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The Aging of the Choroid

  • Chapter
Age-Related Changes of the Human Eye

Part of the book series: Aging Medicine ((AGME))

Abstract

The first section of this chapter describes the anatomy and the physiology of the choroid and the vascular pattern of the choroidal vessels. The choroid is of fundamental importance for nourishment of the retina so that all the alterations of the choroid lead to a disfunction of the retinal pigment epithelium (RPE), Bruch's membrane, and choriocapillary complex. The various methods used to study the choroid and its pathologies in post-mortem studies and in vivo are described—injection of chromopolimer, Indocyanine Green Angiografy, and Doppler flow studies. Age-related changes of choroid are analyzed. Alterations have been described in the various layers of the choroid, which are part of the physiologic aging process. In certain cases, they can cause disease, but sometimes the border between physiologic and pathologic age-related changes is very hard to identify. The choroid represents the preferential target of certain age-related diseases. In particular, we describe the physiopathology of age-related pathologies such as hypertension, diabetes, AMD, and atherosclerosis—so common in the elderly. In particular, diabetes and AMD represent the main causes of blindness in industrialized countries.

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References

  1. Olver JM (1990) Functional anatomy of the choroidal circulation. Eye 4:262–272

    PubMed  Google Scholar 

  2. Hayreh SS (1962) The ophthalmic artery III. Branches. Br J Ophthalmol. 46:212–247

    Article  CAS  Google Scholar 

  3. Hayreh SS (1995) The 1994 Von Sallman Lecture. The optic nerve head circulation in health and disease. Exp Eye Res. 61:257–272

    Article  Google Scholar 

  4. Hayreh SS (2001) The blood supply of the optic nerve head and the evaluation of it: myth and reality. Prog Retin Eye Res. 20:563–593

    Article  PubMed  CAS  Google Scholar 

  5. Ducournau D (1979) Systematisation vasculaire de la choroide. Lyon, France: Association Corporative des Etudiants en Medecine de Lyon 17–22

    Google Scholar 

  6. Olver JM (1990) Functional anatomy of the choroidal circulation: methyl methacrylate casting of human choroid. Eye. 4:262–272

    PubMed  Google Scholar 

  7. Hayreh SS (1974) The long posterior ciliary arteries: an experimental study. Graefes Arch Clin Exp Ophthalmol. 192:197–213

    Article  CAS  Google Scholar 

  8. Hayreh SS, Baines JAB (1972) Occlusion of the posterior ciliary artery I. Effects on choroidal circulation. Br J Ophthalmol. 56:719–735

    Article  PubMed  CAS  Google Scholar 

  9. Hayreh SS, Baines JAB (1972) Occlusion of the posterior ciliary artery II. Chorio-retinal lesions. Br J Ophthalmol. 56:736–753

    Article  PubMed  CAS  Google Scholar 

  10. Hayreh SS, Baines JAB (1972) Occlusion of the posterior ciliary artery III. Effects on the optic nerve head. Br J Ophthalmol. 56:754–764

    Article  PubMed  CAS  Google Scholar 

  11. Hayreh SS, Chopdar A (1982) Occlusion of the posterior ciliary artery V. Protective influence of simultaneous vortex vein occlusion. Arch Ophthalmol. 100:1481–1491

    PubMed  CAS  Google Scholar 

  12. Hayreh SS (1974) Anterior ischaemic optic neuropathy I. Terminology and pathogenesis. Br J Ophthalmol. 58:955–963

    Article  PubMed  CAS  Google Scholar 

  13. Hayreh SS (1974) Anterior ischaemic optic neuropathy II. Fundus on ophthalmoscopy and fluorescein angiography. Br J Ophthalmol. 58:964–980

    Article  PubMed  CAS  Google Scholar 

  14. Hayreh SS (1985) Inter-individual variation in blood supply of the optic nerve head: its importance in various ischemic disorders of the optic nerve head, and glaucoma, low-tension glaucoma and allied disorders. Doc Ophthalmol. 59:217–246

    Article  PubMed  CAS  Google Scholar 

  15. Hayreh SS (1990) Anterior ischaemic optic neuropathy: differentiation of arteritic from nonarteritic type and its management. Eye. 4:25–41

    PubMed  Google Scholar 

  16. Hayreh SS (1996) Acute ischemic disorders of the optic nerve: pathogenesis, clinical manifestations and management. Ophthalmol Clin North Am. 9:407–442

    Google Scholar 

  17. Hayreh SS, Podhajsky PA, Zimmerman B (1998) Ocular manifestations of giant cell arteritis. Am J Ophthalmol. 125:509–520

    Article  PubMed  CAS  Google Scholar 

  18. Hayreh SS (1975) Segmental nature of the choroidal vasculature. Br J Ophthalmol. 59:631–648

    Article  PubMed  CAS  Google Scholar 

  19. Hayreh SS (1983) Physiological anatomy of the choroidal vascular bed. Int Ophthalmol. 6:85–93

    Article  PubMed  CAS  Google Scholar 

  20. Hayreh SS (1990) In vivo choroidal circulation and its watershed zones. Eye. 4:273–289

    PubMed  Google Scholar 

  21. Hayreh SS, Scott WE (1978) Fluorescein iris angiography II. Disturbances in iris circulation following strabismus operation on the various recti. Arch Ophthalmol. 96:1390–1400

    PubMed  CAS  Google Scholar 

  22. Virdi PS, Hayreh SS (1987) Anterior segment ischemia after recession of various recti: an experimental study. Ophthalmology. 94:1258–1271

    PubMed  CAS  Google Scholar 

  23. Hayreh SS (1974) The choriocapillaris. Graefes Arch Clin Exp Ophthalmol. 1974;192:165–179

    Article  CAS  Google Scholar 

  24. Hayreh SS (1981) Controversies on submacular choroidal circulation. Ophthalmologica. 1981;183:11–19

    Article  PubMed  CAS  Google Scholar 

  25. Hayreh SS (1981) Anterior ischemic optic neuropathy. Arch Neurol. 1981;38:675–678.

    PubMed  CAS  Google Scholar 

  26. Takahashi K, Muraoka K, Kishi S, Shimizu K (1996) Watershed zone in the human peripheral choroid. Ophthalmology. 103:336–342

    PubMed  CAS  Google Scholar 

  27. Ernest JT (1976) Stern WH. Archer DB. Submacular choroidal circulation. Am J Ophthalmol. 81:574–582

    PubMed  CAS  Google Scholar 

  28. Torczynski E, Tso MO (1976) The architecture of the choriocapillaris at the posterior pole. Am J Ophthalmol. 81:428–440

    PubMed  CAS  Google Scholar 

  29. Stern WH, Ernest JT (1974) Microsphere occlusion of the choriocapillaris in rhesus monkeys. Am J Ophthalmol. 78:438–448

    PubMed  CAS  Google Scholar 

  30. Hayashi K, de Laey JJ (1985) Indocyanine green angiography of submacular choroidal vessels in the human eye. Ophthalmologica. 190:20–29

    Article  PubMed  CAS  Google Scholar 

  31. Giuffre G (1989) Main posterior watershed zone of the choroid: variations of its position in normal subjects. Doc Ophthalmol. 72:175–180

    Article  PubMed  CAS  Google Scholar 

  32. Giovannini A, Mariotti C, Ripa E, Scassellati Sforzolini B, Tittarelli R (1994) Choroidal filling in age-related macular degeneration: indocyanine green angiographic findings. Ophthalmologica. 208:185–191

    Article  PubMed  CAS  Google Scholar 

  33. Ross RD, Barofsky JM, Cohen G, Baber WB, Palao SW, Gitter KA (1998) Presumed macular choroidal watershed vascular filling, choroidal neovascularization, and systemic vascular disease in patients with age-related macular degeneration. Am J Ophthalmol. 125:71–80

    Article  PubMed  CAS  Google Scholar 

  34. Sato Y, Tomita G, Onda E, Goto Y, Oguri A, Kitazawa Y (2000) Association between watershed zone and visual field defect in normal tension glaucoma. Jpn J Ophthalmol. 44:39–45

    Article  PubMed  CAS  Google Scholar 

  35. Ito YN, Mori K, Young-Duvall J, Yoneya S (2001) Aging changes of the choroidal dye filling pattern in indocyanine green angiography of normal subjects. Retina 21:237–242

    Article  PubMed  CAS  Google Scholar 

  36. Oto S, Yilmaz G, Cakmakci S, Aydin P (2002) Indocyanine green and fluorescein angiography in nonarteritic anterior ischemic optic neuropathy. Retina 22:187–191

    Article  PubMed  Google Scholar 

  37. Hayreh SS, Bauines JA (1973) Occlusion of the vorteix veins: an experimental study. Br J Ophthalmol 57:217–38

    Article  PubMed  CAS  Google Scholar 

  38. Hayreh SS (1974) Submacular choroidal vascular pattern: experimental fluorescein fundus angiographic studies. Graefes Arch Clin Exp Ophthalmol 192:181–96

    Article  CAS  Google Scholar 

  39. Keisuke M (2004) Asimmetry of choroidal venous vascular patterns in the human eye Ophthalmology 111:507–512

    Google Scholar 

  40. Yanoff M, Duker JS (2005) Ophthalmology 3:1–4

    Google Scholar 

  41. Parver LM, Auker C, Carpenter DO (1980) Choroidal blood flow as a heat dissipative mechanism in the macula. Am J Ophthalmol 89:641

    PubMed  CAS  Google Scholar 

  42. Hogan MJ, Alvarado J (1967) Studies on the human macula. IV. Aging changes in Bruch's membrane. Arch Ophthalmol 77:410–20

    PubMed  CAS  Google Scholar 

  43. Ramrattan RS, van der Schaft TL, Mooy CM, de Bruijn WC, Mulder PG, de Jong PT (1994) Morphometric analysis of Bruch's membrane, the choriocapillaris, and the choroid in aging. Invest Ophthalmol Vis Sci 35:2857–64

    PubMed  CAS  Google Scholar 

  44. Killingsworth MC (1987) Age-related components of Bruch's membrane in the human eye. Graefes Arch Clin Exp Ophthalmol 225:406–12

    Article  PubMed  CAS  Google Scholar 

  45. Sarks SH (1976) Ageing and degeneration in the macular region: a clinico-pathological study. Br J Ophthalmol 60:324–41

    Article  PubMed  CAS  Google Scholar 

  46. Feeney-Burns L, Ellersieck MR (1985) Age-related changes in the ultrastructure of Bruch's membrane. Am J Ophthalmol 100:686–97

    PubMed  CAS  Google Scholar 

  47. Green WR, Enger C (1993) Age-related macular degeneration histopathologic studies. The 1992 Lorenz E. Zimmerman Lecture. Ophthalmology 100:1519–35

    PubMed  CAS  Google Scholar 

  48. Sarks SH, Arnold JJ, Killingsworth MC, Sarks JP (1999) Early drusen formation in the normal and aging eye and their relation to age related maculopathy: a clinicopathological study. Br J Ophthalmol 83:358–68

    Article  PubMed  CAS  Google Scholar 

  49. Loeffler KU, Lee WR (1986) Basal linear deposit in the human macula. Graefes Arch Clin Exp Ophthalmol 224:493–501

    Article  Google Scholar 

  50. Curcio CA, Millican CL (1999) Basal linear deposit and large drusen are specific for early age-related maculopathy. Arch Ophthalmol 117:329–39

    PubMed  CAS  Google Scholar 

  51. Burns RP, Feeney-Burns L (1980) Clinico-morphologic correlations of drusen of Bruch's membrane. Trans Am Ophthalmol Soc 78:206–25

    PubMed  CAS  Google Scholar 

  52. Ishibashi T, Sorgente N, Patterson R, Ryan SJ (1986) Aging changes in Bruch's membrane of monkeys: an electron microscopic study. Ophthalmologica 192:179-90

    Article  PubMed  CAS  Google Scholar 

  53. Young RW (1987) Pathophysiology of age-related macular degeneration. Surv Ophthalmol 31:291–306

    Article  PubMed  CAS  Google Scholar 

  54. El Baba F, Green WR, Fleischmann J, Finkelstein D, de la Cruz ZC (1986) Clinicopathologic correlation of lipidization and detachment of the retinal pigment epithelium. Am J Ophthalmol 101:576–83

    PubMed  CAS  Google Scholar 

  55. Friedman E, Smith TR, Kuwabara T (1963) Senile choroidal vascular patterns and drusen. Arch Ophthalmol 69:220–30

    PubMed  CAS  Google Scholar 

  56. Ruberti JW, Curcio CA, Millican CL, Menco BP, Huang JD, Johnson M (2003) Quick-freeze∕ deep-etch visualization of age related lipid accumulation in Bruch's membrane. Invest Ophthalmol Vis Sci 44:1753–9

    Article  PubMed  Google Scholar 

  57. Starita C, Hussain AA, Pagliarini S, Marshall J (1996) Hydrodynamics of ageing Bruch's membrane: implications for macular disease. Exp Eye Res 62:565–72

    Article  PubMed  CAS  Google Scholar 

  58. Fisher RF (1987) The influence of age on some ocular basement membranes. Eye 1:184–9

    PubMed  Google Scholar 

  59. Lakatta EG, Levy D (2003) Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises: Part I: aging arteries: a ‘set up’ for vascular disease. Circulation 107:139–46

    Article  PubMed  Google Scholar 

  60. Haimovici R, Gantz DL, Rumelt S, Freddo TF, Small DM (2001) The lipid composition of drusen, Bruch's membrane, and sclera by hot stage polarizing light microscopy. Invest Ophthalmol Vis Sci 42:1592–9

    PubMed  CAS  Google Scholar 

  61. Barnes MJ, Farndale RW (1999) Collagens and atherosclerosis. Exp Gerontol 34:513–25

    Article  PubMed  CAS  Google Scholar 

  62. Karwatowski WS, Jeffries TE, Duance VC, Albon J, Bailey AJ, Easty DL (1995) Preparation of Bruch's membrane and analysis of the age-related changes in the structural collagens. Br J Ophthalmol 79:944–52

    Article  PubMed  CAS  Google Scholar 

  63. Grunwald JE, Hariprasad SM, DuPont J (1998) Effect of aging on foveolar choroidal circulation. Arch Ophthalmol 116:150–154

    PubMed  CAS  Google Scholar 

  64. Raab MF, Gagliano DA, Teske MP (1988) Retinal arterial macroaneurysms. Surv Ophthalmol 33:73–96

    Article  Google Scholar 

  65. Ring HG, Fujino T (1967) Observations on the anatomy and pathology of the choroidal vascu-lature. Arch Ophthalmol 78:431–444

    PubMed  CAS  Google Scholar 

  66. Robertson DM (1973) Macroaneurysms of the retinal arteries. Trans Am Acad Ophthalmol Otolaryngol 77:55–67

    Google Scholar 

  67. Russell RWR (1963) Observations on intracerebral microaneurysms. J Pathol 93:393–398

    Google Scholar 

  68. Sarks SH (1973) Senile choroidal sclerosis.Br J Ophthalmol 57:98–109

    Article  PubMed  CAS  Google Scholar 

  69. Friedman E, Smith TR, Kuwabara T, Beyer C (1964) Choroidal vascular patterns in hypertension. Arch Ophthalmol 71:842–850

    PubMed  CAS  Google Scholar 

  70. McLeod DS, Lutty GA (1994) Highresolution histologic analysis of the human choroidal vasculature. Invest Ophthalmol Vis Sci 35:3799–3811

    PubMed  CAS  Google Scholar 

  71. Pauleikhoff D (1990) Aging of Bruch's membrane: histological, morphologic and clinical correlation. Proc int soc eye res VI 337:101

    Google Scholar 

  72. Ciulla TA, Harris A, Kagemann et al. (2002) Choroidal perfusion perturbations in non-neovascular age related macular degeneration. Br J Ophthalmol 86:209–13

    Article  PubMed  Google Scholar 

  73. Sarks SH (1978) Changes in the region of the choriocapillaris in aging and degeneration. XXIII Concilium Ophthalmologicum, Kyoto, 1978. Amsterdam: Excerpta Medica 228–38

    Google Scholar 

  74. Sarks JP, Sarks SH, Killingsworth MC (1988) Evolution of geographic atrophy of the retinal pigment epithelium. Eye 2:552–77

    PubMed  Google Scholar 

  75. Korenzweig AB (1977) Changes in the choriocapillaries associated with senile macular degeneration. Ann Ophthalmol 9:753–64

    Google Scholar 

  76. Grunwald JE, Metelitsina TI, Dupont JC, et al. (2005) Reduced foveolar choroidal blood flow in eyes with increasing AMD severity. Invest Ophthalmol Vis Sci 46:1033–8

    Article  PubMed  Google Scholar 

  77. Loeffler KU, Hayreh SS, Tso MOM (1994) The effects of simultaneous occlusion of the posterior ciliary artery and vortex veins. Arch Ophthalmol. 112:674–682

    PubMed  CAS  Google Scholar 

  78. Kishi S, Tso MOM, Hayreh SS (1985) Fundus lesions in malignant hypertension I. A pathologic study of experimental hypertensive choroidopathy. Arch Ophthalmol. 103:1189-1197

    PubMed  CAS  Google Scholar 

  79. Hayreh SS, Servais GE, Virdi PS (1986) Fundus lesions in malignant hypertension VI. Hypertensive choroidopathy. Ophthalmology 93:1383–1400

    PubMed  CAS  Google Scholar 

  80. Hayreh SS (1980) Acute choroidal ischaemia. Trans Ophthalmol Soc UK. 100:400–407

    PubMed  CAS  Google Scholar 

  81. Hayreh SS (1975) Anterior Ischemic Optic Neuropathy. Springer-Verlag, Heidelberg, Germany

    Google Scholar 

  82. Hayreh SS (1983) Macular lesions secondary to choroidal vascular disorders. Int Ophthalmol 6:161–170

    Article  PubMed  CAS  Google Scholar 

  83. Foos RY, Trese MT (1982) Chorioretinal juncture. Arch Ophthalmol 100:1492–1503

    PubMed  CAS  Google Scholar 

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Acknowledgments

We are happy to acknowledge Prof Fernando Galassi (Clinica Oculistica, Universita di Firenze) for his contribution to the color Doppler imaging section of this chapter.

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Authors and Affiliations

  1. Department of Ophthalmology, University of Rome “Tor Vergata,”, Rome, Italy

    Angelica Cerulli MD & Federico Regine MD

  2. San Raffaele Hospital, Department of Ophthalmology and Vision Sciences, University of Milan, Milan, Italy

    Giuseppe Carella MD, PhD & Giuseppe Carella MD, PhD

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  1. Angelica Cerulli MD
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  2. Federico Regine MD
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  3. Giuseppe Carella MD, PhD
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Editors and Affiliations

  1. Department of Cardiovascular, Respiratory and Morphological Sciences, University of Rome, La Sapienza, Rome, Italy

    Carlo A. P. Cavallotti MD, PhD

  2. Department of Ophthalmology, University of Rome, Tor Vergata, Rome, Italy

    Luciano Cerulli MD, PhD

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Cerulli, A., Regine, F., Carella, G. (2008). The Aging of the Choroid. In: Cavallotti, C.A.P., Cerulli, L. (eds) Age-Related Changes of the Human Eye. Aging Medicine. Humana Press. https://doi.org/10.1007/978-1-59745-507-7_11

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  • DOI: https://doi.org/10.1007/978-1-59745-507-7_11

  • Publisher Name: Humana Press

  • Print ISBN: 978-1-934115-55-8

  • Online ISBN: 978-1-59745-507-7

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