Choroidal Structural Changes in Smokers Measured Using Choroidal Vascularity Index

PURPOSE. Cigarette smoking is a known risk factor for vascular dysfunction. This study evaluated choroidal structural changes in smokers using the choroidal vascularity index (CVI) derived from image binarization on spectral domain optical coherence tomography scans with enhanced depth imaging (EDI-OCT). METHODS. This cross-sectional study included 39 smokers and 44 non-smokers. Choroidal images on EDI-OCT were binarized into luminal area (LA) and stromal area (LA). CVI was calculated as the ratio of LA to total choroid area (TCA). CVI, foveal retinal thickness (FRT), and subfoveal choroidal thickness (SFCT) between smokers and non-smokers were compared using likelihood ratio test with linear mixed model. Trend and subgroup analysis were performed to investigate the dose-dependent relationship between CVI/FRT/SFCT and pack-years. RESULTS. CVI in smokers (65 +/- 2%) was lower compared to non-smokers (67 +/- 2%, P = 0.0001). The difference remained significant after adjusting for age (P = 0.001). There was no significant association between cigarette smoking and FRT/SFCT. CVI decreased by 0.12% with each unit increase in smoking measured by pack-year (P = 0.0009). In subgroup analysis, those who smoked 8 to 12 and >12 pack-years had significantly lower CVI compared to non-smokers (both P < 0.05). CONCLUSIONS. Cigarette smoking is associated with decreased choroidal vascularity in healthy subjects, and this association appears to be dose dependent. CVI might be a non-invasive marker of vascular health in smokers.