TOPLINE

Eyes with pachychoroid disease subtypes remained largely stable over 2 years, with progression to a worse subtype occurring in only 7.3% of cases. Neovascularization developed in 3.4% of eyes, and all cases exhibited shallow, irregular retinal pigment epithelium (RPE) elevation at baseline — a potential imaging marker for identifying higher-risk eyes.

METHODOLOGY

• Researchers conducted a prospective cohort study of 205 eyes (125 participants) with pachychoroid features who completed 2-year follow-up, enrolled from three tertiary eye hospitals in Asia.
• A total of 239 eyes (143 participants) were initially enrolled; mean age of those completing the 2-year follow-up was 59.0 years, and 25.6% were female.
• At baseline, eyes were classified as uncomplicated pachychoroid (19.0%), pachychoroid pigment epitheliopathy (49.8%), central serous chorioretinopathy (22.9%), or pachychoroid neovasculopathy (PNV; 8.3%).
• Multimodal imaging — spectral-domain optical coherence tomography (OCT), OCT angiography (OCTA), optical biometry for axial length, and fundus autofluorescence and color fundus photographs — was performed for all eyes as part of the study protocol; visual acuity was assessed at baseline and at months 6, 12, 18, and 24.
• Primary outcome was progression to a worse pachychoroid subtype; secondary outcomes included development of incident PNV detected on OCTA, treatment initiations, and changes in best-corrected visual acuity and choroidal/retinal thickness.

TAKEAWAY

• Progression to a worse subtype occurred in 15 of 205 eyes (7.3%; 95% CI, 4.5%-11.6%) over 2 years, with most progression events (12 of 15) occurring within the first year.
• Incident PNV developed in 7 eyes (3.4%; 95% CI, 1.7%-6.9%), all of which had shallow, irregular RPE elevation at baseline; no eyes without this feature developed neovascularization.
• Female sex was associated with higher risk of progression in multivariate analysis (13.5% vs 5.2% in males; P = .02) and higher risk of neovascularization (7.7% vs 2.0% in males; P = .02).
• Best-corrected visual acuity and anatomical parameters remained relatively stable even when diagnostic progression occurred; of 7 eyes developing PNV, only 3 (42.9%) required anti-VEGF therapy.

IN PRACTICE

"Taken together, within a relatively small cohort, findings suggest eyes with pachychoroid subtype typically are stable over 2 years, although a shallow, irregular RPE elevation may help identify eyes at higher risk for neovascular complications," wrote the authors of the study.

"As incidentally detected pachychoroid becomes increasingly common, the next challenge is not recognizing pachychoroid disease, but recognizing the eye at risk. Continued refinement of imaging biomarkers and imaging-based risk stratification will be essential to guide personalized surveillance and optimize care across the pachychoroid spectrum," an expert mentioned in an invited commentary.

SOURCE

The study was led by Yu Jeat Chong, MBBS, Singapore National Eye Centre, Singapore. It was published online on August 13 in JAMA Ophthalmology.

LIMITATIONS

The study had a relatively small sample size with few progression events, resulting in wide confidence intervals that limit precision of risk estimates. Because the study only included patients aged 45 years and older, the findings may not apply to younger patients. Follow-up was limited to 2 years, and longer observation periods may reveal additional progression patterns.

DISCLOSURES

The study was supported by grants from the National Medical Research Council, Singapore. One author reported personal fees and nonfinancial support from pharmaceutical companies outside the submitted work. Another author reported a research grant from the study's funding agency, received during the conduct of the study.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.