Wide-Field OCTA Evaluation of Dominant Vortex Veins Among Healthy and Pachychoroid Eyes: Distribution Patterns and Choroidal Parameters

Purpose: The purpose of this study was to investigate vortex vein distribution and to compare choroidal parameters between dominant vortex veins (DVVs) and non-DVV (nDVV) regions among healthy eyes and pachychoroid disease (PCD). Methods: This retrospective study used wide-field optical coherence tomography angiography (WF-OCTA) to evaluate DVV number, symmetry, quadrant location, and posterior vortex vein (PVV) presence. Choroidal thickness (CT), choroidal venous volume/area (CVV/a), choroidal stromal volume/area (CSV/a), choroidal vascularity index (CVI), and choroidal stromal index (CSI) were compared between groups and between DVV and nDVV sectors within a 3 × 2 grid. Results: We analyzed 237 eyes from 162 subjects (65.4% male subjects; mean age = 44.66 ± 6.65 years). DVV asymmetry was higher in PCD groups (UCP 88.9% [95% CI = 77.8%-94.8%], PPE 81.7% [95% CI = 71.2%-89.0%], aCSC 93.1% [95% CI = 84.7%-97.0%]) than healthy eyes (75.0%; 95% CI = 59.8%-85.8%) (P = 0.034). Two-DVV patterns were more common in PCD (45.8% UCP, 53.4% PPE, and 49.3% aCSC) than healthy eyes (25.0%; P = 0.006). PVVs were rare in PCD (0% UCP, 0% PPE, and 2.8% [0.8%, 9.6%] aCSC) compared with healthy eyes (15.0% [7.1%, 29.1%]). DVV sectors showed greater temporal CT than nDVV (ΔCT 26.56-38.40 µm across groups), with prominent temporal pachyvessels in PCD. Conclusions: WF-OCTA reveals DVV as a prominent venous feature of PCD. DVV regions exhibit greater thickness and vascularity than nDVV, and diseased eyes display enriched DVV asymmetry with infrequent PVVs. Translational Relevance: DVV asymmetry may serve as an imaging indicator for identifying and monitoring PCD in clinical practice.