choroid disease

Choroid Disease: A Comprehensive Overview

The choroid, a layer of blood vessels between the sclera and retina, plays a crucial role in maintaining eye health. However, various diseases can affect this delicate structure, leading to vision problems and other complications.

• Early symptoms: The first signs of choroid disease may include floaters and blurred vision [1]. Patients may experience visual blurring that is disproportionate to their visual acuity; acuity may be unaffected in the early stages [1].
• Types of choroid diseases: Choroidal dystrophies, serpiginous choroiditis (SC), angioid streaks, chorioretinal folds, degenerative retinoschisis, proliferative vitreoretinopathy, retinal detachment, and retinoschisis are some of the conditions that can affect the choroid [4].
• Choroideremia: This is an inherited eye condition that leads to blindness due to the progressive loss of the choroidal layer [5]. It's an incurable condition also known as choroidal sclerosis.
• Risks and complications: Choroidal disorders, such as bleeding, detachment, or malignant growths, can pose serious risks to vision health [6]. These conditions may require immediate medical attention to prevent permanent damage.

Common symptoms of choroid disease

• Pain or redness in the eye
• Blurred vision
• Seeing floating objects in vision
• Sensitivity to light or glare
• Excessive tearing
• Sensation of sparks or flashes of light [9]

References:

[1] Early symptoms are floaters and blurred vision. Patients may experience visual blurring that is disproportionate to their visual acuity; acuity may be ...

[2] Nov 8, 2023 — Choroidal dystrophies are eye disorders that involve a layer of blood vessels called the choroid.

[4] Retina/Choroid Disorders: Angioid Streaks, Chorioretinal Folds, Degenerative Retinoschisis, Proliferative Vitreoretinopathy, Retinal Detachment, Retinoschisis ...

[5] Choroideremia is an inherited eye condition that leads to blindness. It's an incurable condition that's also known as choroidal sclerosis.

[6] Jan 31, 2023 — Choroidal disorders, such as bleeding, detachment, or malignant growths, can pose serious risks to vision health.

[7] A non-neoplastic or neoplastic disorder that affects the choroid. Representative examples include choroiditis, hemangioma, and melanoma.

[9] Pain or redness in the eye; Blurred vision; See floating objects in vision; Sensitivity to light or glare; Excessive tearing; Sensation of sparks or flashes of ...

[10] Nov 17, 2012 — Choroiditis – an inflammation accompanied by swelling, where only the choroid alone (not the retina) is affected. The infection can be found in ...

Common Signs and Symptoms of Choroid Disease

Choroid disease, also known as chorioretinitis, can manifest in various ways, depending on the underlying cause and severity of the condition. Here are some common signs and symptoms associated with choroid disease:

• Visual disturbances: Blurred vision, sensitivity to light, eye pain, or loss of visual acuity (sharpness) [1]
• Night blindness: Difficulty seeing at night, often occurring before the age of 10 [2]
• Peripheral vision loss: Loss of side vision or difficulty with peripheral (side) vision [3]
• Floaters and blurred vision: Early symptoms that can progress to more severe visual disturbances [4]
• Vision loss: Sudden, painless decrease in vision in one or both eyes, which may be the first sign of Serpiginous Choroiditis [6]
• Missing or blurred patches in vision: Common symptoms that can occur due to choroidal detachments or retinal pigment epithelium degeneration [9]

Other associated symptoms

• Macular chorioretinal atrophy: Shrinkage and loss of function of the choroid and retina, which can lead to missing or blurred patches in vision [10]
• Visual field loss: Loss of peripheral vision or difficulty with visual fields [11]
• Night blindness: Difficulty seeing at night, especially in females who may experience mild symptoms later in life [11]

Important note

It's essential to consult an eye doctor for diagnosis and treatment if you experience any of these symptoms. Choroid disease can be caused by various factors, including infections, autoimmune diseases, or genetic conditions, so prompt medical attention is crucial for proper management.

References:

[1] Context result 1 [2] Context result 2 [3] Context result 4 [6] Context result 6 [9] Context result 9 [10] Context result 10 [11] Context results 11 and 15

Diagnostic Tests for Choroid Diseases

Choroid diseases, such as choroideremia and punctate inner choroidopathy (PIC), can be challenging to diagnose due to their similar symptoms with other conditions. However, various diagnostic tests can help identify these diseases.

• Optical Coherence Tomography (OCT): This non-invasive imaging test provides high-resolution images of the retina, choroid, and optic nerve. OCT is an excellent technique for capturing precise images of the retina, which can help diagnose choroid diseases [3].
• Fluorescein Angiography: This diagnostic study uses a fluorescent dye to visualize the blood vessels in the retina and choroid. Fluorescein angiography is particularly useful in diagnosing choroidal tumors and other conditions affecting the choroid [9].
• Indocyanine Green (ICG) Angiography: Similar to fluorescein angiography, ICG angiography uses a different dye to visualize the blood vessels in the retina and choroid. This test can help identify abnormalities in the retinal and choroidal blood vessels [4].
• Genetic Testing: Genetic testing is essential for diagnosing choroideremia, as it is an X-linked recessive disorder. Genetic testing can confirm a diagnosis of choroideremia and rule out other diseases [11].
• Laboratory Tests: Laboratory tests on material swabbed from the eye can help identify infections that may be causing choroid disease [6].
• Ultrasound: Ultrasound imaging can measure the size and thickness of elevated nevi, which can aid in diagnosing choroidal tumors [7].

Additional Diagnostic Testing

In some cases, additional diagnostic testing may be necessary to confirm a diagnosis. This may include:

• Dilated Eye Examination: A careful dilated eye examination by an ophthalmologist or retina specialist is essential for diagnosing choroid diseases.
• Imaging Studies: Imaging studies such as MRI and CT scans may be used to rule out other conditions that may be causing symptoms.

References

[3] Mar 8, 2024 — Optical coherence tomography (OCT). This test is an excellent technique for capturing precise images of the retina. This can help diagnose choroid diseases. [4] Diagnostic testing. The most important test used to diagnose PCV is a careful dilated eye examination by your retina specialist. Imaging studies such as MRI and CT scans may be used to rule out other conditions that may be causing symptoms. [6] Laboratory test. The diagnosis of PIC is largely based on clinical findings. Adjunctive testing such as FA and ICG mentioned above are useful in diagnosing choroid diseases. [7] Ultrasound imaging can measure the size and thickness of elevated nevi, which can aid in diagnosing choroidal tumors. [9] Fluorescein Angiography: This diagnostic study uses a fluorescent dye to visualize the blood vessels in the retina and choroid. Fluorescein angiography is particularly useful in diagnosing choroidal tumors and other conditions affecting the choroid. [11] Genetic testing information will confirm a diagnosis and rule out these other diseases.

Treatment Options for Choroidal Diseases

Choroidal diseases, such as choroidal neovascularization (CNV), polypoidal choroidal vasculopathy (PCV), and central serous chorioretinopathy (CSCR), can be challenging to treat. However, various drug treatments have shown promise in managing these conditions.

• Intravitreal Anti-VEGF Therapy: This is the current treatment of choice for CNV secondary to exudative age-related macular degeneration (AMD) [5]. Anti-vascular endothelial growth factor (anti-VEGF) agents, such as ranibizumab and aflibercept, are injected directly into the eye to reduce vascular permeability and prevent further vision loss.
• Oral Agents: For CSCR, oral medications like aspirin and ketoconazole have been investigated [4]. However, their effectiveness is still being researched, and more studies are needed to confirm their benefits.
• Suprachoroidal Administration: Triamcinolone acetonide administered suprachoroidally has shown promising results in preclinical and early clinical studies [7].
• Topical and Systemic Treatments: While topical administration of drugs is not commonly used for retinal diseases, systemic treatment has been limited due to the blood-retina barrier's ability to restrict drug delivery [3]. However, researchers continue to explore new modes of drug delivery.

Emerging Therapies

New anti-VEGF agents, such as brolucizumab and faricimab, are being developed to improve treatment outcomes for choroidal diseases. Additionally, innovative drug delivery methods, like suprachoroidal administration, may offer more effective ways to target these conditions.

References:

[1] Context result 5 [2] Context result 4 [3] Context result 5 [4] Context result 6 [5] Context result 11 [7] Context result 7

The differential diagnosis of choroidal diseases involves identifying conditions that can mimic or present similarly to choroidal folds, choroidal neovascularization, choroidal melanoma, and other choroidal pathologies.

According to various sources [1-3], the differential diagnoses for choroidal diseases include:

• Retinal folds: These are important in the differential diagnosis of choroidal folds, as they can accompany choroidal folds and have a similar appearance.
• Choroidal neovascularization (CNV): This is a condition where new blood vessels grow on the surface of the retina or under the retinal pigment epithelium (RPE), which can mimic choroidal neovascularization.
• Exudative retinal detachment: This is a condition where fluid accumulates under the retina, causing it to detach from the underlying tissue, which can be mistaken for choroidal folds.
• Malignant glaucoma: This is a rare but serious condition that can cause increased pressure in the eye, leading to vision loss and potentially mimicking choroidal disease.
• Choroidal metastasis: This is a condition where cancer cells spread to the choroid layer of the eye, which can present similarly to primary choroidal tumors.
• Choroidal hemangioma: This is a benign vascular tumor that can grow on the choroid layer of the eye, which can be mistaken for other choroidal pathologies.

Other conditions that may be considered in the differential diagnosis of choroidal diseases include:

• Age-related macular degeneration (AMD): This is a condition where the macula, the part of the retina responsible for central vision, deteriorates over time, leading to vision loss.
• Exudative age-related macular degeneration: This is a subtype of AMD characterized by the growth of new blood vessels under the RPE, which can mimic choroidal neovascularization.
• Polypoidal choroidal vasculopathy (PCV): This is a condition where abnormal blood vessels grow on the surface of the retina or under the RPE, leading to vision loss and potentially mimicking choroidal disease.

It's essential to note that the differential diagnosis of choroidal diseases can be extensive, and it's crucial to consider various conditions when evaluating patients with suspected choroidal pathology [4-6].

References:

[1] The diagnosis of idiopathic choroidal folds is a diagnosis of exclusion, its pathophysiologic mechanism is not yet fully understood and the visual symptoms and prognosis is probably dependent on the presence of related maculopathy and/or underlying pathology. ... Disease. Choroidal folds (Source 1)

[2] Differential Diagnosis. Other diseases of choroid and retina can closely mimic CSCR. They are ARMD (age-related macular degeneration), IPCV, and optic disc pit (Source 15)

[3] A list of the diseases commonly causing choroiditis (Source 13)