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r e v i e w

Enhanced Depth Imaging Optical

Coherence Tomography
Ian Y. Wong, MRCS, FHKAM (Oph); Hideki Koizumi, MD, PhD;
Wico W. Lai, MD, FHKAM (Oph)

ABSTRACT INTRODUCTION

Imaging the choroid with conventional commercial
spectral-domain optical coherence tomography (SD-
OCT) has been difficult, mainly because of difficulty in
signal transmission beyond the retinal pigment epithe-
lium. A recent modification to the standard technique,
termed enhanced depth imaging optical coherence to-
mography (EDI-OCT), was able to image the choroid
with reasonable clarity using commercial SD-OCTs.
The aim of this article was to review the technique,
principle, recent findings, and possible future develop-
ments regarding EDI-OCT. A MEDLINE search on
all published articles on EDI-OCT was performed up
to December 2010. The principle behind EDI-OCT
was discussed. Modification to the conventional tech-
nique in image acquisition was described and illustrated
with figures. EDI-OCT findings in various retinal and
choroidal diseases were discussed. Advantages and dis-
advantages were also discussed. EDI-OCT has proved
to be a promising novel technique in imaging the cho-
roid. [Ophthalmic Surg Lasers Imaging 2011;42:
S75-S84.]
The introduction of optical coherence tomogra-
phy (OCT) has revolutionized the understanding of
the eye.1-4 It has the advantage of providing the user
an in vivo cross-sectional image of the retina, which
could not be achieved with other means of imaging.
A detailed outline from the inner vitreoretinal inter-
face to the outer retinal pigment epithelium could be
visualized. Presence of vitreoretinal adhesion, retinal
thickening, and intraretinal or subretinal fluid collec-
tion can be seen with high precision. Quantification of
retinal thicknesses is also possible where serial changes
may be useful in documenting progression of disease,
either in retinopathies or glaucoma.5-7
The choroid, which accounts for most ocular
blood flow,8 may be affected in several disease states,
such as polypoidal choroidal vasculopathy and cho-
roidal melanoma. It is also prone to suffer from age-
related degeneration, microvascular artherosclerotic
changes, and changes inherent to other microvascular
systems.9-12 An understanding of the choroid using
non-invasive imaging techniques has been limited. For

From the Eye Institute (IYW, WWL), Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong; and the Department of Ophthalmology (HK),
Kyoto Prefectural University of Medicine, Kyoto, Japan.

Originally submitted January 17, 2011. Accepted for publication February 25, 2011.
The authors have no financial or proprietary interest in the materials presented herein.
Address correspondence to Ian Y. Wong, MRCS, FHKAM (Oph), Room 301, Level 3, Block B, Cyberport 4, 100 Cyberport Road, Hong Kong. E-mail:
ianyhwong@gmail.com
doi: 10.3928/15428877-20110627-07

Ophthalmic Surgery, Lasers & Imaging Vol. 42, No. 4 (Suppl), 2011 S75
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instance, imaging of the choroid with OCT was not
entirely possible.13 This was because the wavelength of
the light source used to image the retina was not long
enough to penetrate into the choroid.14 This was due
to wavelength dependent light scattering and signal
loss that occur in the image path, decreased sensitivity
away from zero-delay, and the various inherited limi-
tations with Fourier transformation.15 The common
commercially available OCTs employ a wavelength of
800 nm, whereas those capable of choroidal imaging
are in the range of 1,060 nm.14,16 One would have to
use a light source nearer to the infrared region to pen-
etrate into the choroid. This was not possible for most
commercially available OCTs, because clarity for reti-
nal structures would be compromised. Following the
introduction of a new imaging technique, referred to
as enhanced depth imaging optical coherence tomog-
raphy (EDI-OCT), choroidal imaging with standard
commercially available spectral-domain OCT (SD-
OCT) was made possible.13 This review provides the
reader with an up-to-date account of this technique
and the various findings published to date.
METHOD
A literature search on MEDLINE was performed
on key words optical coherence tomography, en-
hanced depth imaging, spectral domain OCT, and
choroid up to December 2010. Search results were
limited to those published in English and studies on
human subjects only.
Principle of EDI-OCT
In SD-OCT, a broadband light source is employed
to image the retina. Interference signal is then generated
by comparing the signal received to that from a reference
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Figure 1. Normal appearance of the retina
and choroid at the same location as imaged
with (A) conventional protocol versus (B)
enhanced depth imaging optical coherence
tomography (EDI-OCT). Images were taken
using the Heidelberg Spectralis (Heidelberg
Engineering, Heidelberg, Germany). More
detail of the choroid could be visualized
with EDI-OCT compared to the conventional
method. At the same time, retinal details
could be seen with comparable quality.
arm. The interferogram obtained will then undergo Fou-
rier transformation to form scattering amplitudes. This
will then be analyzed and reformed into the retinal image
obtained on the capturing screen. In SD-OCT, the real
image is always accompanied by an inverted image.17-19
However, only one of the two images is generally shown
on the capturing screen (ie, the upright real image). In the
real image, the inner part of the retina is shown facing up
and the choroid is shown at the bottom of the screen.
The reasons why the choroid cannot be imaged clear-
ly could be attributed to (1) decreasing sensitivity and
resolution with increasing displacement from zero-delay,
(2) decreased maximal dynamic range inherent in Fourier
domain systems, (3) wavelength dependent light scatter-
ing and signal loss in the image path, and (4) the lateral
width of the defocused imaging beam.13 When the instru-
ment is moved closer to the eye to image deeper layers, the
inverted image is displayed such that the choroid is shown
facing up (ie, closer to zero-delay) while the inner retina
is facing down. This has the effect of delivering the most
closely focused portion of the illumination at the level of
the choroid or the inner scleral border. Hence, the choroid
can be imaged at higher sensitivity (Fig. 1).
The wavelength employed by most SD-OCTs is able
to give a relatively low signal-to-noise ratio and, by aver-
aging more frames, a relatively clear and noise-free im-
age could be obtained. Therefore, EDI-OCT is a simple
modification of the conventional SD-OCT technique,
made possible by a slight displacement of the image cap-
turing machine, and computerized image averaging.
Standard Procedure
There are several SD-OCTs available commercially,
but to date, only the Heidelberg Spectralis OCT (Heidel-
berg Engineering, Heidelberg, Germany) and the Cirrus
HD-OCT (Carl Zeiss Meditec Inc., Dublin, CA) have
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been described to be capable of performing EDI-OCT.13,20
Here we explain the principle using the Heidelberg Spec-
tralis OCT, as previously described by Spaide et al.13
After positioning the patient and achieving focus,
the OCT machine is slightly pushed toward the patient
such that an inverted image is obtained on the capturing
screen. Because image quality is best toward zero-delay
(ie, top of the screen), the inverted image is captured
when it is as close to the top as possible. Special attention
is needed to avoid capturing a folded image (ie, when
the machine is not close enough to the eye and the image
has not yet been inverted completely). To enhance clar-
ity and reduce noise signal, each image should be aver-
aged from 100 frames. Eye-tracking technology also im-
proves image quality and acquisition time (Fig. 2). The
appearance of an EDI-OCT image of a normal line scan
through the fovea is shown in Figure 3.
A recent software update by Heidelberg incor-
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Figure 2. Enhanced depth imaging scans
through the same location across the fo-
vea: (A) image obtained after averaging 20
frames and (B) image obtained after averag-
ing 100 frames. Note the lower noise-signal
with more frames averaged, as shown in (B).
Differentiation of the outer retinal pigment
epithelium/choroid border, and the choroid
scleral junction is still possible even by aver-
aging lesser frames.
Figure 3. Appearance of a 6-mm horizontal
raster line scan through the fovea in a normal
subject. Arrow = junction between the retinal
pigment epithelium and choroid; triangle =
junction between the choroid and sclera.
Figure 4. Manual measurements of choroi-
dal thickness at each 1,000-m interval, cen-
tered on the fovea. Calipers were positioned
manually using computer software provided
by the manufacturer.
porates EDI-OCT as an added feature. The software
update (version 5.3) automatically inverts the captur-
ing screen and positions zero-delay inferiorly instead
of superiorly. In doing so, the operator can acquire the
EDI-OCT images with increased ease because now
the image is upright, rather than inverted. However,
this feature is only available in the updated Heidelberg
Spectralis software, whereas for the Cirrus HD OCT,
acquisition using the inverted-image technique is still
required. Despite advancement in image acquisition,
automated choroidal thickness measurement is still un-
available at the time of writing this review.
Image processing is done with the standard Heidel-
berg Explorer software. Because no automatic measuring
software for EDI-OCT exists, manual measurement has
to be done on each image (Fig. 4). Choroidal thickness
is defined as the distance between the outer border of the
retinal pigment epithelium and the inner scleral border
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Table 1 and metabolic activity. The metabolic demand has to

Choroidal Thickness (m) as Measured be met by the choroidal circulation because there is
With Different Spectral-Domain Optical no direct blood supply from the retinal circulation in
Coherence Tomography the fovea. It is therefore reasonable to find the thickest
part of the choroid to be located underneath the fovea,
Mean Choroidal Heidelberg Cirrus HD
Thicknessa Spectralis21 OCT23 where the demand for oxygen is highest.
Temporal 3.0b 261 n/a
Correlation With Age
Temporal 2.5 266 218
Margolis and Spaide also correlated choroidal
Temporal 2.0 268 237 thickness with age.21 It was found that the choroid gets
Temporal 1.5 268 248 thinner with age and the correlation was statistically
Temporal 1.0 273 256 significant at all points measured on the 6-mm line.
Temporal 0.5 277 264 With regression analysis, for instance, subfoveal cho-
Fovea 287 272 roidal thickness was found to decrease by 1.56 m for
Nasal 0.5 276 261
each year of age. The choroid, being a vascular struc-
ture, is prone to be affected by systemic conditions such
Nasal 1.0 253 248
as hypertension and hyperlipidemia, and it is likely to
Nasal 1.5 232 217 undergo artherosclerotic and aging changes similar to
Nasal 2.0 203 186 other microvascular structures within our body.8 In a
Nasal 2.5 170 157 previous study on eye bank and autopsy eyes, the cho-
Nasal 3.0 145 n/a roidal thickness was found to correlate negatively with
n/a = data not available. age (decrease 1.1 m per year of age).22 Results from
a
Mean choroidal thickness as measured from outer border of histological examination may not necessarily agree with
retinal pigment epithelium to inner scleral border.
b
Temporal 3.0 refers to measurement point 3.0 mm temporal to in vivo findings, mainly because (1) the tissue fixation
fovea on a horizontal line scan.
Heidelberg Spectralis is manufactured by Heidelberg Engineer-
method may have altered tissue texture and hence re-
ing, Heidelberg, Germany. Cirrus HD-OCT is manufactured by sults may be altered and (2) choroidal thickness also
Carl Zeiss Meditec, Inc., Dublin, CA.
reflects circulation but circulation ceases in diseased tis-
sue, which may interfere with interpretation.13,21 De-
(Fig. 3). Manual adjustments have to be done on the spite that, in vivo findings obtained by Margolis and
image captured. However, reproducibility was relatively Spaide confirmed that choroidal thickness measured in
good and measurement was possible in most cases.13,20 vivo follows the same pattern.21

FINDINGS IN NORMAL SUBJECTS Measurements With Other SD-OCT

Thickness Profile Along the Macula
In a pilot study by Margolis and Spaide, 54 nor-
mal eyes were studied.21 The choroidal thickness was
measured at 500-m intervals along a 6-mm horizon-
tal line centered on the fovea (ie, measurements were
made from 3 mm nasal to the fovea to 3 mm temporal
to the fovea).21 Results showed that the choroid was
thickest underneath the fovea, with a mean of 287 m.
Choroidal thickness decreased on both sides of the fo-
vea, but more so nasally, and was found to be thinnest
at the nasal end of the imaging line (ie, 3 mm nasal to
the fovea). The choroid is the most vascular structure
within the eye,8 and the fovea, situated at the center
of the macula, has the highest photoreceptor density
Margolis and Spaide did their measurements with
the Heidelberg Spectralis. Manjunath et al. adopted
their protocol and produced results with another mod-
el of SD-OCT, the Cirrus HD OCT.23 The differences
between the Spectralis and Cirrus HD OCT were that
Cirrus lacks eye-tracking ability and it can only per-
form 20 B-scans at a time for each measurement. In
contrast, Spectralis is superior in that it has eye-track-
ing ability and can obtain 100 B-scans simultaneously.
Despite that, Manjunath et al. were still able to produce
comparable results in terms of variation in choroidal
thickness along the macula and the negative correlation
with age.23 Table 1 outlines the measurements of cho-
roidal thicknesses obtained using these two models of
SD-OCT. To date, the Spectralis and Cirrus HD OCT

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are the only commercial models of SD-OCT that were

reported to be capable of performing EDI-OCT.

FINDINGS IN PATHOLOGICAL CONDITIONS

Myopia
Fujiwara et al. studied the EDI-OCT pattern of
choroidal thickness in subjects with myopia of 6 diop-
ters or more.24 A 6-mm horizontal scan line was used,
centered on the fovea. Choroidal thickness was mea-
sured at 1,000-m intervals along the line. The choroid
was found to be thinnest at the nasal end. Thickness
increased in a graded fashion toward the temporal side
and reached maximum at the temporal end. This was in
contrast to that in normal subjects, where thickness was
highest under the fovea.21,23 A possible explanation was
the presence of posterior staphyloma, which may have
distorted the normal architecture of the choroid.24 De-
spite that, choroidal thickness correlated negatively with
age and regression analysis showed a 1.27-m decrease
with each year of age. This was similar to that found in
normal subjects.21,23 Furthermore, choroidal thickness
was found to decrease with increasing myopia. An 8.7-
m decrease was found for each diopter of myopia.24
Fujiwara et al. further subdivided the subjects into
those who had myopic choroidal neovascularization
(CNV) and those who did not.24 Results showed that
in those who had had CNV, the choroid was thinner
when compared to those who did not and the contour
was distorted. This was because of either the effect of
the CNV or the effect of treatment (ie, photodynamic
therapy or anti-vascular endothelial growth factor in-
jection), or a combination of both.24
Age-Related Macular Degeneration
Before the description of the technique of EDI-OCT,
imaging pigment epithelial detachment (PED) with OCT
was difficult. It often appears as optically empty. There-
fore, the pathogenesis of PEDs associated with age-related
macular degeneration (AMD) has been controversial.
Gass postulated that choroidal neovascularization (CNV)
grows under the retinal pigment epithelium and spreads
laterally and causes exudation. Accumulation of exudates
increases the pressure between the choroid and retinal
pigment epithelium and causes ballooning and PED for-
mation.25 On the other hand, Bird and Marshall thought
that abnormal interaction between the retinal pigment
epithelium and Bruchs membrane causes the formation of
Figure 5. Segmental imaging of pigment epithelium detachment
(PED) with Heidelberg Spectralis (Heidelberg Engineering, Hei-
delberg, Germany) using enhanced depth imaging (EDI-OCT).
Heterogeneity within the PED could be seen when EDI-OCT was
employed. (A) Image of PED taken with conventional method.
Relative hollowness of the PED is seen. (B) Same section through
PED images with EDI-OCT. Contents within PED better shown.
Band of hyperreflective tissue seen overlying Bruchs membrane,
as outlined by arrowheads, was not seen clearly in (A).
PEDs.26 It was thought that the Bruchs membrane turns
increasingly hydrophobic and impermeable to fluid with
age, and fluid would accumulate underneath the retinal
pigment epithelium during the normal outflow pathway.
Hence a PED would form if enough fluid accumulates
beneath the retinal pigment epithelium, and CNV forms
as a secondary product.27 Other theories exist, but none
have been conclusive.28-31
With EDI-OCT, sensitivity and resolution is en-
hanced because the choroidal side of the image is placed
closer to zero-delay. In a retrospective study of 22 eyes
with PEDs associated with AMD, Spaide was able to
image the inner contents with this new technique.15
In his study, the full extent of the choroid was imaged
with this new technique in all eyes. The PED was filled
with hyperreflective tissue in half of them, whereas it
was filled with serous fluid and reflective substance
in the remaining half (Fig. 5). He went on to postu-

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late that the reflective substance represents CNV and
should be part of the PED complex, but it was not be-
ing visualized before. In one particular case among his
series, Spaide noted a reflective band underneath the
retinal pigment epithelium inside the PED that also
contained serous fluid. One week after treatment with
ranibizumab, the band straightened and separated from
the undersurface of the PED, followed by partial col-
lapse of the whole PED. A month later, serous content
was absent and the PED flattened out and was totally
filled with the reflective substance, presumably CNV.15
Spaide concluded that PED in association with AMD
is likely neovascular in origin, and that the Gass hy-
pothesis is more likely to be the case.15
A point worth noting is that signals in the highest
part of the PED tend to be blurred when performing
EDI-OCT in subjects with large PEDs. This is because
the higher the PED is, the further away it is from zero-
delay. As mentioned earlier, signals are clearest nearer
zero-delay. Because this is intrinsic to the principle of
EDI-OCT, successful capturing of large PEDs may
only be possible when future enhancement in OCT
technique is available, possibly by enhancing the ef-
fective imaging depth and improving noise reduction
algorithms.
Although the new findings may lead us to a deeper
understanding of the pathogenesis of PEDs, there is still
more to be done, histological correlation in particular.
Also, further studies have to be done for other variants
seen in the AMD spectrum (ie, geographical atrophy or
classic CNV). Nevertheless, EDI-OCT proved to be a
promising future development to allow us to improve
the management and understanding of AMD.
Central Serous Chorioretinopathy
Central serous chorioretinopathy (CSC) is char-
acterized by serous detachment of the neurosensory
retina, sometimes accompanied by a serous PED. It
was thought that vascular dilatation, congestion, and
hyperpermeability of the choroidal vessels create an in-
creased hydrostatic pressure within the choroid, lead-
ing to PED formation. This collection of fluid subse-
quently leaks into the subretinal space through focal
leakage points, causing CSC formation.32-44 The above
theories were backed up by studies using indocyanine
green angiography.
With EDI-OCT, Imamura et al. have found new
supporting evidence for these theories.44 In a study of
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19 patients with CSC, they found a mean subfoveal
choroidal thickness of 505 m (standard deviation =
124 m; range = 439 to 573 m). This was higher than
normative data reported previously.21,23 Among those
who had unilateral CSC, choroidal thickness was also
increased in the disease-free fellow eye.44 Increased
choroidal thickness may represent increased circulation
and vascular dilatation. This is in agreement with pre-
vious indocyanine green angiography studies, in that
both eyes have increased choroidal circulation even if
only one eye has clinically demonstrable CSC.39 There
are several known risk factors for CSC, such as stress,
pregnancy, sympathomimetic agent use, corticosteroid
use, hypertension, and autonomic dysfunction.44-49
These are systemic risk factors rather than local ones,
and the choroid is prone to be affected because it is a
vascular structure with no autoregulation. The results
demonstrated by Imamura et al. further confirmed this
finding.44
In another study on CSC with EDI-OCT, Maruko
et al. have shown that choroidal thickness is reduced af-
ter successful treatment with photodynamic therapy.50
In their study, 20 patients with CSC were treated with
either laser photocoagulation or photodynamic therapy.
Pre-treatment choroidal thickness was 345 m in the
laser photocoagulation group and 389 m in the pho-
todynamic therapy group. Choroidal thicknesses at 4
weeks were 340 m in the laser photocoagulation group
(P = .2) and 330 m in the photodynamic therapy group
(P < .001). There was a transient increase in choroidal
thickness during the initial 2 days in the photodynamic
therapy group that decreased at 4 weeks to a lower level
than that at pre-treatment. Photodynamic therapy is ca-
pable of producing choriocapillaris damage and vascular
remodeling in the choroid.51-59 Applying photodynamic
therapy in CSC was thought to reduce vascular hyper-
permeability and in return cessation of the pathological
process.50 In contrast, those treated with laser photoco-
agulation did not have reduction in choroidal thickness,
meaning hyperpermeability was not reduced. This was
because the area of hyperpermeability was larger than
the spot of focal laser applied.60,61 Although local effect
was achieved around the laser spot, diffuse reduction
in hyperpermeability was not observed; thus, choroidal
thickness reduction was not evident. Although the study
by Maruko et al. cannot be a guide for better treatment
for CSC, it did highlight the value of EDI-OCT in fu-
ture studies of CSC.
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Inherited Retinal Diseases
EDI-OCT imaging in inherited retinal diseases is
possible and correlates well with the clinical appear-
ance of the disease. Yeoh et al. reported EDI-OCT
imaging of the choroid in 20 patients with inherited
retinal diseases, including Stargardts disease, macular
dystrophy, cone/rod dystrophy, Bests disease, Biettis
disease, choroideremia, and bifocal chorioretinal at-
rophy.62 Although the subjects were heterogeneous
in terms of etiology, some general principles were ob-
served. It was found that choroidal thickness varied ac-
cording to the type of disease, and the severity of the
underlying disease. In general, choroidal thinning was
observed where visible retinal or chorioretinal changes
were present. Choroidal thinning may be focal or dif-
fuse depending on the underlying retinal dystrophy,
and was symmetrical bilaterally in all cases, which was
in agreement with the bilateral nature of the respec-
tive inherited retinal disease. Yeoh et al. divided those
with mild to moderate thinning from those with severe
thinning.62 Mild to moderate thinning was thought to
represent choriocapillaris atrophy secondary to retinal
pigment epithelium cell death, whereas severe thinning
was thought to be genetic in nature and caused atro-
phic changes in larger choroidal vessels.
Due to the retrospective nature, limited number
of cases, and heterogeneity of etiologies, it was difficult
to allocate a specific type of choroidal thinning pattern
to one particular retinal disease. However, the study
formed a framework for future studies in this regard.
Repeatability
Repeatability is critical when an imaging tech-
nique is to be implemented in practice. For EDI-OCT,
there is no automated software to measure choroidal
thickness. All measurements must done manually. This
raises concern regarding inter-observer and inter-ses-
sion repeatability.
Spaide et al. reported good inter-observer repeat-
ability with the Heidelberg Spectralis (r = 0.93 right
eye, r = 0.97 left eye; P < .001).13 Rahman et al. pro-
duced similar results and found that a change of more
than 32 m is likely to exceed inter-observer variability
(inter-observer coefficient of repeatability was 32 m,
95% confidence interval was 30 to 34 m).20
Although good inter-observer repeatability was
produced with manual measurements, there are still
difficulties sometimes. The main problems are the rela-
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tively lower resolution in choroidal images than in con-
ventional retinal scans and the lack of eye-tracking in
some models of OCT (only the Heidelberg Spectralis is
currently able to perform eye-tracking for EDI-OCT).
To enhance repeatability, automated measurement
software should be developed for choroidal measure-
ments and eye-tracking function should be ideally in-
corporated into every OCT machine.
DISCUSSION
Before the introduction of EDI-OCT, the means
of assessing the choroid included contact ultrasonogra-
phy,63 magnetic resonance imaging,64 and histological
studies.22,65 Contact ultrasonography can provide an in
vivo image of the choroid and can still function in the
presence of dense media opacity (eg, cataract), but it
has low resolution and precise location of measurement
is difficult.65 Magnetic resonance imaging is non-inva-
sive, yet differentiation between retina, choroid, and
sclera is difficult.64 Histological studies have disadvan-
tages in that (1) the eye has to be removed for study, (2)
tissue fixation may affect tissue texture, and (3) cessa-
tion of circulation may influence the histology.22
Therefore, EDI-OCT has several advantages: (1) it
uses a commercially available machine, (2) it is non-in-
vasive, (3) it provides an in vivo account of the choroid,
and (4) its operation is simple and has high repeatabil-
ity. However, it is still limited by (1) the lack of auto-
mated choroidal thickness measurement software that
requires manual measurement to be done, which can
be time-consuming and creates bias; (2) the presence
of media opacities, which hinders signal transmission
and reception between the OCT and the choroid; and
(3) the relative high cost of the SD-OCT machine. A
summary of recent important findings in EDI-OCT is
given in Table 2 for reference.
A dedicated automated software to measure choroi-
dal thickness is clearly required. Further correlation in
normal subjects is needed, for example in the pediatric
population. Correlation in pathological conditions is
also needed, especially in those of choroidal origin (eg,
choroidal nevus or polypoidal choroidal vasculopathy).
CONCLUSION
The introduction of EDI-OCT has provided new
means of assessing the choroid with commercially avail-
 Table 2

S82
Summary of Findings in Enhanced Depth Imaging Optical Coherence Tomography
Investigator No. Pathology Scanning Protocol OCT Machine Choroidal Thickness Other Important Findings/Remarks

Spaide et al., 17 Normal 7 sections, each comprised 100 averaged scans, Heidelberg Mean 318 to 335 m under fovea. High reproducibility (r = 0.93 to 0.97; P < .01).
200813 volunteers within a 5 3 15 degree rectangle centered on the Spectralis
fovea. Eye-tracking mode on.
Margolis & Spaide, 30 Normal 7 sections, each comprised 100 averaged scans, Heidelberg Mean 287 m under fovea. Thinnest Negative correlation with age, decrease by
200921 volunteers within a 5 3 30 degree rectangle centered on Spectralis nasal end, thickest at fovea, gradual 15.6 m each decade of life.
the fovea, at 500-m intervals from 3 mm nasal decrease in thickness from fovea to
to fovea to 3 mm temporal to fovea. Eye-track- temporal end.
ing mode on.
Spaide, 200915 22 AMD with 7 sections, each comprised 100 averaged scans, Heidelberg Not studied. In 50% of cases, PEDs were entirely filled with
PED within a 5 3 15 degree or larger rectangle to Spectralis hyperreflective tissue. In the remaining 50%
encompass the PED and associated neovascu- of cases, PEDs contained hyperreflective tis-
larization. Eye-tracking mode on. sue and serous fluid collection. Administrat-
ing ranibizumab caused PED to flatten and
hyperreflective tissue inside to contract.
i

Fujiwara et al., 31 High myopia 7 sections, each comprised 100 averaged scans, Heidelberg Mean 93.2 m under fovea. Mean Negative correlation with age, (P = .006),
200924 >6D within a 5 3 30 degree rectangle centered on Spectralis refractive error -11.9 D. decrease by 12.7 m each decade of life.
the fovea, at 1,000-m intervals from 3 mm Negative correlation with refractive error (P
nasal to fovea to 3 mm temporal to fovea. Eye- < .001), decrease by 8.7 m each diopter of
m

tracking mode on. myopia. Negative correlation with history of

choroidal neovascularization (P = .013).
Imamura et al., 19 CSC Same as Margolis & Spaide21 Heidelberg Mean 505 m under the fovea (ie, Choroidal thickness in the fellow eye had a
a

200944 Spectralis mean 214 m thicker than previously mean of 451 m, which was also higher than
reported, P < .001). that reported in normals.
Maruko et al., 20 CSC Same as Spaide et al.13 In addition, scanning Heidelberg In the LP group, mean thickness was Choroidal thickness was higher than normal
g

201050 was done before and after treatment, either by Spectralis 345 m before and 340 m after in CSC. Subretinal fluid resolved in all
LP or PDT. treatment (Not significant, P = .2). In cases after treatment. Changes in choroidal
the PDT group, mean thickness was thicknesses were noted after PDT, but not
i

389 m at baseline, 462 m at day 2, after LP. Suggested therapeutic mechanism

360 m at 1 week, and 330 m at 4 difference between LP and PDT.
weeks (P < .05 at all points).
n

Yeoh et al., 201066 20 Inherited Scanning done on areas of focal retinal thinning, Heidelberg 50% had no choroidal thinning and Choroidal thickness correlated well with clinical
retinal and adjacent areas of normal-looking retina. Spectralis mean subfoveal choroidal thickness appearance of retinopathy, and was found to
diseases Eye-tracking mode on. was 312 to 317 m. Among the other be symmetrical. Extent of choroidal thinning
50%, some degree of thinning was dependent on the stage of disease. Cho-
g

found, ranging from mild, moder- roidal thinning did not necessarily correlate
ate, to severe. Thinnest choroid was with vision.
70 m in the affected area; despite
that, adjacent area was found to be
normal.
Rahman et al., 50 Normal 2 horizontal and 2 vertical line scans through the Heidelberg Mean 332 m under fovea. Good repeatability was found. Intra-observer
201020 volunteers fovea, each averaged from 100 frames. Eye- Spectralis CR was 23, inter-observer CR was 32 to 34.
tracking mode on. A change of more than 32 m was likely to
exceed inter-observer variability.
Manjunath et al., 34 Normal 1 horizontal line scan through the fovea, Cirrus HD-OCT Mean 272 m under fovea. Thinnest Good inter-observer correlation (r = 0.92 to
201023 volunteers measured at 500-m intervals, along the line nasal end, thickest at fovea, gradual 0.93, P < .0001). Poor retinal-choroidal thick-
2,500 m temporal to 2,500 m nasal of the decrease in thickness from fovea to ness correlation (r = -0.23, P = .18).
fovea. Each line was averaged from 20 frames, temporal end. Negative correlation
without eye-tracking mode. with age (r = -0.62, P < .0001).
OCT = optical coherence tomography; AMD = age-related macular degeneration; PED = pigment epithelium detachment; D = diopter; CSC = central serous chorioretinopathy; LP = laser photocoagulation; PDT =
photodynamic therapy; CR = coefficient of repeatability.
a
Choroidal thickness defined as distance between outer border of retinal pigment epithelium to inner scleral border.
Heidelberg Spectralis is manufactured by Heidelberg Engineering, Heidelberg, Germany. Cirrus HD-OCT is manufactured by Carl Zeiss Meditec, Inc., Dublin, CA.

Copyright SLACK Incorporated

 i m a g
able SD-OCTs. Its operation is simple, it is non-inva-
sive, it provides an in vivo account of the choroid, and
it has high repeatability. With this technique, choroidal
changes in some retinal and choroidal diseases were re-
vealed. New insights into the pathogenesis and treat-
ment response were reported, which may light the path
for future research. To date, published data regarding
EDI-OCT are still limited. There is a demand for more
work to be done.
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