Polypoidal choroidal vasculopathy (PCV) represents a significant proportion of neovascular age-related macular degeneration cases among Asian populations. Recently, advancements in diagnostic imaging and pharmaceutical potency have transformed the clinical landscape. These developments specifically encourage a shift toward specialized Anti-VEGF therapy in PCV. Historically, clinicians relied heavily on combination therapy involving photodynamic therapy (PDT). However, the emergence of newer agents like Aflibercept and Faricimab has redefined standard care protocols. Today, practitioners prioritize non-invasive monitoring and durable monotherapy to optimize visual outcomes for their patients.

The PLANET trial provided pivotal evidence showing that Aflibercept monotherapy is noninferior to combination therapy. Consequently, retinal specialists now prefer monotherapy for most treatment-naïve patients. This shift also occurred because PDT access remains limited in many regions across India. Proactive regimens, such as "treat and extend," further help reduce the overall treatment burden. By using fluid markers on OCT, doctors can customize injection intervals effectively while maintaining stable visual acuity.

Advancing Outcomes with Anti-VEGF Therapy in PCV

Potent molecules such as Brolucizumab and Faricimab offer superior drying effects compared to older generation drugs. The HAWK and HARRIER trials demonstrated that Brolucizumab effectively manages sub-RPE fluid, although practitioners must monitor patients for potential intraocular inflammation. Additionally, interim data from the SALWEEN trial indicates that Faricimab achieves high rates of complete polyp regression. These newer agents allow for extended treatment intervals, sometimes reaching up to 16 or 20 weeks. Therefore, characterizing specific PCV phenotypes via OCT is crucial for selecting the most effective drug and regimen. Modern management focuses on maximizing vision while minimizing the frequency of invasive injections.

Frequently Asked Questions

Why is monotherapy now preferred over combination therapy for PCV?

Monotherapy became the preferred approach after the PLANET trial proved Aflibercept was noninferior to combination therapy with PDT. Additionally, the limited availability of PDT and the efficacy of newer anti-VEGF agents have made monotherapy more practical and accessible.

How do newer agents like Faricimab help reduce the treatment burden?

Newer agents offer greater durability and potency, allowing for extended dosing intervals of up to 16 or 20 weeks. This reduces the number of clinic visits and injections required while maintaining stable anatomical and visual results.

Disclaimer: This content is for informational and educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of a qualified healthcare provider with any questions regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Giridhar A et al. Anti-vascular endothelial growth factor therapy in polypoidal choroidal vasculopathy. Indian J Ophthalmol. 2026 May 01. doi: 10.4103/IJO.IJO_3237_25. PMID: 42054086.

Lee J et al. Faricimab for Polypoidal Choroidal Vasculopathy: Week 16 Results From the Phase 3b/4 SALWEEN Trial. Invest Ophthalmol Vis Sci. 2025;66(8):1859.

Dugel PU et al. HAWK and HARRIER: Ninety-six-week outcomes from the phase 3 trials of brolucizumab for neovascular age-related macular degeneration. Ophthalmology. 2021;128(1):89-99.