Managing Polypoidal Choroidal Vasculopathy

In this interview from AAO 2016, Dr. Gregg Kokame discusses his approach to managing polypoidal choroidal vasculopathy (PCV). Because this sub-type of AMD primarily affects Asian populations, Dr. Kokame believes the disease is under-diagnosed in North America. He estimates between 15% to 20% of wet AMD cases in the US are actually PCV. The gold standard currently available to differentiate PCV from other types of neovascularization is indocyanine green angiography (ICG angiography). If ICG angiography is unavailable, Dr. Kokame says that B-scan and en face OCT can help with screening and detection of PCV. In contrast to AMD, some PCV patients fail to respond to anti-VEGF treatment and do better with verteporfin photodynamic therapy (PDT). Recent studies indicate that the combination of PDT and an anti-VEGF agent provides added benefit in treating PCV. Though anti-VEGF is typically the first-line treatment, in cases with vision worse than 20/50, Dr. Kokame offers his patients the option of PDT first.