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Jeffrey K K Luttrull, Bryant J Lum, David Kent, John R Samples; Improved VEP and visual fields following panmacular subthreshold diode micropulse laser (SDM) in open angle glaucoma. Invest. Ophthalmol. Vis. Sci. 2017;58(8):5849.
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© ARVO (1962-2015); The Authors (2016-present)
To determine the effect of panmacular subthreshold diode micropulse laser (SDM) on optic nerve function measured by visually evoked potentials (VEP) as an indicator of neuroprotection in open angle glaucoma (OAG).
The records of all patients in a private vitreoretinal subspecialty practice (JKL) with advanced OAG evaluated by VEP testing both before and after panmacular SDM were reviewed. Additional testing included automated Omnifield resolution perimetry (ORP).
88 eyes of 48 patients were identified for study, 20 male and 28 female, aged 57-94 (avg. 79). All patients had glaucomatous optic nerve cupping and/or visual field loss prior to SDM. Pretreatment, IOPs ranged 6-23mm Hg (avg. 13) on 0-3 (avg. 1.6) medications. 33 eyes had undergone major glaucoma surgery. Visual acuities ranged 20/15 to count fingers (median 20/60) prior to SDM. Following SDM, VA and IOP were unchanged. VEP P1 amplitudes significantly improved (p=0.001). Best logMAR visual acuities with 6 degrees of fixation (BA6); global macular acuity (an average of logMAR acuities within 10 degrees of fixation, GMA); and visual area by ORP all significantly improved as well following SDM (p<0.0001, p=0.003, and p<0.0001 respectively). There were no adverse treatment effects.
Significantly improved VEP P1 amplitudes indicate a neuroprotective effect from panmacular SDM in OAG. The improvements in optic nerve function were accompanied by significant improvements in mesopic visual function. All improvements were achieved without IOP lowering or adverse treatment effects. These findings suggest panmacular SDM may be the first clinically useful neuroprotective treatment for OAG that can also improve visual function and visual fields, independent of IOP lowering.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
Omnifield resolution perimetry prior to SDM. Note marked visual field constriction and poor logMAR visual acuity indices (BA6=best acuity witin central 6 degrees; GMA=global macular acuity; VA=visual area).
Visual field by Omnifield resolution perimetry, showing post-treatment visual field of same eye one month post panmacular SDM. Note marked improvement in all field field and all logMAR visual acuity indices.
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