Polypoidal Choroidal Vasculopathy (PCV): Diagnosis, Treatment, and Where Integrative Care Fits

In short. Polypoidal choroidal vasculopathy (PCV) is a type of wet age-related macular degeneration, in which abnormal vessels under the retina form small bulges called polyps. It is more common in people of Asian and African descent. A retina specialist diagnoses it with an OCT scan and, ideally, an ICG angiogram, a dye test that shows the polyps. Treatment is anti-VEGF eye injections, sometimes combined with a light-activated drug treatment called photodynamic therapy (PDT). A sudden drop in vision can mean bleeding under the retina and needs same-day care. Integrative care can sit alongside this plan, but it does not replace it.

What PCV is. PCV starts in the choroid, the layer of blood vessels under the retina. A branching network of abnormal vessels grows there, with polyp-like bulges at its edges that leak fluid and blood [1]. Many eyes with PCV have a thick, congested choroid, part of the "pachychoroid" group that also includes central serous chorioretinopathy (see central serous chorioretinopathy) [1].

How common it is depends on who is studied. In 1,600 Japanese patients with wet AMD, 45.8% had PCV [2]. In a mostly white US series of 167 people with presumed wet AMD, 7.8% had PCV, more often in non-white patients [3].

In a large series of Black patients in Martinique, the polyps were often next to the optic nerve [4]. Symptoms are blurred or bent central vision, a grey patch, or sudden loss of vision from bleeding. Some people have no symptoms until a bleed.

How it is diagnosed. An OCT scan often shows signs that point to PCV. These include a sharp-peaked bump in the pigment layer, a ring-like lesion beneath it, and an uneven lift of that layer. In a test group of 80 eyes, these three signs together told PCV from typical wet AMD with 82% accuracy [5].

ICG angiography is still the reference test, because it shows the polyps directly and guides where PDT is aimed [1]. Ask your specialist whether you have had one.

Treatments with good evidence

Anti-VEGF injections combined with PDT. Anti-VEGF drugs such as ranibizumab, aflibercept and faricimab block a signal (VEGF) that makes abnormal vessels leak. The EVEREST II trial randomised 322 Asian patients with ICG-confirmed PCV to ranibizumab plus PDT or ranibizumab plus sham PDT [7]. At 12 months, vision improved by 8.3 letters with the combination versus 5.1 letters with injections alone [7].

The polyps closed completely in 69.3% versus 34.7%, and the combination group needed a median of 4 injections instead of 7 [7]. At 24 months the gap held: 9.6 versus 5.5 letters gained, and complete closure in 56.6% versus 26.7% [8]. The combination group needed a median of 6 injections against 12, and half needed two PDT sessions or fewer [8].

What PDT involves. A drug called verteporfin is given through a drip in the arm. A low-power laser is then shone on the polyps to activate the drug and close them. For 5 days afterwards you must keep your skin and eyes out of direct sunlight and bright indoor light [9].

Aflibercept injections, with PDT kept for poor responders. The PLANET trial treated 318 patients with aflibercept and added PDT only if the response was poor [10]. At one year, vision improved by 10.7 letters with aflibercept alone and 10.8 letters with added PDT. More than 80% had no leaking polyps at one year [10].

Fewer than 15% needed the rescue PDT, so the trial could not show whether adding PDT helps [10]. Both approaches work. Your specialist will weigh how active the polyps are, how often you can attend, and whether PDT is available nearby.

Newer injections. Faricimab blocks VEGF and a second signal, angiopoietin-2. In the SALWEEN study of 135 Asian patients with PCV, vision improved by 8.9 letters at about one year [11]. At week 48, 83.4% were on injections every 12 weeks or longer [11].

Of those with reading centre-confirmed polyps, 60.8% had complete polyp closure [11]. SALWEEN had no comparison group, so it cannot show that faricimab beats older drugs.

Brolucizumab was compared with aflibercept in 69 Japanese patients with PCV inside a larger trial. Vision gains were similar, about 10 to 11 letters, and more eyes were dry with brolucizumab [12]. It caused more inflammation inside the eye than aflibercept, which limits its use [12].

Long-term follow-up. PCV is a long-term condition. In a five-year study of 192 patients with wet AMD or PCV, the disease became active again in 81.3%, more often in PCV [13]. In another five-year study, first-year vision gains had faded back to the starting level by years three to five on as-needed treatment [14].

Regular scans, and treatment when activity returns, are what protect vision over time.

What is not proven

• Acupuncture and herbal medicine. We found no trials of acupuncture, Chinese herbs or Ayurvedic herbs in PCV. There is no evidence that they close polyps, dry the macula or prevent bleeds.
• Eye vitamins as a treatment. The AREDS2 trial tested vitamin formulas in people at risk of late AMD. Adding lutein and zeaxanthin did not significantly lower that risk in the main analysis [15]. These vitamins do not treat active PCV, and drusen are less common in PCV [3], so ask your specialist whether they suit you.
• Anything that asks you to delay injections or PDT. Leaking and bleeding can scar the macula for good, so delay has a real cost.

Where Netra fits

Netra Eye Institute is an acupuncture and Oriental medicine practice. We do not diagnose or treat PCV, and we do not replace your retina specialist. Our role is adjunctive:

• We check that the basics are in place with your doctors: blood pressure, smoking, your injection and scan schedule, and whether you have had an ICG angiogram.
• We offer acupuncture and, where appropriate, Chinese herbal medicine within Netra Restoration Therapy (NRT), with the evidence explained before you start. Herbs are reviewed against your medicines, especially blood thinners, because some herbs can add to bleeding risk.
• We keep our sessions clear of your injection visits. After PDT, we follow the light precautions your clinic gives you.
• We share what we see with your eye doctor. If your vision drops or a new dark patch appears, we send you back the same day.

NRT is not a treatment for polypoidal choroidal vasculopathy and does not replace anti-VEGF injections or photodynamic therapy. If you want to talk through whether integrative care makes sense alongside your treatment, request a consultation.

For clinic staff: ICD-10-CM codes

There is no separate ICD-10-CM code for PCV. It is usually coded as exudative (wet) age-related macular degeneration, H35.32[eye][activity]. Eye: 1 right, 2 left, 3 both. Activity: 0 stage unspecified, 1 with active choroidal neovascularization, 2 with inactive choroidal neovascularization, 3 with inactive scar. So H35.3211 is wet AMD in the right eye with active neovascularization. Confirm against the current code set before billing.

Questions people ask

Can polypoidal choroidal vasculopathy be cured?

No, it does not go away for good, but it can usually be controlled with injections, with or without PDT. In EVEREST II the polyps closed fully in over half of eyes on combined treatment [8]. Activity often comes back, so follow-up continues for years [13].

What are "eye polyps"?

In PCV, "polyps" are small balloon-like bulges at the ends of abnormal blood vessels under the retina. They are not growths like bowel polyps and they are not cancer. A bump on the white or surface of the eye is a different problem, so ask your eye doctor about it.

How is PCV diagnosed?

With an eye exam, an OCT scan and usually an ICG angiogram. OCT signs can strongly suggest PCV [5], but ICG shows the polyps directly [1].

What does PCV look like on OCT?

The pigment layer under the retina often rises into a sharp peak, with a ring-shaped lesion beneath it [5]. At each visit the same scan checks for fluid, which shows whether the disease is active.

Is PCV the same as wet macular degeneration?

It is a type of wet AMD [1]. It is treated with the same injections, but PDT is an extra option, planned with the ICG test [1, 7].

How many injections will I need?

It varies. In EVEREST II, the median over two years was 6 with PDT and 12 without [8]. With faricimab, most people in SALWEEN had reached gaps of 12 weeks or more by the end of the first year [11].

References

1. Cheung CMG, Lai TYY, Ruamviboonsuk P, et al. Polypoidal choroidal vasculopathy: definition, pathogenesis, diagnosis, and management. Ophthalmology. 2018;125(5):708-724.
2. Saito M, Iida T, Saito K, et al. Long-term characteristics of exudative age-related macular degeneration in Japanese patients. PLoS One. 2021;16(12):e0261320.
3. Yannuzzi LA, Wong DW, Sforzolini BS, et al. Polypoidal choroidal vasculopathy and neovascularized age-related macular degeneration. Arch Ophthalmol. 1999;117(11):1503-1510.
4. Lazrak A, Bonnafous M, Jean-Charles A, et al. Exploring clinical features of polypoidal choroidal vasculopathy in Black patients: a cross-sectional study and a comprehensive review. Ophthalmol Retina. 2025;9(9):860-869.
5. Cheung CMG, Lai TYY, Teo K, et al. Polypoidal choroidal vasculopathy: consensus nomenclature and non-indocyanine green angiograph diagnostic criteria from the Asia-Pacific Ocular Imaging Society PCV Workgroup. Ophthalmology. 2021;128(3):443-452.
6. Gabrielle PH, Delyfer MN, Glacet-Bernard A, et al. Surgery, tissue plasminogen activator, antiangiogenic agents, and age-related macular degeneration study: a randomized controlled trial for submacular hemorrhage secondary to age-related macular degeneration. Ophthalmology. 2023;130(9):947-957.
7. Koh A, Lai TYY, Takahashi K, et al. Efficacy and safety of ranibizumab with or without verteporfin photodynamic therapy for polypoidal choroidal vasculopathy: a randomized clinical trial. JAMA Ophthalmol. 2017;135(11):1206-1213.
8. Lim TH, Lai TYY, Takahashi K, et al. Comparison of ranibizumab with or without verteporfin photodynamic therapy for polypoidal choroidal vasculopathy: the EVEREST II randomized clinical trial. JAMA Ophthalmol. 2020;138(9):935-942.
9. US Food and Drug Administration. Visudyne (verteporfin for injection) prescribing information. Revised 2023. accessdata.fda.gov label 021119s034.
10. Lee WK, Iida T, Ogura Y, et al. Efficacy and safety of intravitreal aflibercept for polypoidal choroidal vasculopathy in the PLANET study: a randomized clinical trial. JAMA Ophthalmol. 2018;136(7):786-793.
11. Cheung CMG, Lee WK, Chen SJ, et al. Faricimab for polypoidal choroidal vasculopathy: 48-week results from the phase IIIb/IV SALWEEN trial. Ophthalmol Retina. 2026. Published online ahead of print. doi:10.1016/j.oret.2026.08.003.
12. Ogura Y, Jaffe GJ, Cheung CMG, et al. Efficacy and safety of brolucizumab versus aflibercept in eyes with polypoidal choroidal vasculopathy in Japanese participants of HAWK. Br J Ophthalmol. 2022;106(7):994-999.
13. Kim JH, Kim JW, Kim CG. Five-year reactivation after ranibizumab or aflibercept treatment for neovascular age-related macular degeneration and polypoidal choroidal vasculopathy. J Ocul Pharmacol Ther. 2021;37(9):525-533.
14. Miyata M, Ooto S, Yamashiro K, et al. Five-year visual outcomes after anti-VEGF therapy with or without photodynamic therapy for polypoidal choroidal vasculopathy. Br J Ophthalmol. 2019;103(5):617-622.
15. Age-Related Eye Disease Study 2 Research Group. Lutein + zeaxanthin and omega-3 fatty acids for age-related macular degeneration: the Age-Related Eye Disease Study 2 (AREDS2) randomized clinical trial. JAMA. 2013;309(19):2005-2015.