Polypoidal choroidal vasculopathy: a common type of neovascular age-related macular degeneration in Caucasians

Abstract

The prevalence of PCV in Caucasians is higher than previously reported. Indocyanine Green Angiography should be a standard investigation for all new patients with NAMD, particularly those with occult NAMD, to avoid missing this important subset.

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

“…The presenting characteristics of serous retinal detachment (in 66.7%) and subretinal hemorrhage (in 37%) in this study of PCV in Caucasian patients were very similar to those reported in a large study on Japanese patients, 52% of whom were found to have serous macular detachment and 30% of whom had submacular hemorrhage [27]. Although the highest prevalence of PCV has been noted in Asian countries and populations [3], it has been recently recognized more frequently in Caucasian patients when using ICGA with the SLO for the evaluation of exudative AMD [13][14][15][16][17]. In a study in Brazil on patients of mostly European descent, the prevalence of PCV in Caucasian patients with exudative AMD was 24.5% [14].…”

“…PCV is a subtype of exudative AMD which has been underrecognized in Caucasian populations, often due to the lack of imaging with ICGA in occult choroidal neovascularization associated with AMD [16,17]. A recent increase in the prevalence of PCV in exudative AMD in Caucasian patients, i.e., from 20 to 31%, has been reported [13][14][15].…”

“…Because PCV is thought to be relatively rare in Caucasian patients with exudative AMD and because ICGA is not always available or utilized, it can often go undiagnosed [16,17]. Fluorescein angiography (FA), an imaging technique more commonly used in the diagnosis of exudative AMD, does reveal the presence of subretinal leakage and neovascularization, but lacks the ability to clearly visualize the terminal aneurysmal lesions required to make a PCV diagnosis.…”

“…However, ICGA is less frequently performed due to the low availability, the greater time commitment, the higher cost of dye and imaging equipment, and the lack of understanding and training in reading ICGA for PCV. For these reasons, the prevalence of PCV may be higher in Caucasian populations than previously recognized [13][14][15][16][17]. This underdiagnosis is problematic because there is a higher incidence of resistance to medications targeting vascular endothelial growth factor (VEGF) in PCV [15,[18][19][20] and other possible beneficial treatments for PCV other than anti-VEGF injections [3,15,21].…”

“…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].…”