Long-term best-corrected visual acuity (BCVA) deteriorates in patients both with polypoidal choroidal vasculopathy (PCV) and those with typical neovascular age-related macular degeneration (nAMD), according to research published in Acta Ophthalmologica. However, the patients with PCV are likely to have better visual outcomes than those with typical nAMD, the real-world study demonstrates.
The researchers used electronic medical records of the Bundang nAMD cohort in the Seoul National University Bundang Hospital and the Asan Medical Center nAMD cohort in the Asan Medical Center. They evaluated and compared mean changes in BCVA from baseline in the eyes of patients with PCV and patients with typical nAMD with a follow up of 1 year or longer, between 2005 and 2018.
A total of 285 eyes of 261 patients with PCV (mean age at onset, 68.5±8.3 years) and 902 eyes of 877 patients (72.5±8.4 years; P <.001) with typical nAMD were included in the study. The PCV group included a higher percentage of males than the typical nAMD group (66.3% vs 55.0%; P <.001), and the typical nAMD group included a higher proportion of patients with hypertension than the PCV group (47.9% vs 40.4%; P = .026).
The researchers found that the baseline BCVA was better in the PCV group than that in the typical nAMD group (0.59±0.52 vs 0.79±0.63 logarithm of the minimum angle of resolution; P <.001). The mean follow-up period of all patients was 4.3±2.8 years. At 1, 3, 5, and 7 years, the team observed mean changes in BCVA from baseline of +2.1, -0.2, -3.9, and -8.7 letters in the PCV group and -0.1, -3.7, -10.5, and -12.1 letters in the typical nAMD group, respectively.
The researchers report that before 2006, the initial BCVA was maintained for approximately 1 year in eyes with PCV and for less than half of a year in eyes with typical nAMD, and that after 2007 when anti-vascular endothelial growth factor (VEGF) agents became available, the initial BCVA was maintained for 4 years in the eyes with PCV and for 1 year in eyes with typical nAMD.
“Long-term visual acuity gradually deteriorated in patients with PCV and typical nAMD in the real world, but patients with PCV showed better visual outcomes than those with nAMD. The change of treatment strategy from [photodynamic therapy] to anti-VEGF injections improved overall visual outcomes in both groups,” wrote the researchers.
Limitations of the study included the retrospective design, exclusion of patients followed for less than 1 year, an overall 5-year follow-up loss rate of 57.8%, lack of investigation of the exact location of PCV and the presence of macular involvement by lesions, the potential impact of the Korean healthcare insurance policy on treatment decisions, evolving criteria and treatment options for nAMD over time, unknown time from diagnosis to first treatment, and inclusion of nAMD patients that received no treatment.
Park JY, Park YJ, Park SJ, et al. Comparison of visual outcomes of polypoidal choroidal vasculopathy and typical neovascular age-related macular degeneration-up to 10 years of follow-up. Published online April 1, 2022. Acta Ophthalmol. doi:10.1111/aos.15149