Characteristics and racial variations of polypoidal choroidal vasculopathy in tertiary centers in the United States and United Kingdom

Abstract

Purpose To evaluate the characteristics and racial variations amongst patients with polypoidal choroidal vasculopathy (PCV) in the United States and the United Kingdom.MethodsFundus photos and indocyanine green angiography images were evaluated in a multicenter retrospective study to establish the diagnosis of PCV. Visual acuity (VA) was recorded in ETDRS letter count.ResultsEighty eyes of 71 PCV patients (average age of 69.4 ± 10.4 years) were included in the analysis. Of the total 71 subjects, 46 (65%) were women, 33 (46.5%) were Blacks, 16 (22.5%) were Whites, 19 (26.8%) were Asians and 3 (4.2%) belonged to other races. The Black subgroup had vision gain of 3.5 letters. The White and Asian subgroups had vision loss of 13.1 and 3.5 letters, respectively. There was female predominance in Blacks (67%), Whites (69%), and Asians (58%). PCV was found to be a bilateral disease in 14 patients (20%). There was significant decrease of 7 letters with every decade increase in age (p = 0.005). Final VA was worse in males when compared to females (p = 0.042), and worse in Whites when compared to Blacks (p = 0.005). For every 10 letters worse in initial VA upon diagnosis with PCV, the final VA was worse by 6 letters (p < 0.001). The location of the polypoidal lesion within the macula was associated with significant decrease of 14 letters in BCVA (p = 0.02). The length of follow up was significantly associated with worse visual outcome (p = 0.012). Final VA had no significant correlation with the lens status, or the different treatment modalities.ConclusionsBased on our cohort from tertiary centers in the United States and United Kingdom, PCV is a bilateral disease in one-fifth of patients. It features a variable female predominance based on ethnicity. Increased age, worse vision upon initial presentation, longer follow up and macular location of the polyp were associated with worse visual outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s40942-017-0060-4) contains supplementary material, which is available to authorized users.

Clinical Characteristics of Polypoidal Choroidal Vasculopathy and Anti-Vascular Endothelial Growth Factor Treatment Response in Caucasians

“…Polypoidal lesions were more commonly noted in the peripapillary region in Caucasian and Black female patients. Previous studies on PCV in Caucasian populations produced varying results regarding the extent of macular involvement: Alasil et al [24] reported it in 84%, Lafaut et al [9] in 49%, and Yadav et al [16] in 47%. In contrast to the initial reports on Caucasian and Black patients, PCV in Asian patients tends to be more in the macular region and predominantly in males [18].…”

Polypoidal Choroidal Vasculopathy in Congolese Patients

“…We found a female predominance (57.1%) in the present series. e predominance of female in black PCV patients was also reported among Nigerians (80%) [13], Afro-Caribbean from the French West Indies (71.4%) [36], and in a combined sample of African-Americans and blacks from the United Kingdom (UK) in Alasil et al's study (67%) [10]. Similarly, studies in Caucasians have consistently found females to be more affected than males [10,16,17,19,[25][26][27].…”

“…Across Asian countries, PCV has been reported to affect patients with a mean age range of 65.1-74.5 years in China [20,[28][29][30], 63-67.8 years in Korea [22,31,32], and 65.7-71.9 years in Japan [21,[33][34][35]. e multiracial cohort in Alasil et al's study [10] had a mean age of 69.4 years and, interestingly, no statistically significant difference was observed between blacks (71.1 years), whites (67.8 years), and Asians (67.8 years). Upon close review of the above studies, it appears PCV often occurs in the 7 th and 8 th decades of life.…”

“…Although PVC has been reported to be more frequent in people of African heritage, most available data have come from studies conducted in Europe and the USA [10][11][12]. While it is assumed that blacks in sub-Saharan Africa (SSA) are prone to developing PCV, data to support such an assumption are largely lacking.…”

The needle, or the knife?

“…of patients from the United States and United Kingdom reported a 20% incidence of bilateral disease, variable female predominance and identified poor visual prognostic features of advanced age, worse presenting vision and macular polyp location. Risk factors for submacular haemorrhage specifically may include pulsatile polyps, cluster‐like lesions and systemic anticoagulation …”