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Purpose: To compare phenotypic and genetic variations in polypoidal choroidal vasculopathy (PCV) between Caucasian and Asian patients., Methods: We analysed phenotypic and genotypic data from two sites, Association for Innovation and Biomedical Research on Light and Image, Portugal and Singapore National Eye Centre, Singapore. Baseline fundus photography, spectral domain-optical coherence tomography, indocyanine green and fluorescein angiography scans were analysed by respective reading centres using a standardised grading protocol. Single nucleotide polymorphisms across 8 PCV loci were compared between cases and controls selected from each population., Results: One hundred and forty treatment-naïve PCV participants (35 Portuguese and 105 Singaporean) were included. The Portuguese cohort were older (72.33±8.44 vs 68.71±9.40 years, p=0.043) and were comprised of a lower proportion of males (43% vs 71%, p=0.005) compared with the Singaporean cohort. Differences in imaging features include higher prevalence of soft drusen (66% vs 30%, p=0.004), lower prevalence of subretinal haemorrhage (14% vs 67%, p<0.001), smaller polypoidal lesion (PL) area (0.09±0.09 vs 0.76±0.93 mm 2 , p<0.001), lower ratio of PL to branching vascular network area (3% vs 38%, p<0.001) and lower central retinal thickness (346.48±93.74 vs 493.16±212.92 µm, p<0.001) in the Portuguese cohort. CETP rs3764261 (OR 2.467; 95% CI 1.282 to 4.745, p=0.006) in the Portuguese population was significantly associated with PCV and CFH rs800292 (OR 1.719; 95% CI 1.139 to 2.596, p=0.010) in the Singaporean population, respectively., Conclusion: Among Asian and Caucasian patients with PCV, there are significant differences in the expression of phenotype. We also identified different polymorphisms associated with PCV in the two populations., Competing Interests: Competing interests: RS reported receiving personal fees as member of the advisory board for Allergan, Alimera Sciences, Bayer, Novartis, Roche, Novo Nordisk and Thea Pharmaceuticals; JNM is a member of the scientific advisory board of Alcon; JF reported being a member of advisory boards for Alimera, Allergan, Bayer, Boehringer and Novartis; SV-P reported receiving personal fees as a consultant for Alimera Sciences, Bayer and Novartis. FC reported receiving personal fees as a consultant for Bayer, Allergan, Novartis, Brill-Alimera, Roche, Alcon and Dorc. AB reported receiving from Bayer consultation fees (advisory board), speaker fees, travel fees (for meetings) and reported receiving from Allergan consultation fees (advisory board), speaker fees, and travel fees (for meetings). The other authors declare that they have no conflict of interest., (© Author(s) (or their employer(s)) 2021. No commercial re-use. See rights and permissions. Published by BMJ.)