Polypoidal choroidal vasculopathy in Canada

Polypoidal choroidal vasculopathy (PCV) is an exudative age-related macular degeneration (AMD) subtype found more frequently among Asians than Caucasians. If untreated, it may lead to severe vision loss. PCV appears to be frequently underdiagnosed in Canada, although misdiagnosis of PCV as AMD carries the risk of inadequate treatment and unsatisfactory clinical outcomes. Diagnosis can be made on the basis of multimodal imaging, including optical coherence tomography (OCT) and OCT angiography combined with colour fundus photography, or by other imaging techniques; the gold-standard indocyanine green angiography (ICGA) is not widely used in Canada. Treatment involves anti-vascular endothelial growth factor (anti-VEGF) agents (bevacizumab, ranibizumab, or aflibercept), alone or in combination with photodynamic therapy (PDT). Recent clinical trials have shown that ranibizumab in combination with PDT is superior to ranibizumab monotherapy (EVEREST II), and aflibercept monotherapy is as effective in patients meeting PDT rescue criteria as aflibercept combined with rescue PDT (PLANET). It appears that most Canadian PCV patients are treated with anti-VEGF monotherapy, with or without PDT.