A Pilot Randomized Controlled Study on the Effect of Laser Photocoagulation of Confluent Soft Macular Drusen

doi:10.1016/S0161-6420(97)30261-9

Ophthalmology

Volume 104, Issue 4, April 1997, Pages 623-631

https://doi.org/10.1016/S0161-6420(97)30261-9 Get rights and content

Purpose: The authors determined the effect of photocoagulation of drusen on visual acuity and progression to subretinal neovascular membranes (SRNV).

Methods: One of paired eyes was randomized to photocoagulation with other eye to control in 27 patients having symmetrical maculopathy and visual acuities, aged 46 to 81 years (mean, 69.7 years); follow-up 1 to 6 years (mean, 3.2 years).

Results: Final visual acuity was improved in treated eye or decreased in control eye in 12 patients, equal in 13 patients, and decreased in treated eye in 2 patients (P < 0.006). Progression to SRNV was less with treatment.

Conclusion: Laser photocoagulation of confluent soft macular drusen may improve long-term visual prognosis.

References (20)

WR Green et al.
Pathologic features of senile macular degeneration
Ophthalmology
(1985)
WE Smiddy et al.
Diagnosis of patients with bilateral macular drusen
Ophthalmology
(1984)
SB Bressler et al.
Natural course of choroidal neovascular membranes within foveal avascular zone in senile macular degeneration
Am J Ophthalmol
(1982)
EL Chuang et al.
The pathogenesis of tears of the retinal pigment epithelium
Am J Ophthalmol
(1988)
D Pauleikhoff et al.
Aging changes in Bruch's membrane: a histochemical and morphologic study
Ophthalmology
(1990)
WR Green et al.
Senile macular degeneration: a histopathologic study
Trans Am Ophthalmol Soc
(1977)
NM Bressler et al.
Clinicopathologic correlation of drusen and retinal pigment epithelial abnormalities in age-related macular degeneration
Retina
(1994)
SH Sarks
Drusen and their relationships to senile macular degeneration
Am J Ophthalmol
(1980)
JD Gass
Drusen and disciform macular detachment and degeneration
Arch Ophthalmol
(1973)
ER Strahlman et al.
The second eye of patients with senile macular degeneration
Arch Ophthalmol
(1983)

There are more references available in the full text version of this article.

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A common eye disorder known as age-related macular degeneration (AMD) eventually results in blindness and vision loss. AMD has a complicated and poorly understood aetiology. The main pathological processes associated with AMD include oxidative damage, inflammation, and neovascularization. Flavonoids are naturally occurring bioactive substances with extensive distribution and antioxidant, anti-inflammatory, and neovascularization inhibitory properties. Several in vitro and in vivo AMD-related models pertinent to vision and this ocular ailment have been used to assess the mechanisms of action of various flavonoids. This article will discuss the research progress of flavonoids in AMD, especially the characteristics and mechanism of flavonoids in treating AMD.
Drusen regression is associated with local changes in fundus autofluorescence in intermediate age-related macular degeneration
2013, American Journal of Ophthalmology
To investigate the association of spontaneous drusen regression in intermediate age-related macular degeneration (AMD) with changes on fundus photography and fundus autofluorescence (FAF) imaging.
Prospective observational case series.
Fundus images from 58 eyes (in 58 patients) with intermediate AMD and large drusen were assessed over 2 years for areas of drusen regression that exceeded the area of circle C1 (diameter 125 μm; Age-Related Eye Disease Study grading protocol). Manual segmentation and computer-based image analysis were used to detect and delineate areas of drusen regression. Delineated regions were graded as to their appearance on fundus photographs and FAF images, and changes in FAF signal were graded manually and quantitated using automated image analysis.
Drusen regression was detected in approximately half of study eyes using manual (48%) and computer-assisted (50%) techniques. At year-2, the clinical appearance of areas of drusen regression on fundus photography was mostly unremarkable, with a majority of eyes (71%) demonstrating no detectable clinical abnormalities, and the remainder (29%) showing minor pigmentary changes. However, drusen regression areas were associated with local changes in FAF that were significantly more prominent than changes on fundus photography. A majority of eyes (64%-66%) demonstrated a predominant decrease in overall FAF signal, while 14%-21% of eyes demonstrated a predominant increase in overall FAF signal.
FAF imaging demonstrated that drusen regression in intermediate AMD was often accompanied by changes in local autofluorescence signal. Drusen regression may be associated with concurrent structural and physiologic changes in the outer retina.
Laser Treatment in Patients with Bilateral Large Drusen. The Complications of Age-Related Macular Degeneration Prevention Trial
2006, Ophthalmology
Citation Excerpt :
Previous studies had provided important information that influenced the CAPT study design and treatment protocol. These included the following: (1) fellow eyes of participants with unilateral late AMD have an increased risk of developing choroidal neovascularization after prophylactic laser treatment; (2) laser treatment delivered in a grid or scatter pattern typically did not cause persistent or symptomatic scotomata; (3) laser burns could be applied either directly to drusen or adjacent to drusen with no discernible long-term difference in terms of promoting resolution of drusen or causing side effects; (4) more intense laser burns were associated with a tendency to develop choroidal neovascularization, sometimes at the site of the laser burn; and (5) laser application could be repeated after an interval of 6 to 12 months to promote further resolution of drusen without any apparent significant adverse effect.8,9,12,13,15,16,44 Laser treatment in the CAPT had no effect at 5 years on either VA or the incidence of late AMD (Figs 4, 5).
To evaluate the efficacy and safety of low-intensity laser treatment in the prevention of visual acuity (VA) loss among participants with bilateral large drusen.
Multicenter randomized clinical trial. One eye of each participant was assigned to treatment, and the contralateral eye was assigned to observation.
A total of 1052 participants who had ≥10 large (>125 μm) drusen and VA≥20/40 in each eye enrolled through 22 clinical centers.
The initial laser treatment protocol specified 60 barely visible burns applied in a grid pattern within an annulus between 1500 and 2500 μm from the foveal center. At 12 months, eyes assigned to treatment that had sufficient drusen remaining were retreated with 30 burns by targeting drusen within an annulus between 1000 and 2000 μm from the foveal center.
Proportion of eyes at 5 years with loss of ≥3 lines of VA from baseline. Secondary outcome measures included the development of choroidal neovascularization or geographic atrophy (GA), change in contrast threshold, change in critical print size, and incidence of ocular adverse events.
At 5 years, 188 (20.5%) treated eyes and 188 (20.5%) observed eyes had VA scores ≥ 3 lines worse than at the initial visit (P = 1.00). Cumulative 5-year incidence rates for treated and observed eyes were 13.3% and 13.3% (P = 0.95) for choroidal neovascularization and 7.4% and 7.8% (P = 0.64) for GA, respectively. The contrast threshold doubled in 23.9% of treated eyes and in 20.5% of observed eyes (P = 0.40). The critical print size doubled in 29.6% of treated eyes and in 28.4% of observed eyes (P = 0.70). Seven treated eyes and 14 observed eyes had an adverse event of a ≥6-line loss in VA in the absence of late age-related macular degeneration or cataract.
As applied in the Complications of Age-Related Macular Degeneration Prevention Trial, low-intensity laser treatment did not demonstrate a clinically significant benefit for vision in eyes of people with bilateral large drusen.
Long-Term Effect of Laser Treatment for Dry Age-Related Macular Degeneration on Choroidal Hemodynamics
2006, American Journal of Ophthalmology
Citation Excerpt :
This increase in flow is mainly the result of an increase in blood volume; this may be attributable to vasodilatation. Many studies have shown evidence suggesting that laser photocoagulation treatment can reduce the number of drusen in patients with AMD.6–8,11–13 Although the exact mechanism by which laser treatment causes drusen resolution is not known, it is possible that the choroidal circulation may play a role in this phenomenon.
To determine whether laser treatment applied according to the complications of age-related macular degeneration prevention trial (CAPT) has an effect on the choroidal circulation.
Randomized controlled trial.
This study included 30 CAPT patients with bilateral drusen. Laser Doppler flowmetry was used to measure relative choroidal blood flow (Ch_flow) in the fovea. Measurements were obtained through dilated pupils in both eyes of each patient before photocoagulation was applied in one eye. Measurements were repeated at three months (30 patients) and 28 months (23 patients).
Average Ch_flow at baseline, three months, and 28 months was 7.2 ± 2.1 (±1 SD), 7.3 ± 2.5, and 6.8 ± 2.7 arbitrary units (AU) in the control eyes and 6.6 ± 1.6, 7.0 ± 2.3, and 7.8 ± 3.0 AU in the treated eyes. In comparison to control eyes, there was no significant change in Ch_flow in the treated eyes at three months after treatment. At 28 months, however, there was a 5.6% drop in Ch_flow in control eyes and an 18.2% increase in Ch_flow in treated eyes from baseline. The average difference of 23.8% between the percentage changes in Ch_flow observed in the control and treated eyes was statistically significant (paired two-tailed Student t test; P = .05).
Our results suggest an increase in choroidal blood flow 28 months after laser treatment according to the CAPT protocol. This increase may play a role in the mechanism leading to the disappearance of drusen after photocoagulation. Whether removal of drusen after photocoagulation is beneficial to the patients is not known at this time.
Prophylactic Treatment of Age-Related Macular Degeneration Report Number 1: 810-Nanometer Laser to Eyes with Drusen. Unilaterally Eligible Patients
2006, Ophthalmology
To determine the effects of subthreshold 810-nm-diode laser treatment on the rate of development of choroidal neovascularization (primary end point) and the effect on visual acuity (VA) in participants with multiple large drusen in one eye and a preexisting neovascular age-related macular degeneration (AMD) lesion in the other.
Multicenter, prospective, randomized controlled trial.
Two hundred forty-four patients ≥50 years of age and with a neovascular or advanced AMD lesion in one eye and, in the fellow “study” eye, (1) at least 5 drusen ≥ 63 μm in diameter, (2) Early Treatment Diabetic Retinopathy Study best-corrected VA (BCVA) of 20/63 or better, and (3) no evidence of neovascularization at baseline.
Patients were randomized to treatment or observation of their study eye at each of 22 centers. At each visit, the protocol specified that BCVA, a complete retinal examination, and fluorescein angiography be documented. Treated eyes had a grid of 48 extrafoveal, subthreshold diode (810 nm) laser spots, 125 μm in diameter, placed in an annulus outside of the foveola. Patients were seen at baseline and at 3, 6, 12, 18, 24, 30, and 36 months after randomization. No retreatments were allowed.
Development of choroidal neovascularization (as confirmed by fluorescein angiography) and change in BCVA.
Throughout follow-up, the rate of choroidal neovascularization events in treated eyes consistently exceeded that in observed eyes. At 1 year, the difference was 15.8% versus 1.4% (P = 0.05). Most of the intergroup differences in choroidal neovascularization events occurred during the first 2 years of follow-up. Treated eyes showed a higher rate of VA loss (≥3 lines) at 3- and 6-month follow-ups relative to observed eyes (8.3% vs. 1% and 11.4% vs. 4%, respectively; Ps = 0.02, 0.07). After 6 months, no significant differences were observed in VA loss between groups.
Prophylactic subthreshold 810-nm-diode laser treatment to an eye with multiple large drusen in a patient whose fellow eye has already suffered a neovascular event places the treated eye at higher risk of developing choroidal neovascularization. We advise against using prophylactic subthreshold diode laser treatment in these eyes.
Age-Related Macular Degeneration: Nonneovascular Early AMD, Intermediate AMD, and Geographic Atrophy
2005, Retina: Fourth Edition

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: Presented at the American Academy of Ophthalmology Annual Meeting, Atlanta, November 1995. The authors have no proprietary interest in any of the materials used in this study.

View full text

A Pilot Randomized Controlled Study on the Effect of Laser Photocoagulation of Confluent Soft Macular Drusen

Ophthalmology

Ophthalmology

Am J Ophthalmol

Am J Ophthalmol

Ophthalmology

Senile macular degeneration: a histopathologic study

Trans Am Ophthalmol Soc

Clinicopathologic correlation of drusen and retinal pigment epithelial abnormalities in age-related macular degeneration

Retina

Drusen and their relationships to senile macular degeneration

Am J Ophthalmol

Drusen and disciform macular detachment and degeneration

Arch Ophthalmol

The second eye of patients with senile macular degeneration

Arch Ophthalmol