Reduced Choroidal Vascularity Index in Erectile Dysfunction: An Exploratory Study

To compare choroidal vascularity index (CVI) and choroidal thickness between patients with erectile dysfunction (ED) and healthy controls in an exploratory case–control study. Thirty men with ED and 30 age-matched controls underwent enhanced depth imaging optical coherence tomography. ED was defined as an International Index of Erectile Function–Erectile Function (IIEF-EF) score < 26. Macular CVI, a fovea-centered regional CVI (CVI1500), and subfoveal choroidal thickness (SFCT) were measured using ImageJ after Niblack binarization. Multivariable regression adjusted for age, smoking status, body mass index, spherical equivalent, OCT scan quality, axial length, and, in an exploratory model, SFCT; a non-smoker sensitivity analysis was also performed. Patients with ED had lower SFCT (276.67 ± 49.18 vs. 304.20 ± 45.31 μm, p = 0.028), macular CVI (63.68 ± 2.52% vs. 67.01 ± 1.90%, p < 0.001; d = 1.49), and CVI1500 ( p < 0.001; d = 1.39) mainly reflecting lower luminal area. The ED–CVI association was essentially unchanged after adjustment for SFCT (β = −3.89, p < 0.001) and persisted in non-smokers, although residual confounding cannot be excluded. Interobserver reliability was good to excellent, with ICC values ranging from 0.861 to 0.939. In this exploratory study, ED was associated with reduced choroidal vascularity index, mainly due to lower luminal area and independent of choroidal thinning. CVI may warrant further investigation as a marker of ocular microvascular change in ED.