1
|
van Dijk EHC, Holtz JK, Sirks MJ, Larsson JME, Diederen RMH, Schlingemann RO, Boon CJF, Subhi Y. European Prevalence of Polypoidal Choroidal Vasculopathy: A Systematic Review, Meta-Analysis, and Forecasting Study. J Clin Med 2022; 11:jcm11164766. [PMID: 36013005 PMCID: PMC9410106 DOI: 10.3390/jcm11164766] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/01/2022] [Accepted: 08/11/2022] [Indexed: 11/17/2022] Open
Abstract
The purpose of this study was to provide an estimate of the number of current and future patients with polypoidal choroidal vasculopathy (PCV) in Europe. We systematically searched 11 literature databases on 18 May 2022 for studies on the prevalence of PCV among a consecutive and representative group of patients with suspected neovascular age-related macular degeneration (AMD). Prevalence of PCV in patients with suspected neovascular AMD was summarized and included in a prevalence meta-analysis. We then used current population data and population forecasts by Eurostat and the Office for National Statistics to determine current and future number of patients with neovascular AMD in Europe. Then, we calculated the number of patients with PCV with our calculated estimate of the prevalence of PCV among Europeans suspected with neovascular AMD. A total of five eligible studies were identified which included a total of 1359 patients. All these studies used the gold standard of indocyanine green angiography as a routine part of their diagnostic approach. Among patients undergoing detailed retinal examination for suspected neovascular AMD, our meta-analysis calculated the prevalence of PCV to be 8.3% (95% confidence interval: 6.8–9.8%). Our population estimates find that a total of 217,404 patients with PCV exist in Europe in the year 2022, which constitutes 0.04% of the entire population of Europe. This number is estimated to increase to 287,517 patients in the year 2040. Our estimates are important for different healthcare stakeholders, especially when planning and allocating expensive resources.
Collapse
Affiliation(s)
- Elon H. C. van Dijk
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jeppe K. Holtz
- Department of Ophthalmology, Odense University Hospital, 5000 Odense, Denmark
- Department of Otolaryngology, Odense University Hospital, 5000 Odense, Denmark
| | - Marc J. Sirks
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | | | - Roselie M. H. Diederen
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Reinier O. Schlingemann
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
- Department of Ophthalmology, Jules Gonin Eye Hospital, Fondation Asile Des Aveugles, University of Lausanne, 1015 Lausanne, Switzerland
| | - Camiel J. F. Boon
- Department of Ophthalmology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
- Department of Ophthalmology, Amsterdam University Medical Centers, University of Amsterdam, 1012 WX Amsterdam, The Netherlands
| | - Yousif Subhi
- Department of Ophthalmology, Rigshospitalet, 2600 Glostrup, Denmark
- Department of Clinical Research, University of Southern Denmark, 5230 Odense, Denmark
- Correspondence:
| |
Collapse
|
2
|
Polypoidal choroidal vasculopathy in Canada. Can J Ophthalmol 2020; 55:199-211. [DOI: 10.1016/j.jcjo.2019.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/06/2019] [Accepted: 10/15/2019] [Indexed: 11/19/2022]
|
3
|
Polypoidal Choroidal Vasculopathy in Congolese Patients. J Ophthalmol 2020; 2020:4103871. [PMID: 32051763 PMCID: PMC6995324 DOI: 10.1155/2020/4103871] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/21/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose Polypoidal choroidal vasculopathy (PCV) is a visually debilitating disease that mostly affects people of African and Asian heritage. Indocyanine green angiography (ICGA) is the recommended exploratory method for definitive diagnosis. The disease has been extensively described in Asians and Caucasians, but not in Africans. This study was conducted to document the clinical presentation and optical coherence tomography features of polypoidal choroidal vasculopathy (PCV) in Congolese patients. Methods A prospective case series of patients with PCV was performed between January 2017 and June 2019. Routine ocular examination was performed including best corrected visual acuity measurement, slit-lamp examination, dilated direct fundoscopy, and spectral domain optical coherence tomography (OCT). The diagnosis was based on a combination of clinical and OCT signs. Results Fourteen patients were diagnosed with PCV during this period. The average age was 64.7 ± 6.9 years. There were 8 females. Ten (71.4%) patients had systemic hypertension. Most patients (n = 9, 64.3%) had bilateral involvement. Blurred vision was the most common complaint (71.4%). The main clinical presentation was subretinal exudates, seen in 19 (82.6%) eyes of 11 (78.6%) patients and subretinal hemorrhage in 10 (43.5%) eyes. Macular localization was found in 16 eyes (69.5%) of 12 (85.7%) patients. Drusen were observed in 35.7% of the patients. On OCT imaging, thumb-like pigment epithelial detachment and subretinal exudation were the most frequent features, observed in 92.9% and 71.4% of the patients, respectively. Conclusions PCV in Congolese patients showed features that are more similar to those observed in Caucasians. In this setting where indocyanine green angiography is not available, OCT facilitates the diagnosis of PCV.
Collapse
|
4
|
Kokame GT, Liu K, Kokame KA, Kaneko KN, Omizo JN. Clinical Characteristics of Polypoidal Choroidal Vasculopathy and Anti-Vascular Endothelial Growth Factor Treatment Response in Caucasians. Ophthalmologica 2019; 243:178-186. [PMID: 31707394 DOI: 10.1159/000503834] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 10/01/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS To identify the clinical characteristics of polypoidal choroidal vasculopathy (PCV) in Caucasian patients and assess the prevalence of anti-vascular endothelial growth factor (anti-VEGF) resistance. METHODS This involved a retrospective chart review of Caucasian patients diagnosed with PCV and utilizing indocyanine green angiography with the scanning laser ophthalmoscope. Data collected included patients' demographics, disease characteristics, and treatment response. RESULTS There were 54 eyes of 49 patients with PCV; 51.0% were male and 49.0% were female with a mean age of 72.9 years. Forty-four patients (89.8%) had PCV unilaterally and 10.2% (5 patients) had PCV bilaterally. PCV was located in the macula in 79.6%, in the peripapillary region in 16.7%, and in both regions in 3.7%. PCV commonly presents with serous detachment (66.7%), retinal pigment epithelial detachment (RPED) (51.9%) and subretinal hemorrhage (37.0%). Twenty-nine eyes were included in the treatment response analysis, with 18 eyes (62.1%) showing persistent disease activity after 3 initial injections of anti-VEGF treatment. CONCLUSION PCV in Caucasian patients is more often unilateral and presents more commonly in the macular region than the peripapillary region. Serous detachment and RPED are the 2 most common findings. Resistance to current anti-VEGF treatment was noted frequently; it is thus extremely important to identify this subtype of type I subretinal neovascularization.
Collapse
Affiliation(s)
- Gregg T Kokame
- Division of Ophthalmology, Department of Surgery, University of Hawaii School of Medicine, Honolulu, Hawaii, USA, .,The Retina Center at Pali Momi, Aiea, Hawaii, USA, .,Retina Consultants of Hawaii, Aiea, Hawaii, USA, .,Hawaii Macula and Retina Institute, Aiea, Hawaii, USA, .,University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA,
| | - Keke Liu
- The Retina Center at Pali Momi, Aiea, Hawaii, USA.,Retina Consultants of Hawaii, Aiea, Hawaii, USA.,Hawaii Macula and Retina Institute, Aiea, Hawaii, USA.,University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, USA
| | - Kelli A Kokame
- The Retina Center at Pali Momi, Aiea, Hawaii, USA.,Retina Consultants of Hawaii, Aiea, Hawaii, USA.,Hawaii Macula and Retina Institute, Aiea, Hawaii, USA
| | - Kyle N Kaneko
- The Retina Center at Pali Momi, Aiea, Hawaii, USA.,Retina Consultants of Hawaii, Aiea, Hawaii, USA.,Hawaii Macula and Retina Institute, Aiea, Hawaii, USA
| | - Jase N Omizo
- The Retina Center at Pali Momi, Aiea, Hawaii, USA.,Retina Consultants of Hawaii, Aiea, Hawaii, USA.,Hawaii Macula and Retina Institute, Aiea, Hawaii, USA
| |
Collapse
|
5
|
PREVALENCE OF POLYPOIDAL CHOROIDAL VASCULOPATHY IN WHITE PATIENTS WITH EXUDATIVE AGE-RELATED MACULAR DEGENERATION: Systematic Review and Meta-Analysis. Retina 2019; 38:2363-2371. [PMID: 29059101 DOI: 10.1097/iae.0000000000001872] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE Polypoidal choroidal vasculopathy (PCV) is a disease with significant inter-ethnical differences. In this study, we systematically review the literature on the prevalence of PCV in whites referred with a diagnosis of exudative age-related macular degeneration (AMD). METHODS We searched PubMed, Embase, the Cochrane Library, and the Web of Science on 24 March, 2017 for studies evaluating the prevalence of PCV in white patients with exudative AMD. Data extraction and risk of bias assessments were performed in duplicate. Studies were included for a qualitative review and a meta-analysis, including subgroup analysis for differences in age and sex. RESULTS We included data from 11 studies (>2,200 participants). For diagnosis, indocyanine green angiography was used together with a set of supporting criteria on fundus examination and optical coherence tomography. Extramacular location was more prevalent in eyes with PCV. Drusen was present in the fellow eye in 17% to 27%. Pooled prevalence of PCV in white patients with exudative AMD was 8.7% (confidence interval 95%: 7.2%-10.3%). Patients with PCV were 3.7 years (confidence interval 95%: 2.1 years-5.3 years) younger than those with other exudative AMD. Sex did not differ significantly. CONCLUSION Polypoidal choroidal vasculopathy is not a rare subtype of exudative AMD in whites-it is present in approximately one in 11 patients.
Collapse
|
6
|
Palkar AH, Khetan V. Polypoidal choroidal vasculopathy: An update on current management and review of literature. Taiwan J Ophthalmol 2019; 9:72-92. [PMID: 31198666 PMCID: PMC6557071 DOI: 10.4103/tjo.tjo_35_18] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (nAMD), commonly seen in the Asian population. It is dissimilar in epidemiology, genetic heterogeneity, pathogenesis, natural history, and response to treatment in comparison to nAMD. Confocal scanning laser ophthalmoscopy-based simultaneous fluorescein angiography and indocyanine green angiography, spectral-domain optical coherence tomography (OCT) with enhanced depth imaging, swept-source OCT, and OCT angiography have improved the ability to detect PCV, understand its pathology, and monitor treatment response. A plethora of literature has discussed the efficacy of photodynamic therapy, anti-vascular endothelial growth factor (VEGF) monotherapy, and combination of both, but only a few studies with higher level of evidence and limited follow-up duration are available. This review discusses the understanding of PCV with respect to epidemiology, pathogenesis, clinical features, natural history, imaging techniques, and various treatment options. Recent clinical trials (EVEREST-II and PLANET study) have emphasized that either anti-VEGF monotherapy or combination treatment is equally capable to strike a balance between polyp regression and stabilization of visual acuity. The recurrent nature of the disease, the development of macular atrophy, and the long-term poor visual prognosis despite treatment are concerns that open avenues for further research.
Collapse
Affiliation(s)
- Amit Harishchandra Palkar
- Department of Vitreoretinal Services, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Vikas Khetan
- Department of Vitreoretinal Services, Shri Bhagwan Mahavir Vitreoretinal Services, Sankara Nethralaya, Chennai, Tamil Nadu, India
| |
Collapse
|
7
|
Teo KYC, Gillies M, Fraser-Bell S. The Use of Vascular Endothelial Growth Factor Inhibitors and Complementary Treatment Options in Polypoidal Choroidal Vasculopathy: A Subtype of Neovascular Age-Related Macular Degeneration. Int J Mol Sci 2018; 19:ijms19092611. [PMID: 30177632 PMCID: PMC6165414 DOI: 10.3390/ijms19092611] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/17/2018] [Accepted: 08/27/2018] [Indexed: 02/04/2023] Open
Abstract
Polypoidal choroidal vasculopathy (PCV) is a subtype of neovascular age-related macular degeneration (AMD; nAMD) which occurs more commonly in Asian populations as compared to Caucasians. PCV and nAMD share pathological mechanisms, including pathological expression of vascular endothelial growth factor (VEGF). The advent of anti-vascular endothelial growth factor (VEGF) revolutionized the treatment of nAMD. Despite being a subtype of nAMD, PCV responds less well to VEGF inhibitors; thus, photodynamic therapy (PDT) in combination with anti-VEGF treatment may be considered. This review aims to summarize the current evidence for the treatment of PCV, especially whether VEGF inhibitors should be used alone or in combination with PDT.
Collapse
Affiliation(s)
- Kelvin Yi Chong Teo
- Singapore National Eye Centre, Singapore 168751, Singapore.
- Singapore Eye Research Institute, Singapore 169856, Singapore.
- Sydney Eye Hospital Foundation, Sydney Eye Hospital, Sydney 2000, Australia.
| | - Mark Gillies
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney 2000, Australia.
| | - Samantha Fraser-Bell
- The Save Sight Institute, Sydney Medical School, University of Sydney, Sydney 2000, Australia.
| |
Collapse
|
8
|
Ozkaya A, Alagoz C, Garip R, Alkin Z, Perente I, Yazici AT, Taskapili M. The role of indocyanine green angiography imaging in further differential diagnosis of patients with nAMD who are morphologically poor responders to ranibizumab in a real-life setting. Eye (Lond) 2016; 30:958-65. [PMID: 27080484 DOI: 10.1038/eye.2016.71] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/15/2016] [Indexed: 11/09/2022] Open
Abstract
PurposeTo evaluate the neovascular age-related macular degeneration (nAMD) in patients who were morphologically poor responders to intravitreal ranibizumab (IVR) treatment using indocyanine green angiography (ICGA) for further investigation.MethodsThis was a cross-sectional, retrospective study. The patients with an initial diagnosis of nAMD who made through the clinical examination, optical coherence tomography, and fluorescein angiography imaging, and were treated with at least three monthly IVR injections that resulted with a morphological poor response, were included. ICGA was obtained from the patients and evaluated in regard to differential diagnosis of other macular diseases, which might mimic nAMD.ResultsThe study included 132 eyes of 117 patients. The mean age was 67.4±9.4 years. After ICGA imaging, 13 eyes (9.8%) were diagnosed as true nAMD, 74 eyes (56.1%) as polypoidal choroidal vasculopathy (PCV), 35 eyes (26.5%) as chronic central serous chorioretinopathy (CSC), 3 eyes (2.3%) as retinal angiomatous proliferation (RAP), 3 eyes (2.3%) as choroidal neovascularization secondary to CSC, 2 eyes (1.5%) as adult-onset vitelliform macular dystrophy, and 2 eyes (1.5%) as drusenoid pigment epithelial detachment with vitelliform material, respectively. The duration between the initial diagnosis and the revised diagnosis was 15.6±10.5 months in the non-AMD group, and the mean injection number of these patients was 6.6±4.4.ConclusionsMost of the nAMD patients who were thought to be morphologically poor responders to IVR were diagnosed as having non-AMD diseases via ICGA. A detailed differential diagnostic work-up is needed before considering these patients as poor responders.
Collapse
Affiliation(s)
- A Ozkaya
- Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - C Alagoz
- Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - R Garip
- Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - Z Alkin
- Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - I Perente
- Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - A T Yazici
- Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| | - M Taskapili
- Beyoglu Eye Training and Research Hospital, Istanbul, Turkey
| |
Collapse
|
9
|
Pereira FB, Veloso CE, Kokame GT, Nehemy MB. Characteristics of Neovascular Age-Related Macular Degeneration in Brazilian Patients. Ophthalmologica 2015; 234:233-42. [DOI: 10.1159/000439359] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2015] [Accepted: 08/10/2015] [Indexed: 11/19/2022]
Abstract
Purpose: To report features of neovascular age-related macular degeneration (AMD) in Brazilian patients. Procedures: Data were prospectively collected from patients diagnosed with neovascular AMD. Eyes were classified as having typical neovascular AMD, polypoidal choroidal vasculopathy (PCV), or retinal angiomatous proliferation (RAP). Results: In total, 265 eyes of 207 patients of predominantly Caucasian ancestry were included; 166 (62.6%) eyes had typical neovascular AMD, 65 (24.5%) eyes had PCV, and 34 (12.8%) eyes had RAP. RAP demonstrated a higher percentage of bilateral cases (p = 0.015). The mean foveal subfield thickness was significantly lower in eyes with PCV (p < 0.001). Cases with typical neovascular AMD had a higher percentage of predominantly classic and minimally classic lesions on fluorescein angiography (FA; p = 0.005). Conclusions: In Brazilian patients, PCV and RAP represented 24.5 and 12.8% of neovascular AMD cases. Neovascular AMD subtypes differ in relation to clinical features, mean foveal subfield thickness and FA presentation.
Collapse
|
10
|
Broadhead GK, Hong T, Chang AA. Treating the untreatable patient: current options for the management of treatment-resistant neovascular age-related macular degeneration. Acta Ophthalmol 2014; 92:713-23. [PMID: 24925048 DOI: 10.1111/aos.12463] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 05/06/2014] [Indexed: 02/06/2023]
Abstract
Anti-vascular endothelial growth factor (anti-VEGF) agents represent the current standard of care for neovascular age-related macular degeneration (nAMD). Although effective in a majority of cases, a significant proportion of patients have persisting retinal exudation despite regular anti-VEGF therapy. This exudation is considered to produce poorer visual outcomes in these patients. Some of these patients may have misdiagnosed nAMD variants such as polypoidal choroidal vasculopathy; however, the majority of these eyes have what has been termed treatment-resistant nAMD. Currently, the best way to care for these patients is uncertain. Here, we review the evidence for different approaches to the management of treatment-resistant nAMD, including high-dose anti-VEGF therapy, combination regimes and switching of anti-VEGF agents, and discuss possible therapeutic approaches for patients with treatment-resistant nAMD.
Collapse
Affiliation(s)
- Geoffrey K. Broadhead
- Sydney Institute of Vision Science; Sydney NSW Australia
- Save Sight Institute; The University of Sydney; Sydney NSW Australia
| | - Thomas Hong
- Sydney Institute of Vision Science; Sydney NSW Australia
| | - Andrew A. Chang
- Sydney Institute of Vision Science; Sydney NSW Australia
- Save Sight Institute; The University of Sydney; Sydney NSW Australia
| |
Collapse
|
11
|
Tan CSH, Lim LW, Ngo WK, Lim TH. Polypoidal choroidal vasculopathy in patients diagnosed with age-related macular degeneration. Acta Ophthalmol 2013; 91:e578-9. [PMID: 23782725 DOI: 10.1111/aos.12214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Colin S H Tan
- National Healthcare Group Eye Institute, Tan Tock Seng Hospital, SingaporeFundus Image Reading Center, National Healthcare Group Eye Institute, Singapore
| | | | | | | |
Collapse
|