A prospective, multicenter, observational cohort study followed 205 eyes from 125 participants across 4 pachychoroid subtypes (uncomplicated pachychoroid, PPE, CSCR, and PNV) recruited at Asian centers for 2 years (July 2020–November 2023), assessing diagnostic progression, neovascularization, visual acuity, and choroidal thickness changes.
Progression occurred in only 15 of 205 eyes (7.3%; 95% CI, 4.5%–11.6%) over 2 years; all 7 eyes that developed neovascularization had shallow, irregular RPE elevation at baseline (out of 116 eyes with that finding). Mean BCVA and SFCT changes were not statistically significant (−0.02 logMAR, P = .33; +6 µm, P = .32).
Small cohort (n=125 participants); recruitment exclusively from Asian centers limits generalizability; only 6.0% of the overall baseline pool at risk for neovascularization developed it, so the predictive value of shallow irregular RPE elevation needs confirmation in larger studies.
Pachychoroid subtype rarely progresses over 2 years, so intensive short-interval follow-up may not be warranted for most patients. However, eyes with shallow, irregular RPE elevation on multimodal imaging should be monitored more closely given their exclusive association with incident neovascularization.
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