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Mala Subash, Ahmed Samy, Dania Qatarneh, Serafeim Antonakis, Gerald Liew, Victoria Mccudden, Richard G Weleber, Tunde Peto, Louisa Wickham, Michel Michaelides; A Prospective Pilot Study of the Effects of Panretinal Photocoagulation Delivered with a Multi-spot Laser on Retinal Sensitivity and Driving Eligibility in Patients with Diabetic Retinopathy. Invest. Ophthalmol. Vis. Sci. 2014;55(13):3894.
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The gold standard treatment for severe non-proliferative and proliferative diabetic retinopathy (DR) is panretinal photocoagulation (PRP), that may have a damaging effect on retinal function. Multi-spot laser systems are increasingly used and believed to cause less collateral retinal damage. This study describes the baseline characteristics of the cohort of recruited patients who have undergone Valon-multispot laser and have had detailed retinal imaging and retinal sensitivity testing pre- and post-treatment.
Laser-naïve patients requiring bilateral PRP were enrolled. All subjects underwent standard clinical examination including best-corrected visual acuity and macular spectral-domain optical coherence tomography. Ultra-widefield colour fundus photography and fundus fluorescein angiography (FFA) using the Optos system (Optos, Dunfermline, UK) were performed at baseline and at 6 months from initial visit. The Moorfields Reading Centre (MEHRC) is grading the ETDRS severity of DR (baseline and 6 months), the severity of peripheral capillary closure (baseline), and the coverage of retinal laser burns (6 months) using the Optos images. Retinal sensitivity was assessed using Binocular Estermann Driving Visual Fields on the Humphrey Visual Field Analyser and full-field static testing on the Octopus 900. The Valon (Dual Laser Ltd, Finland) multi-spot laser was used to deliver standardised PRP.
Forty-seven patients have been recruited to date (total=50), of these 20 were males, 16 had Type 1 diabetes and the average age was 47.3 with the average duration of diabetes being 17.6 years. Of the 47 recruited, 25 have completed 6-months follow-up to date. The driving visual fields remained unchanged in 24. Provisional results suggest a significant likelihood of maintaining the visual field criteria to hold a UK driving license following bilateral multi-spot PRP.
Multi-spot PRP lasers are being used increasingly worldwide. Interim data from this study suggests that a significant proportion of patients will retain driving eligibility following PRP. Further analysis comparing Optos-image derived retinal ischaemia area and retinal laser coverage, with retinal sensitivity data will be valuable and add to our understanding of peripheral retinal sensitivity pre- and post- laser therapy.
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