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Background: To compare the differences in clinical manifestation of Coats' disease between younger and older patients in the Far East. Methods: Coats' disease cases diagnosed at one Taiwanese hospital from July 1986 to June 2004 were retrospectively reviewed ( n = 30; 32 eyes). Patients were stratified into groups according to the initial diagnosis of Coats' disease at the age of <20 years (Group Y) or ≥20 years (Group O). The clinical manifestations of Coats' disease in Group Y (19 eyes) and Group O (13 eyes) were compared. Results: A higher proportion of female patients was noted in Group O ( P = 0.046). Diseases were generally limited geographically, with 14 eyes (73.7%) manifesting involvement greater than 6 clock hours in Group Y and four eyes (30.8%) in Group O. The involved area including retinal telangiectasia and exudates was smaller in Group O ( P = 0.016). Patients without posterior pole involvement were associated with better visual outcome (adjusted odds ratio, 6.5; 95% confidence interval, 1.1–40.1, P = 0.044). Conclusion: Coats' disease manifestation was different between different age groups. Treatment is important to prevent disease progression. Visual prognosis is associated with posterior pole involvement. [ABSTRACT FROM AUTHOR]