In Reference to The Association Between Choroidal Thickness and Meniere's Disease: A Cross‐Sectional Study

I am writing to you as an interested reader to discuss the findings and implications of the study titled "The Association Between Choroidal Thickness and Meniere's Disease: A Cross-Sectional Study" conducted by Maliheh Akbarpour et al.1 This study assessed choroidal thickness (ChT) in Meniere's disease (MD) patients using enhanced-depth imaging optical coherence tomography, comparing 37 MD patients to 37 healthy controls. Significant differences were noted in mean subfoveal CT (SCT), large choroidal vessel (LCV) thickness, and the LCV/SCT ratio, with more pronounced LCV thickening in long-term MD cases. We would like to emphasize the importance of considering confounding factors. ChT evaluation was conducted on OCT images with uncertain features. In fact, we wonder why authors utilized microns instead of pixels scale. Also, LCV layer assessment was based on various appearance of choroidal structures, but the brightness impact, that could modify choroidal reflectivity and choroidal vascularization parameters, as highlighted by Rosa et al.2 was not evaluated. Furthermore, the ChT evaluation should be performed taking into account the axial length (AL). In fact, it is well known that choroidal thickness is inversely proportional to AL and an accurate AL estimation is crucial to perform a ChT follow-up, especially in the context of systemic pathologies.3, 4 Additionally, while adjustments were made for age, sex, and migraine, other potential confounding factors such as hypertension and diabetes should be considered in future analyses to ensure the robustness of the findings.5-8 Systemic factors such as autoimmune responses, allergies, and hormonal imbalances, which are known to influence MD, or the use of mydriatic eye drops, were not considered.9-11 These factors could potentially affect choroidal thickness. Lastly, the presence and severity of endolymphatic hydrops (ELH) can vary significantly among patients with MD, which may influence CT measurements. The study overlooked histopathological differences in MD patients' cochlear and vestibular systems, such as endolymphatic sac dysfunction and saccular hydrops, which could affect outcomes. It also failed to consider the temporal variability of MD symptoms, with fluctuating results potentially occurring between active and quiescent phases of the disease. Longitudinal studies are needed to understand these variations better. Genetic factors contributing to MD were not explored. Genetic predisposition can play a significant role in the disease's manifestation and progression, and future research should consider genetic profiling of participants.12, 13 I encourage further research to deepen these findings and explore new therapeutic avenues that could improve disease management.