Purpose: To determine how fundus visibility relates to optical coherence tomography (OCT)-derived morphologic and topographic features of focal choroidal excavation (FCE) and to evaluate systemic and ocular associations in a health-screening cohort. Methods: We analyzed 19,048 individuals undergoing health examinations with spectral-domain OCT and fundus photography. FCEs were classified as fundus-visible or fundus-invisible. A 1:2 propensity score matching (age/sex) was performed to compare participants with FCE against non-FCE controls. Generalized estimating equations were used to analyze lesion characteristics, systemic comorbidities, and ocular parameters including intraocular pressure (IOP), choroidal thickness, and macular degeneration. Results: We identified 252 FCE lesions in 192 participants (1.0%). Compared to matched controls, the FCE group showed no significant differences in systemic comorbidities but had significantly lower IOP ( P = 0.026), greater choroidal thickness ( P < 0.001), and a higher prevalence of macular degeneration ( P = 0.002). Among FCEs, fundus-visible lesions had greater median horizontal diameter (681.0 vs 518.0 µm; P < 0.001) and depth (69.5 vs 45.0 µm; P < 0.001), were located closer to the fovea (611.5 vs 1385.0 µm; P < 0.001), and exhibited higher rates of steep slopes (62.5% vs 42.7%; P = 0.002) and outer nuclear layer thickening (61.7% vs 31.5%; P < 0.001) compared to fundus-invisible lesions. Conclusion: FCE is associated with distinct ocular profiles, including lower IOP and increased choroidal thickness, independent of systemic risk factors. Fundus visibility indicates larger, deeper, and paramacular lesions with specific structural alterations, underscoring the need to recognize subtle fundoscopic irregularities for early OCT detection.
Kim et al. (2026) studied this question.