Does Laser Prevent ARMD?

December 21, 2009

A study reports that prophylactic laser does not prevent loss of vision in  non-exudative, or dry, macular degeneration.  The risk of choroidal neovasculization was also not affected.

In the Prophylactic Treatment of Age-Related Macular Degeneration (PTAMD), 639 patients with 5 or more retinal drusen were treated with grid photocoagulation around the macula in one eye.  The fellow eye of the 639 patients enrolled served as control.  Participants had at least 5 drusen of 63 um in both eyes to participate.

While there was slight improvement in vision at 2 years into the study, the advantage did not last to the end of the study at 3 years.  The incidence of choroidal neovascularization was  11% in the treatment group and 9% in the observed group.

The authors recommend against laser photocoagulation in this setting.  There is also nolong term benefit against the development of choroidal neovascularization.

What Does this Mean? Findings of this study, PTAMD, and CAPT (Complications of Age-Related Macular Degeneration Prevention Trial) suggest that the incidence choroidal neovascularization is not reduced with laser treatment.  The study rationale has been to determine if patients, with high-risk characteristics such as intermediate or large drusen, derive a benefit from prophylactic treatment with laser.  Laser has been shown to resolve drusen in other studies.  Had there been a benefit seen to prophylaxis, the economic and clinical savings would be tremendous if choroidal neovascularzation were prevented.

Randall V. Wong, M.D.
Retina Specialist
Fairfax, Virginia




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