SYMPTOMATIC CHOROIDAL NEOVASCULARIZATION IN BLACKS

Objective: To acquire descriptive clinical information regarding choroidal neovascularization (CNV) in black Americans. Design: Retrospective review of 1308 fluorescein angiograms obtained during a 4-year interval. Color photographs and clinical records of all black patients with angiographically apparent CNV were subsequently reviewed. Setting: Retina service of an inner-city county hospital in Atlanta, Ga, serving a predominantly black population. Results: Thirty blacks with CNV (36 of 59 eyes) were identified, 26 (87%) of whom were female. Active, exudative neovascularization was present in at least one eye of 21 patients (70%). Patients were assigned to one of four diagnostic groups for analysis. Group 1 was made up of 13 patients (43%) with age-related macular degeneration with CNV. Women outnumbered men 5.5:1. Choroidal neovascularization was peripapillary in seven (54%) of these 13 patients. Group 2 was made up of six patients (20%) with idiopathic CNV, which was peripapillary in all eyes. Group 3 consisted of three women (10%) with idiopathic polypoidal choroidal vasculopathy. Group 4 was composed of eight patients (27%) with secondary CNV. The CNV was peripapillary in three (33%) of nine eyes, and women outnumbered men 7:1. Conclusions: The spectrum of neovascular maculopathy in blacks in the current study differed from that typically seen in whites, both clinically and demographically. Clinically, CNV was most commonly juxtapapillary (13 [68%] of 19 patients) and unilateral (12 [92%] of 13 patients) among the age-related macular degeneration and idiopathic groups, while six (20%) of 30 patients (all older than 50 years) had CNV in the absence of drusen or other known predisposing conditions. Disciform-stage CNV in both groups was associated with a greater degree of pigment proliferation than that typically noted in whites. Demographically, female predominance (87% overall) was dramatic compared with prior studies.