Polypoidal Choroidal Vasculopathy Differs in Caucasian Patients

Although polypoidal choroidal vasculopathy is more prevalent in Asian and African populations, older and female patients are more at risk for this disease among Caucasian patients. Photo: Jessica Haynes, OD. Click image to enlarge. It’s often the case that patients of different racial or ethnic backgrounds are variably susceptible to particular diseases. For instance, patients with polypoidal choroidal vasculopathy (PCV) are more often from Asian or African backgrounds.1 A lower prevalence of PCV in Caucasian patients has been reported, but this may be due to underdiagnosis in European countries and North America.2 In a recent study, researchers from the Netherlands assessed medical data and multimodal images of Caucasian patients with PCV to classify, describe and further understand its characteristics.3“A thorough phenotyping and PCV classification system is required to recognize potentially different phenotypes of the disease, as they can result from different pathophysiological mechanisms,” wrote the researchers in their paper, published in Ophthalmology Retina. “Moreover, these phenotypes may also have a different prognosis and may require different treatment strategies.”PCV is closely, but not exclusively, associated with age-related macular degeneration (AMD). It is characterized by a network of branching inner choroidal vessels with terminal, polyp-like aneurismal dilations that appear as multiple reddish-orange protrusions from the choroid into the subretinal space.In order to better understand the characteristics of this retinal disease in a Caucasian population, the researchers gathered medical information on 332 eyes from 305 PCV patients in the Netherlands. Their conditions were categorized as one of the following: PCV with drusenoid AMD (PCV-AMD)PCV without drusen but with a branching neovascular network (PCV-BNN)Isolated PCV without drusen or a branching neovascular network (PCV-i) PCV with a background of central serous chorioretinopathy (PCV-CSC)In addition, the median outcomes of their best-corrected visual acuity (BCVA) and polypoidal lesions per eye were reported.After observing images and patient data, the researchers discovered that PCV-AMD is the most prevalent phenotype for Caucasian patients (58.4%). This was followed by PCV-BNN (18.9%), PCV-CSC (18%) and PCV-i (4.7%). Patients with PCV-AMD were predominantly older and female. It is worth mentioning that the average age of the sample population was 73, and the majority were female (58.7%). The median BCVA was 0.3 logMAR (~20/40 Snellen) and a median of two polypoidal lesions per eye were identified. However, BCVA ranges differed amongst phenotypes while the number of lesions per eye did not.“We believe it is interesting to distinguish between these different types, as they may represent different pathophysiology, and may correlate with a different genetic risk profile, prognosis and management strategy,” concluded the researchers in their paper on the work. “Therefore, this classification may be used in future studies, and we suggest the following nomenclature: type A (PCV-AMD), type B (PCV-BNN), type C (PCV-i), and type D (PCV-CSC). Future studies will have to delineate these phenotypic differences and their pathophysiological background. Longitudinal data can shed further light on prognosis, and potential differences in optimal treatment between these PCV types.” Click here for the journal source.  1. Wong CW, Yanagi Y, Lee W-K, et al. Age-related macular degeneration and polypoidal choroidal vasculopathy in Asians. Progress in Retinal and Eye Research. 2016;53:107-139.2. van Dijk EHC, Holtz JK, Sirks MJ, et al. European prevalence of polypoidal choroidal vasculopathy: A systematic review, meta-analysis, and forecasting study. J Clin Med. 2022;11:4766.3. Sirks MJ, van Dijk EHC, Ghalayini H, et al. The clinical spectrum of polypoidal choroidal vasculopathy in Caucasian patients: A retrospective multicenter cohort study. Ophthalmology Retina. May 1, 2025. [Epub ahead of print].