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Danny H.-Kauffmann Jokl, Sankha Amarakoon, Celine Saade, Robert Post, Ansh Johri, Sander Kesting, Suzanne Yzer, Theodore Smith, Rando Allikmets, Jan C. van Meurs; Stabilization of Visual Acuity with Bilateral Macular Drusen - a 10 year prospective study of uniocular peripheral retina argon laser therapy. Invest. Ophthalmol. Vis. Sci. 2015;56(7 ):5161. doi: https://doi.org/.
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Anti VEGF therapy can reduce the neovascular complications of AMD, only AREDS supplements<br /> can decrease such progression over a similar time period. Natural history of drusen shows 71% with bilateral medium soft drusen progressing to large drusen and, in 14%, to AMD over 10 years, though, if AMD did not develop, with preservation of good vision. (Chew JAMA Ophthalmol 2014;132:272). Following a serendipitous observation that a retinal laser treatment for an incidental retinal tear in an eye with medium soft drusen, with AMD in the other eye, was followed by diminution of drusen and stabilization of vision over 10 years, we investigated the effect of such treatment on patients with bilateral soft drusen.
Fourteen patients from the Rotterdam Eye Hospital with bilateral macular drusen and visual acuity in each eye from 20/20-20/40 consented to a single uniform treatment of 200 argon laser applications (200 microns, 200 mw each) to the anterior superior temporal retina. Eleven subjects (5 M, 6F; ages 58-83) were followed for 10 years (3 subjects died during this period) with clinical examinations and digitalized fundus photos. Drusen areas in each eye were calculated and DNA of all subjects was analyzed for selected AMD-associated SNPs in ARMS2 and CFH, the two major genetic loci for AMD. The masked clinical and genetic data were then correlated.
Uniocular visual loss (≤20/100) to AMD in the 10 year follow up period occurred in three (3/11) patients, in each case in the non-treated eye. Bilateral visual loss to AMD occurred in one patient. Two patients with high genetic risk showed a decrease in the drusen area (Fig.1). The same 2 out of eleven (2/11) patients with high genetic risk did not progress to late AMD in 10 years (Fig. 2). There was no association between the progression of drusen area and the visual outcome (Fig. 3).
Due to the small cohort size, this 10 year prospective pilot study can only suggest that a focal peripheral laser treatment in one eye may provide a mechanism, e.g., an inflammatory response that preserves binocular vision in some subjects with bilateral macular drusen relative to the natural history and does not correlate with the extent of macular soft drusen. A much larger cohort study would be necessary to draw conclusions as to the genetic correlations, if any, with this laser mode of therapy.
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