Association between retinal/choroidal vascularity and macular sensitivity in myopic macular degeneration: Aier-SERI high myopia adult cohort study.

Abstract

To investigate the associations between retinal/choroidal vascular parameters and macular sensitivity (MS) in adults with myopic macular degeneration (MMD). This cross-sectional study included a total of 439 eyes from 253 participants of the Aier-SERI high myopia cohort in Changsha, central China. MS was evaluated using the microperimetry (MP-3). Retinal and choroidal vascular parameters, including superficial vascular density (SVD), deep vascular density (DVD), choriocapillaris perfusion area (CCPA) and choroidal vascularity index (CVI), were quantified using swept-source optical coherence tomography angiography (SS-OCTA). Differences in MS across MMD severity categories were analysed via one-way analysis of variance, and relationships between retinal/choroidal vascular parameters and MS were evaluated using multivariable linear regression models with generalised estimating equations to account for inter-eye correlations. Participants had an average age of 44.6±6.6 years with a mean spherical equivalent (SE) of -9.1±4.1 D and axial length (AL) of 27.2±1.8 mm. MS, SVD, DVD and CVI in different regions decreased with increasing severity of MMD (all <i>P</i> values <0.05), but CCPA not (p>0.05). In multivariate models, factors related to reduced MS included older age (β=-0.074, p=0.007), longer AL (β=-0.388, p<0.001), increasing severity of MMD (β≤-0.677, all p<0.05), lower SVD (β=0.077, p=0.022), lower DVD (β=0.069, p=0.019) and lower CVI (β=3.083, p=0.015). CVI demonstrated significantly greater discriminatory power for MS impairment compared with SVD and DVD in different regions (all P values <0.05). Reduced MS is associated with more severe MMD, older age, longer AL, lower SVD, lower DVD and lower CVI. Among retinal/choroidal vascular biomarkers, CVI exhibits superior diagnostic utility for identifying MS impairment in MMD, highlighting the choroid's potential role as a sensitive indicator of visual function.