1
SCIEnTIFIC REpoRTS | (2018) 8:4411 | DOI:10.1038/s41598-018-22745-4
www.nature.com/scientificreports
Macular Choroidal Small-Vessel
Layer, Sattler’s Layer and Haller’s
Layer Thicknesses: The Beijing Eye
Study
Jing Zhao
1
, Ya Xing Wang
1
, Qi Zhang
1
, Wen Bin Wei
2
, Liang Xu
1
& Jost B. Jonas
1,3
To study macular choroidal layer thickness, 3187 study participants from the population-based
Beijing Eye Study underwent spectral-domain optical coherence tomography with enhanced depth
imaging for thickness measurements of the macular small-vessel layer, including the choriocapillaris,
medium-sized choroidal vessel layer (Sattler’s layer) and large choroidal vessel layer (Haller’s layer).
In multivariate analysis, greater thickness of all three choroidal layers was associated (all P < 0.05)
with higher prevalence of age-related macular degeneration (AMD) (except for geographic atrophy),
while it was not signicantly (all P > 0.05) associated with the prevalence of open-angle glaucoma or
diabetic retinopathy. There was a tendency (0.07 > P > 0.02) toward thinner choroidal layers in chronic
angle-closure glaucoma. The ratio of small-vessel layer thickness to total choroidal thickness increased
(P < 0.001; multivariate analysis) with older age and longer axial length, while the ratios of Sattler’s
layer and Haller’s layer thickness to total choroidal thickness decreased. A higher ratio of small-vessel
layer thickness to total choroidal thickness was signicantly associated with a lower prevalence of AMD
(early type, intermediate type, late geographic type). Axial elongation-associated and aging-associated
choroidal thinning aected Haller’s and Sattler’s layers more markedly than the small-vessel layer. Non-
exudative and exudative AMD, except for geographic atrophy, was associated with slightly increased
choroidal thickness.
Based on histological examinations performed by anatomists such as Sattler and Haller as early as 1876, the
choroid has been stratied into three layers: the choriocapillaris, forming the inner layer and contributing its
basement membrane to the structure of Bruch’s membrane; the middle choroidal layer, also called Sattler’s layer
and including the middle-sized choroidal blood vessels; and the outer choroidal layer, also called Haller’s layer
and containing the large choroidal blood vessels
1–3
. A fourth element in the choroidal compartment can be the
suprachoroidal space if the choroid detaches from the sclera in conditions such as ocular hypotony. e choroid
has been described by Nickla and Wallman as a multifunctional tissue, including vascular supply to the outer ret-
ina, temperature regulation, modulation of vascularization and growth of the sclera, and they focusing on some
of the functions attributed to it
3
. Since Spaide and colleagues described in their landmark study the technique for
visualization and semi-quantitative assessment of the choroid by applying the enhanced depth imaging mode of
spectral-domain optical coherence tomography (OCT), numerous investigations have focused on measuring the
thickness of the choroid as a whole and assessing the associations between total choroidal thickness and other
ocular and systemic parameters
4–6
.
The spatial resolution of spectral-domain OCT also allows for visualization of the medium-sized and
small-sized blood vessels in the choroid so that the choroid can be stratied into Haller’s layer, Sattler’s layer, and
the remaining small-vessel layer, which also includes the choriocapillaris. Previous studies have demonstrated
the involvement of the choroid in ocular diseases, such as central serous choroidopathy, polypoidal choroidal
1
Beijing Institute of Ophthalmology and Beijing Ophthalmology and Visual Science Key Lab, Beijing Tongren Eye
Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China.
2
Beijing Tongren Eye Center, Beijing
Tongren Hospital, Capital Medical University, Beijing, China.
3
Department of Ophthalmology, Medical Faculty
Mannheim, Ruprecht-Karls-University Heidelberg, Heidelberg, Germany. Correspondence and requests for materials
should be addressed to Y.X.W. (email: yaxingw@gmail.com) or W.B.W. (email: tr_weiwenbin@163.com) or L.X.
(email: xlbio1@163.com)
Received: 12 October 2017
Accepted: 27 February 2018
Published: xx xx xxxx
OPEN
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