Relationship of Smoking and Cardiovascular Risk Factors with Polypoidal Choroidal Vasculopathy and Age-related Macular Degeneration in Chinese Persons

Cackett, Peter; Yeo, Ian; Cheung, Chui Ming Gemmy; Vithana, Eranga N.; Wong, Doric; Tay, Wan Ting; Tai, E. Shyong; Aung, Tin; Wong, Tien Yin

doi:10.1016/j.ophtha.2010.09.026

Cited by 68 publications

(51 citation statements)

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“…Previous reports have indicated an increase risk and severity of choroidal neovascularization in smokers, 5,7,32 which may be related to nicotine-induced increase in retinal pigment epithelial vascular endothelial growth factor. 48,49 Similarly we observed a strong correlation between increased pack-years and a history of choroidal neovascularization in fellow eyes of those with chronic tobacco smoke exposure, indicating a dose-dependent increased risk of late AMD in smokers.…”

Section: Discussionmentioning

confidence: 95%

“…Smoking has also been associated with increased risk of polypoidal choroidal vasculopathy (PCV), a process typically demonstrating a thicker than normal choroid. 32 However, it may be difficult to accurately assess choroidal thickness in the context of a neovascular process, since type 1 neovascularization adds to choroidal thickness. Additional smoking related factors may be important in PCV, such as complement factor, and VEGF alterations.…”

Section: Discussionmentioning

confidence: 99%

“…26,27 Both smoking history and the presence of early AMD are associated with the development of late AMD, including both geographic atrophy and choroidal neovascularization. 1,[8][9][10][11][12][13]32 Therefore, choroidal thickness may be an additional useful clinical variable in assessing risk of AMD progression or the development of late AMD, particularly considering its apparent anatomic association with these two well-known risk factors. While a thin choroid is not necessarily related to blood flow or overall function, 50 there is evidence of regional choroidal blood flow alterations in AMD, [51][52][53][54][55] which may involve an overall decrease in blood flow and regional volume.…”

Section: Discussionmentioning

confidence: 99%

“…Smokers may also be at higher risk for the development and severity of choroidal neovascularization. 7,32 We hypothesized that smokers may have distinct choroidal anatomic features that may include an overall thin choroid. The purpose of the present study was to evaluate central macular choroidal thickness among patients with drusen, early-atrophic AMD, and normals.…”

Section: Introductionmentioning

confidence: 99%

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Smoking and choroidal thickness in patients over 65 with early-atrophic age-related macular degeneration and normals

Sigler

Randolph

Calzada

et al. 2014

Eye

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Objective To compare macular choroidal thickness between cigarette smokers, those with a history of smoking, and nonsmokers in patients over 65 years of age with earlyatrophic age-related macular degeneration (AMD) and normals. Methods Prospective, consecutive, observational case series. Enhanced depth imaging spectral domain optical coherence tomography 12-line radial scans were performed and choroidal thickness manually quantified at 84 points in the central 3 mm of the macula. Data of normals, soft drusen alone, and soft drusen with additional features of early AMD were compared. A multivariate analysis of variance (MANOVA) model, controlling for age, was constructed to evaluate the effect of smoking history and AMD features on choroidal thickness. Results A history of smoking was significantly associated with a thinner choroid across all patients via logistic regression (P ¼ 0.004; O.R. ¼ 12.4). Mean macular choroidal thickness was thinner for smokers (148±63 mm) than for nonsmokers (181±65 mm) among all diagnosis categories (P ¼ 0.003). Subgroup analysis of patients with AMD features revealed a similar decreased choroidal thickness in smokers (121 ± 41 mm) compared with nonsmokers (146 ± 46 mm, P ¼ 0.006). Bivariate analysis revealed an association between increased pack-years of smoking and a thin choroid across all patients (Po0.001) and among patients with features of early AMD (Po0.001). Both the presence of features of macular degeneration (Po0.001) and a history of smoking (P ¼ 0.024) were associated with decreased choroidal thickness in a MANOVA model. ConclusionChronic cigarette smoke exposure may be associated with decreased choroidal thickness. There may be an anatomic sequelae to chronic tobacco smoke exposure that underlies previously reported AMD risk.

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Smoking and choroidal thickness in patients over 65 with early-atrophic age-related macular degeneration and normals

Sigler

Randolph

Calzada

et al. 2014

Eye

View full text Add to dashboard Cite

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“…Another report demonstrated that C-reactive protein levels were increased in patients with PCV [41]. Cigarette smoking is a potent risk factor for PCV [42], and a history of central serous chorioretinopathy was a significant risk factor for PCV [38]. …”

Section: Epidemiologymentioning

confidence: 99%

Polypoidal Choroidal Vasculopathy: Clinical Features and Genetic Predisposition

2013

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Polypoidal choroidal vasculopathy (PCV) is currently recognized as a phenotype of age-related macular degeneration (AMD). PCV is believed to be a type of choroidal neovascularization, although some cases of PCV show a distinct vascular abnormality of the choroidal vessels. PCV often shows several unique clinical manifestations which are apparently different from typical neovascular AMD (tAMD). In addition, the natural course and response to treatment are often different between tAMD and PCV. Moreover, recent genetic studies suggested a possible difference in the genetic susceptibility to disease between tAMD and PCV, as well as the existence of heterogeneity among PCV cases. In viewing the accumulation of knowledge about PCV, we have summarized the recent literature regarding PCV in this review article to improve the understanding of this clinical entity including possible susceptibility genes. We will also discuss the optimal treatment strategies for PCV in accordance with the results of recent clinical and genetic studies.

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Efficacy and Safety of Ranibizumab With or Without Verteporfin Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

et al. 2017

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for the EVEREST II study group IMPORTANCE Polypoidal choroidal vasculopathy (PCV) is a common subtype of exudative age-related macular degeneration among Asian individuals. To our knowledge, there are no large randomized clinical trials to evaluate intravitreal ranibizumab, with and without verteporfin photodynamic therapy (vPDT), for the treatment of PCV.OBJECTIVE To compare the efficacy and safety of combination therapy of ranibizumab and vPDT with ranibizumab monotherapy in PCV. DESIGN, SETTING, AND PARTICIPANTSA double-masked, multicenter randomized clinical trial of 322 Asian participants with symptomatic macular PCV confirmed by the Central Reading Center using indocyanine green angiography was conducted between August 7, 2013, and March 2, 2017.INTERVENTIONS Participants were randomized 1:1 to ranibizumab, 0.5 mg, and vPDT (n = 168; combination therapy group) or ranibizumab, 0.5 mg, and sham PDT (n = 154; monotherapy group). All participants received 3 consecutive monthly ranibizumab injections, followed by a pro re nata regimen. Participants also received vPDT/sham PDT on day 1, followed by a pro re nata regimen based on the presence of active polypoidal lesions. MAIN OUTCOMES AND MEASURESStep 1 assessed whether combination therapy was noninferior (5-letter margin) to monotherapy for change in best-corrected visual acuity from baseline and superior in complete polyp regression. If noninferiority was established, step 2 assessed whether combination therapy was superior to monotherapy measured by best-corrected visual acuity change at month 12.RESULTS Baseline demographics of the 322 participants were comparable between the treatment groups. Mean (SD) age of the patients was 68.1 (8.8) years, and overall, 69.9% of the patients were men. At baseline, the overall mean best-corrected visual acuity and mean central subfield thickness were 61.1 letters and 413.3 μm, respectively. At 12 months, mean improvement from baseline was 8.3 letters with combination therapy vs 5.1 letters with monotherapy (mean difference, 3.2 letters; 95% CI, 0.4-6.1), indicating that combination therapy met the predefined criterion for noninferiority as well as being superior to monotherapy (P = .01). Combination therapy was also superior to monotherapy in achieving complete polyp regression at month 12 (69.3% vs 34.7%; P < .001). Over 12 months, the combination therapy group received a median of 4.0 ranibizumab injections compared with 7.0 in the monotherapy group. Vitreous hemorrhage was the only ocular serious adverse event (combination therapy group, 1 [0.6%]; monotherapy group, 3 [2.0%]).CONCLUSIONS AND RELEVANCE After 12 months, combination therapy of ranibizumab plus vPDT was not only noninferior but also superior to ranibizumab monotherapy in best-corrected visual acuity and superior in complete polyp regression while requiring fewer injections. Combination therapy should be considered for eyes with PCV.TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01846273.

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Relationship of Smoking and Cardiovascular Risk Factors with Polypoidal Choroidal Vasculopathy and Age-related Macular Degeneration in Chinese Persons

Cited by 68 publications

References 54 publications

Smoking and choroidal thickness in patients over 65 with early-atrophic age-related macular degeneration and normals

Smoking and choroidal thickness in patients over 65 with early-atrophic age-related macular degeneration and normals

Polypoidal Choroidal Vasculopathy: Clinical Features and Genetic Predisposition

Efficacy and Safety of Ranibizumab With or Without Verteporfin Photodynamic Therapy for Polypoidal Choroidal Vasculopathy

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