Comparison of Progression to Advanced Stage between Polypoidal Choroidal Vasculopathy and Age-Related Macular Degeneration in Korea

Abstract

To compare the rate of progression to advanced stage in the fellow eye of patients with typical age-related macular degeneration (AMD) and polypoidal choroidal vasculopathy (PCV) in a South Korean cohort. This is an observational, consecutive retrospective case series. Patients with unilateral advanced stage AMD (n = 288; 180 typical AMD patients and 108 PCV patients). Clinical assessment included detailed eye examination, including fundus photography, fluorescein angiography, and indocyanine green angiography. Five-year progression rate to advanced stage in the fellow eye based on initial Age-Related Eye Disease Study (AREDS) score and the correlation between the initial AREDS score and progression to advanced disease in the fellow eye according to types of AMD. Five-year progression to advanced disease in the fellow eye was similar between typical AMD and PCV cases (11.1% vs. 14.8 %, respectively; P= 0.466, log-rank test). Among patients with initial AREDS score of 2 (normal macula or small drusen on the fellow eye), a higher proportion of patients progressed to advanced disease in the PCV group compared with typical AMD patients (10.4% vs. 2.4 %, respectively; P= 0.0042, log-rank test). Initial AREDS score correlated significantly with progression of the fellow eye to advanced stage in the typical AMD group, after adjusting for age, gender, and other comorbidities (hazard ratio [HR], 9.5; 95% confidence interval [CI], 2.80-32.12; P= 0.0003). However in the PCV group, initial AREDS score did not correlate with progression to advanced stage in the fellow eye (HR, 1.84; 95% CI, 0.83-4.05; P= 0.13). Unlike typical AMD, PCV progresses without typical features such as drusen or pigmentary abnormality. Baseline AREDS score was less likely to predict progression of the fellow eye to advanced-stage disease in PCV compared with typical AMD. Therefore, the globally recognized risk-scoring AREDS system may not be applicable in Asia, where PCV is a prevalent subtype of AMD.