Abstract
Age related macular degeneration (AMD) in Asians has been suggested to differ from their Western counterparts in terms of epidemiology, pathogenesis, clinical presentation and treatment. In particular, polypoidal choroidal vasculopathy (PCV) appears to be the predominant subtype of exudative AMD in Asian populations, in contrast to choroidal neovascularization secondary to AMD (CNV-AMD) in Western populations. Epidemiological data on PCV has been largely limited to hospital-based studies and there are currently no data on the incidence of PCV. Similarities and differences in risk factor profile between PCV and CNV-AMD point to some shared pathogenic mechanisms but also differential underlying mechanisms leading to the development of each phenotype. Serum biomarkers such as CRP, homocysteine and matrix metalloproteinases suggest underlying inflammation, atherosclerosis and deranged extracellular matrix metabolism as possible pathogenic mechanisms. In addition, recent advances in genome sequencing have revealed differences in genetic determinants of each subtype. While the standard of care for CNV-AMD is anti-vascular endothelial growth factor (VEGF) therapy, photodynamic therapy (PDT) has been the mainstay of treatment for PCV, although long-term visual prognosis remains unsatisfactory. The optimal treatment for PCV requires further clarification, particularly with different types of anti-VEGF agents and possible benefits of reduced fluence PDT.
Highlights
Age-related macular degeneration (AMD) is a disease characterized by chronic and progressive degenerative changes in the central retina and is a leading cause of vision loss [1]
Sakurada et al, compared the associations of systemic risk factors between the two in a hospital-based, cross-sectional, study of 703 cases of polypoidal choroidal vasculopathy (PCV) and CNV-Age related macular degeneration (AMD) [40], They found a higher prevalence of diabetes mellitus (DM) and end stage renal disease (ESRD)
vascular endothelial growth factor (VEGF) related mechanisms might be more important in the pathogenesis of choroidal neovascularization secondary to AMD (CNV-AMD) than PCV. This theory is supported by previous findings that aqueous levels of VEGF are lower in PCV than in CNV-AMD [53]
Summary
Age-related macular degeneration (AMD) is a disease characterized by chronic and progressive degenerative changes in the central retina and is a leading cause of vision loss [1]. The epidemiology, natural history, risk factors, clinical features and treatment of AMD have been well described in Western societies, largely in Caucasian populations [2,3]. AMD has been shown to differ significantly in these areas in Asian populations. Polypoidal choroidal vasculopathy (PCV), a vascular disease of the choroid, appears to be the predominant subtype of exudative or “wet” AMD in Asian populations, in contrast to choroidal neovascularization secondary to AMD (CNV-AMD) in Western populations [4]. CNV-AMD have an excellent therapeutic option, avoiding what used to be an inexorable progression to central retinal scarring and loss of vision. This review summarizes the main advances in our knowledge of PCV in Asians, current therapeutic strategies, outcomes and highlight areas for future research
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