Beyond Typical AMD: A Vodcast Exploring the Clinical and Therapeutic Landscape of PCV

00:00:00: You are listening to an AIDIS Journal podcast.

00:00:06: Hello and welcome to this podcast, I'm Junya V from Asan Medical Center in Seoul.

00:00:12: In today's podcast i'd like to discuss polypolytic corridor vasculopathy PCB In particular.

00:00:19: Are we focused on how PCB differs from new vascular AMD?

00:00:24: Why can't it be challenging to diagnose and treat And How our approach managing disease is evolving?

00:00:32: In this podcast, I will first review the key clinical and pathological features of PCB.

00:00:39: Are we then discuss why PCB remains challenging to diagnose and managing?

00:00:44: Particularly in cases where patients show suboptimal responses to conventional AMD treatments... ...I'll also briefly touch on how current treatment strategies for PCB have evolved from those used in typical AMD And how this has led to the needs for more tailored PCB specific approaches.

00:01:07: Finally, I will summarize current treatment landscape including remaining amenities and future directions in PCB management.

00:01:17: What is PCB?

00:01:19: PCB is an extractive maculopathy characterized by recurrent sinus-sanguine pigment epithelial detachment.

00:01:27: PCB is defined by a unique vascular structure including polypoidal region and branching vascular network.

00:01:36: Importantly, PCBs are not uniform diseases.

00:01:41: There's significant phenotype heterogeneity which can influence both clinical representation and treatment response.

00:01:49: Although each exact classification remains debated PCB is increasingly recognized as part of the broader pachychloride spectrum disease.

00:02:01: From a pathological perspective, PCBs closely associate with the pachychloride-spectrum disease which includes the centrosuittus coryretinopathy, pachydchorid pigment epitheliopathy and pachytchoroid nilvastropathy.

00:02:19: The key features include a thickened choroid dilated hollow vessels, and attenuation of coriocabularis.

00:02:30: These changes suggest that PCV is primarily a coloid-driven disease which is mechanistically different from typical neovascular AMD.

00:02:40: How PCV differs from typical Neovascular AMD?

00:02:45: Clinically, PCV differed from the typical Nevascular AMD in several important ways.

00:02:53: It is more prevalent in Asian or African populations, and has a greater tendency for hemorrhaging complications.

00:03:02: The vascular morphology also distincts with polypolation that can be unstevered and sometimes versatile.

00:03:13: In addition, PCB often shows a suboptimal or incomplete response to antifreeze of monotherapy.

00:03:22: Why Is PCB Clinical Challenging?

00:03:26: While the initial anatomical responses may be achieved, they are often short-lived with high recurrence rates and incomplete polypolytoregration.

00:03:41: We have reported that patients with PCB shows an anatomal and functional fluctuation even during the maintenance page of treatments.

00:03:52: PCB is also a heterogeneous disease meaning treatment response can vary significantly between patients.

00:04:02: Ultimately, long-term outcomes often driven by complications such as hemorrhaging fibrosis and atrophy rather than actuation alone.

00:04:14: the diagnostic approaches for PCB when it comes to diagnosis endocyanic green angiotherapy or ICGA remains the gold standard for PCB diagnosis.

00:04:29: It allows direct visualization of polypoidal lesion and branch bascal network, which are the defining feature for diseases.

00:04:39: However in the routine clinical practice, Osteen-Ostene Geography is increasingly used as important adjunct tools.

00:04:47: The certain osteoarthritis features such a sharp peak pigment after detachment or double layer signs can raise strong suspicion for PCB.

00:05:00: In addition OCT and OCT angiography may help assess disease activity, and guide treatment decisions.

00:05:08: Therefore only an accurate differentiation of PCV from neovascular end is critical as misclassification can lead to suboptimal treatment outcome.

00:05:22: Treatment goes in PCB.

00:05:24: When we consider treatment in PCB An important question is What does success actually mean?

00:05:35: From an anatomical perspective, success may include polypoidal regression or inactivation as well achieving a dry macular.

00:05:46: Functionally we aim for stabilization while improvement in visual query.

00:05:53: Our recent study highlights the importance of early and effective treatment for preserving visual sensitivity at the site of PCB legions.

00:06:04: And importantly From a long-term perspective, reducing recurrence and treatment burden is also critical.

00:06:14: However one of the major challenges that these endpoints are not consistently defined across studies.

00:06:24: The anatomical improvements do not always translate into durable disease control or better long term vision.

00:06:33: When treatment response is suboptimal patient may experience persistent fluid, the current hemorrhaging or lack of vision improvements.

00:06:45: Over time this can lead to irreversible damage including fibrosis and atrophy ultimately resulting in permanent vision loss.

00:06:55: therefore defining meaningful clinical relevant end point remains an important amenities in PCB management treatment landscape and limitation.

00:07:08: In terms of current treatment landscape, antifreeze therapy remains the main state-of-the-treatment.

00:07:16: Many patients do respond well and in some cases outcome can be comparable to those in typical linear vascular AMD.

00:07:26: however response in PCB are highly heterogeneous.

00:07:31: In a subset or patient conventional anti-freeze therapy may be insufficient with incomplete anatomical response, or early records.

00:07:43: This has led us to use a combination strategy such as botodynamic therapy together with anti-fugeot agents.

00:07:50: At the same time it is important to recognize that PCB specific treatment guideline remains limited and much of our current approach has evolved from therapies originally designed for typical AMD.

00:08:07: more recently There has been a shift away from the purely neglected approaches towards strategies focused on controlling disease activity, often guided by OST and OST angiography.

00:08:23: In real-world practice The challenges such as recurrence, variable treatment response And risk of hemorrhaging remain significant highlighting the needs for more tailored and durable treatment strategies, when & why we change treatments.

00:08:46: In clinical practice an important question is When & Why We Should Change Treatments?

00:08:53: The common triggers include a poor anatomical response after loading phase or early currents following initial improvements.

00:09:09: In addition, patient-specific factors such as treatment burden, excess and tolerance also play an important role.

00:09:18: When this issue arises, clinicians may consider several strategies including switching antifreeze agents shortening treatment intervals or introducing combination therapy such as botanical therapy.

00:09:33: Importantly careful interpretation of anatomical response is very essential as apparent improvements may not always reflect true disease control.

00:09:45: Overall, management PCB often require a flexible and individualized approaches rather than fixed treatment mechanism.

00:09:56: Future directions Looking ahead the future of PCB management will depends on more integrated understanding of disease biology imaging and treatments.

00:10:10: Increasingly PCBs are being viewed as a pachychorespectum disease with underlying abnormalities in order of structure and function.

00:10:22: Advances in multimodal imaging, including OST and OST angiography and ICGA Are allowing us to better define these phenotypes And identify relevant biomarkers.

00:10:38: These biomarker may help guide more personal treatment strategy including selecting appropriate therapy or optimize treatment intervals.

00:10:50: In terms of treatments, there is growing interest in combination approaches as well as longer-lasting therapy that may help reduce treatment burden.

00:11:03: Ultimately the goal is to move toward more proactive and individualized approaches where treatment decisions are guided not only by fluid but also by disease phenotype and long-term risk of progression.

00:11:20: To summarize, PCV is not simply another form of A&D Looking ahead.

00:11:28: advances in imaging a better understanding of apachecord biology And more personalized treatment approaches will be key to improving patient care.

00:11:41: It's distinct clinical entity with unique biological structure features which directly influenced how the disease behaves in response to treatment.

00:11:53: Only an accurate differentiation is critical, as this can significantly impact treatment decisions and long-term

00:12:00: outcomes.".

00:12:02: Thank you for listening!

00:12:14: For a full list of declarations, including funding and author disclosure statements and copyright information please visit the article page on The Journal website.