Understanding the pachychoroid disease spectrum
Reviewed by Zhihang Cheng

This article provides a comprehensive review of the pachychoroid disease spectrum, a group of chorioretinal disorders characterised by abnormal choroidal thickening and various pathological changes in the choroid, retinal pigment epithelium, and retina. It also highlights the controversies and knowledge gaps in this field. The authors examine the epidemiology and risk factors associated with central serous chorioretinopathy, pachychoroid pigment epitheliopathy, pachychoroid neovasculopathy, and polypoidal choroidal vasculopathy. The article extensively covers the role of various imaging modalities, including OCT, OCT angiography, en face OCT, fluorescein angiography, indocyanine green angiography, infrared imaging, and fundus autofluorescence, in the diagnosis and management of pachychoroid disorders. The article delves into the structural and vascular changes in the choroid, retinal pigment epithelium, and outer retina associated with pachychoroid disorders, drawing insights from in vivo imaging and post-mortem studies. The authors discusses how the evolving understanding of pachychoroid pathogenesis has influenced diagnostic and treatment approaches, their potential impact on personalised therapeutic approaches, including optimised photodynamic therapy based on imaging biomarkers.

Pachychoroid disease spectrum: how multimodal imaging and OCT angiography have improved our knowledge.
Viggiano P, Boscia G, Sadeghi E, et al.
PROGRESS IN RETINAL AND EYE RESEARCH
2025;107:101372.