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Review Education GroupChoroidal Folds: A New Wrinkle in Retinal Care

This course is COPE-approved for two hours of CE credit.

As optometrists, we must never underestimate the importance of seemingly trivial clinical findings. One such overlooked aspect, choroidal folds, might be the key to identifying serious ocular and systemic conditions in our patients.

Key Points:

  • Choroidal folds, often overlooked in clinical settings, can have significant implications for a patient’s overall health.
  • They present as wave-like crinkles in the inner choroid, often appearing as alternating light/dark bands​.
  • Choroidal folds can be identified through various imaging techniques like OCT, OCT angiography, Fluorescein angiography, and fundus autofluorescence​.
  • Although not typically associated with visual acuity changes, they can cause blur or metamorphopsia if they develop quickly​.
  • Choroidal folds form due to changes in tension on the sclera, choroid, BM, or RPE, and require investigation upon discovery​.

Additional Points:

  • A mnemonic, THIN-RPE, can help remember the broad differentials for the typical causes of choroidal folds. These include Tumor, Hypotony, Intraocular inflammation, Neoplasms (intraocular or extraocular), Retinal detachment, Pseudotumor cerebri, and Eye surgery​.
  • The underlying cause of choroidal folds can sometimes be a result of medication, such as corticosteroids or even diuretics​.


  • It is important to pay attention to minor clinical findings like choroidal folds. Recognizing and understanding these folds could be pivotal in identifying and managing serious ocular and systemic conditions in patients.

Optometry A-Z

“When we observe choroidal folds clinically, we should never just brush them off but rather ask ourselves what may have caused them to develop in the first place. In most cases, you will find an underlying source if you commit to looking for it.”

Sara Weidmayer, OD​
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