagnosing pachychoroid spectrum used in the current study included choroidal thickness >270 μm, presence of new vessels themselves or even extravasated fluid would have resulted in increased choroidal thickness and a misdiagnosis of pachychoroid spectrum. Hence, ruling out posteriorly loculated fluid is very essential, especially in eyes in which other features of pachychoroid were absent.

We hope our discussion adds value to this interesting study and keenly await the authors’ response.