December 2015
Volume 56, Issue 13
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Letters to the Editor  |   December 2015
Tailoring Myopic CNV Treatment Based on Preexisting Ophthalmic Condition
Author Affiliations & Notes
  • Tianwei Ellen Zhou
    Department of Medicine McGill University, Montréal, Québec, Canada
    Department of Pharmacology and Therapeutics, McGill University, Montréal, Québec, Canada
    Hôpital Maisonneuve-Rosemont Research Center, Université de Montréal, Montréal, Québec, Canada
  • Vikrant K. Bhosle
    Department of Pharmacology and Therapeutics, McGill University, Montréal, Québec, Canada
    Hôpital Maisonneuve-Rosemont Research Center, Université de Montréal, Montréal, Québec, Canada
    Departments of Pediatrics and Ophthalmology, Centre Hospitalier Universitaire (CHU) Sainte-Justine Research Center, Université de Montréal, Montréal, Québec, Canada.
  • Sylvain Chemtob
    Department of Pharmacology and Therapeutics, McGill University, Montréal, Québec, Canada
    Hôpital Maisonneuve-Rosemont Research Center, Université de Montréal, Montréal, Québec, Canada
    Departments of Pediatrics and Ophthalmology, Centre Hospitalier Universitaire (CHU) Sainte-Justine Research Center, Université de Montréal, Montréal, Québec, Canada.
Investigative Ophthalmology & Visual Science December 2015, Vol.56, 8362-8363. doi:10.1167/iovs.15-18314
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      Tianwei Ellen Zhou, Vikrant K. Bhosle, Sylvain Chemtob; Tailoring Myopic CNV Treatment Based on Preexisting Ophthalmic Condition. Invest. Ophthalmol. Vis. Sci. 2015;56(13):8362-8363. doi: 10.1167/iovs.15-18314.

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      © ARVO (1962-2015); The Authors (2016-present)

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We read with great interest the article by Ahn et al.,1 which described decreased subfoveal choroidal thickness in patients with myopic choroidal neovascularization (CNV) following anti-VEGF treatment in nonrecurrent eyes. The article raised awareness about choroidal thinning associated with anti-VEGF treatment for high myopia, which may be applicable to another condition frequently associated with severe myopia and recently detected choroidal thinning, notably patients with a previous history of retinopathy of prematurity (ROP), at times also treated with anti-VEGF therapy. 
A number of reports have recently documented choroidal thinning in patients with a history of ROP,24 as well as in the well-established rodent model of ROP.5 Choroidal thickness decreased in patients with threshold ROP compared with those with spontaneously regressed ROP. Moreover, involution of the choroid was correlated with a poor best-corrected visual acuity.3 In a separate study, choroid was markedly thinner in subfoveal and macular regions even in patients with regressed ROP.4 High myopia, defined as a refractive error of −6.0 diopters or worse, is a common sequela associated with ROP.6 Among patients with high-risk prethreshold ROP as defined by the International Committee for Classification of ROP (typically defined as zone I any ROP less than threshold, zone II stage 2 with plus disease, zone II stage 3 without plus, or zone II stage 3 less than 5 contiguous clock hours or less than 8 noncontiguous clock hours with plus7), 70% developed myopia as early as 6 months of age, and the proportion with high myopia increased steadily as the subjects got older.6 Converging lines of evidence also indicate a correlation between the severity of ROP and the presence of myopia.8,9 
With increasing survival of extremely premature neonates (<28 weeks) and very low birthweight (<1500 g at birth) infants,10 long-term changes afflicting the subretina are now being detected in older children and young adults with former history of ROP and those at risk of ROP.11,12 This is especially true in emerging economies, such as China and India13,14; interestingly, these countries also have a high incidence of myopia.15 In addition to ROP and myopia,16,17 several other ophthalmic conditions, notably diabetic retinopathy,18 geographic atrophy,19 and nonarteritic anterior ischemic optic neuropathy20 display progressive choroidal atrophy (Table). We, therefore, advise to further stratify patients with myopic CNV according to preexisting and current ophthalmic disorder, to guide treatment decisions. For instance, one could perform optical coherence tomography to rule out preexisting choroidal involution in patients who formerly had ROP and should carefully consider if anti-VEGF is appropriate at this time. 
Table
 
Conditions That Are Linked to Choroidal Thinning
Table
 
Conditions That Are Linked to Choroidal Thinning
Acknowledgments
The authors alone are responsible for the content and the writing of the paper. 
References
Ahn SJ, Park KH, Woo SJ. Subfoveal choroidal thickness changes following antivascular endothelial growth factor therapy in myopic choroidal neovascularization. Invest Ophthalmol Vis Sci. 2015; 56: 5794–5800.
Park KA, Oh SY. Analysis of spectral-domain optical coherence tomography in preterm children: retinal layer thickness and choroidal thickness profiles. Invest Ophthalmol Vis Sci. 2012; 53: 7201–7207.
Wu WC, Shih CP, Wang NK, et al. Choroidal thickness in patients with a history of retinopathy of prematurity. JAMA Ophthalmol. 2013; 131: 1451–1458.
Anderson MF, Ramasamy B, Lythgoe DT, Clark D. Choroidal thickness in regressed retinopathy of prematurity. Eye (Lond). 2014; 28: 1461–1468.
Shao Z, Dorfman AL, Seshadri S, et al. Choroidal involution is a key component of oxygen-induced retinopathy. Invest Ophthalmol Vis Sci. 2011; 52: 6238–6248.
Quinn GE, Dobson V, Davitt BV, et al. Progression of myopia and high myopia in the early treatment for retinopathy of prematurity study: findings to 3 years of age. Ophthalmology. 2008; 115: 1058–1064.e1.
International Committee for the Classification of Retinopathy of Prematurity. The International Classification of Retinopathy of Prematurity revisited. Arch Ophthalmol. 2005; 123: 991–999.
Choi MY, Park IK, Yu YS. Long term refractive outcome in eyes of preterm infants with and without retinopathy of prematurity: comparison of keratometric value axial length, anterior chamber depth, and lens thickness. Br J Ophthalmol. 2000; 84: 138–143.
Quinn GE, Dobson V, Kivlin J, et al. Prevalence of myopia between 3 months and 5 1/2 years in preterm infants with and without retinopathy of prematurity. Cryotherapy for Retinopathy of Prematurity Cooperative Group. Ophthalmology. 1998; 105: 1292–1300.
Patel RM, Kandefer S, Walsh MC, et al. Causes and timing of death in extremely premature infants from 2000 through 2011. N Engl J Med. 2015; 372: 331–340.
Hansen RM, Tavormina JL, Moskowitz A, Fulton AB. Effect of retinopathy of prematurity on scotopic spatial summation. Invest Ophthalmol Vis Sci. 2014; 55: 3311–3313.
Siatkowski RM, Dobson V, Quinn GE, Summers CG, Palmer EA, Tung B. Severe visual impairment in children with mild or moderate retinal residua following regressed threshold retinopathy of prematurity. J AAPOS. 2007; 11: 148–152.
Chen Y, Li X. Characteristics of severe retinopathy of prematurity patients in China: a repeat of the first epidemic? Br J Ophthalmol. 2006; 90: 268–271.
Vinekar A, Dogra MR, Sangtam T, Narang A, Gupta A. Retinopathy of prematurity in Asian Indian babies weighing greater than 1250 grams at birth: ten year data from a tertiary care center in a developing country. Indian J Ophthalmol. 2007; 55: 331–336.
Pan CW, Ramamurthy D, Saw SM. Worldwide prevalence and risk factors for myopia. Ophthalmic Physiol Opt. 2012; 32: 3–16.
Ho M, Liu DT, Chan VC, Lam DS. Choroidal thickness measurement in myopic eyes by enhanced depth optical coherence tomography. Ophthalmology. 2013; 120: 1909–1914.
Flores-Moreno I, Lugo F, Duker JS, Ruiz-Moreno JM. The relationship between axial length and choroidal thickness in eyes with high myopia. Am J Ophthalmol. 2013; 155: 314–319.e1.
Regatieri CV, Branchini L, Carmody J, Fujimoto JG, Duker JS. Choroidal thickness in patients with diabetic retinopathy analyzed by spectral-domain optical coherence tomography. Retina. 2012; 32: 563–568.
McLeod DS, Grebe R, Bhutto I, Merges C, Baba T, Lutty GA. Relationship between RPE and choriocapillaris in age-related macular degeneration. Invest Ophthalmol Vis Sci. 2009; 50: 4982–4991.
Schuster AK, Steinmetz P, Forster TM, Schlichtenbrede FC, Harder BC, Jonas JB. Choroidal thickness in nonarteritic anterior ischemic optic neuropathy. Am J Ophthalmol. 2014; 158: 1342–1347.e1.
Esmaeelpour M, Povazay B, Hermann B, et al. Mapping choroidal and retinal thickness variation in type 2 diabetes using three-dimensional 1060-nm optical coherence tomography. Invest Ophthalmol Vis Sci. 2011; 52: 5311–5316.
Adhi M, Lau M, Liang MC, Waheed NK, Duker JS. Analysis of the thickness and vascular layers of the choroid in eyes with geographic atrophy using spectral-domain optical coherence tomography. Retina. 2014; 34: 306–312.
Table
 
Conditions That Are Linked to Choroidal Thinning
Table
 
Conditions That Are Linked to Choroidal Thinning
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