Polypoidal Choroidal Vasculopathy (PCV)

Polypoidal choroidal vasculopathy (PCV) is a retinal disease in which abnormal blood vessels develop beneath the retina and form aneurysm-like enlargements called polyps. These abnormal vessels can leak fluid or blood, leading to swelling, bleeding, and vision loss.

PCV is considered a subtype of macular neovascular disease and shares many similarities with wet age-related macular degeneration (wet AMD). However, PCV has distinct characteristics and may require a different treatment approach.

Early diagnosis and treatment are important because PCV can cause recurrent bleeding and permanent central vision loss if left untreated.

What Is the Choroid?

The choroid is a layer of blood vessels located beneath the retina. It supplies oxygen and nutrients to the retina and retinal pigment epithelium (RPE).

In PCV, abnormal blood vessels develop within the choroid and beneath the retina. These vessels can form balloon-like dilations, or polyps, which are prone to leakage and bleeding.

Who Gets PCV?

PCV is most commonly diagnosed in adults over age 50.

Risk factors may include:

Increasing age
High blood pressure
Smoking
Family history of retinal disease

PCV occurs in all ethnic groups but is more common in individuals of Asian and African ancestry than in Caucasian populations.

Many patients initially receive a diagnosis of wet macular degeneration before specialized imaging identifies PCV.

Symptoms of PCV

Symptoms depend on the amount of fluid or bleeding beneath the retina.

Common symptoms include:

Blurred central vision
Distorted or wavy vision
Dark spots in central vision
Difficulty reading
Sudden vision loss from retinal bleeding

Symptoms often affect one eye initially but can occur in both eyes.

Some patients experience periods of stability followed by episodes of recurrent leakage or bleeding.

How Is PCV Diagnosed?

A retinal specialist diagnoses PCV using a combination of examination and advanced retinal imaging.

Optical Coherence Tomography (OCT)

OCT provides detailed cross-sectional images of the retina and may reveal:

Fluid beneath the retina
Pigment epithelial detachments
Characteristic features suggestive of PCV

Fluorescein Angiography

This imaging test evaluates retinal blood vessel leakage and helps assess macular damage.

Indocyanine Green Angiography (ICGA)

ICGA is considered the gold standard for diagnosing PCV.

This test uses a special dye to visualize the choroidal circulation and identify:

Polyps
Branching vascular networks
Areas of leakage

Fundus Photography

Retinal photographs document bleeding, fluid, and disease progression over time.

How Is PCV Different from Wet Macular Degeneration?

PCV shares many features with wet AMD, including:

Abnormal blood vessel growth
Fluid leakage
Central vision loss

However, PCV differs because:

It forms characteristic polyp-like lesions
It may cause larger retinal hemorrhages
It often responds differently to treatment
Specialized imaging is usually needed for diagnosis

Correct diagnosis is important because treatment strategies may vary.

Treatment for PCV

Modern treatments have significantly improved outcomes for patients with PCV.

Anti-VEGF Injections

Anti-VEGF medications are often the first-line treatment.

These medications help:

Reduce fluid leakage
Stabilize vision
Improve retinal anatomy

Common medications include:

Aflibercept
Faricimab
Ranibizumab
Bevacizumab

Many patients require ongoing injections to maintain disease control.

Photodynamic Therapy (PDT)

Photodynamic therapy may be used in selected patients, particularly when polyps persist despite anti-VEGF treatment.

PDT involves:

Intravenous administration of a light-sensitive medication
Application of a specialized laser
Closure of abnormal blood vessels

In some cases, PDT is combined with anti-VEGF therapy.

Treatment of Retinal Hemorrhage

Large retinal hemorrhages may occasionally require additional procedures or surgery.

What Is the Prognosis?

The outlook for PCV has improved dramatically with modern treatment.

Many patients:

Maintain useful vision
Experience reduced retinal fluid
Achieve long-term disease control

However, PCV may be chronic and recurrent, requiring ongoing monitoring and treatment.

Untreated disease can result in:

Permanent central vision loss
Scarring
Recurrent retinal bleeding

Regular follow-up with a retina specialist is essential.

Living With PCV

Patients with PCV should:

Attend all scheduled appointments
Monitor vision using an Amsler grid if recommended
Report sudden visual changes immediately
Control blood pressure
Avoid smoking

Early treatment of recurrent disease can help preserve vision.

Frequently Asked Questions (FAQ)

Is PCV the same as wet macular degeneration?

Not exactly. PCV is considered a distinct condition with unique abnormal blood vessels, although it shares many similarities with wet AMD.

Can PCV cause blindness?

If left untreated, PCV can cause significant central vision loss. Early diagnosis and treatment greatly improve outcomes.

Will I need injections forever?

Possibly. Some patients require long-term anti-VEGF treatment, while others may achieve longer periods of stability. Treatment plans are individualized based on disease activity.

More Information

For additional patient information, visit the American Society of Retina Specialists Polypoidal Choroidal Vasculopathy Page