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Danny H.- Kauffmann Jokl, Theodore Smith, Rando Allikmets, Sankha Amarakoon, Suzanne Yzer, Jan van Meurs; In patients with bilateral central drusen, a one time, uniocular, peripheral retinal laser treatment over a 10 year period delayed the onset of AAMD and preserved binocular visual acuity. Invest. Ophthalmol. Vis. Sci. 2017;58(8):2322.
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There exists today no treatment for bilateral drusen prior to the progression to advanced age-related macular degeneration (AAMD) other than dietary supplements. We undertook a unique treatment for patients with AAMD and present the 10 year prospective outcomes following a single, uniocular, focal, discrete, peripheral retinal laser treatment.
With patient consent and IRB approval, ( Rotterdam Eye Hospital, Rotterdam, The Netherlands. IRB # ISRCTN 967546), 14 patients with bilateral medium sized central drusen and visual acuity in each eye of 20/20-20/40, underwent a single, uniocular argon laser treatment to the anterior superior temporal retina. (200 laser spots at 200 microns and 200 mW ). Eleven patients (5 M, 6F; ages 58-83) completed the 10 year study (3 patients died) and were periodically examined and fundus photos and central drusen volume measurements obtained as were DNA SNPs for CFH and ARMS2. These genetic findings were tabulated for each patient in the order of their risk severity for progression to AAMD. At the conclusion of the 10 year prospective trial, the clinical and genetic data were correlated by masked examiners.
64% of the cohort had no visual loss; 27% had uniocular visual loss; 9% had binocular visual loss from AAMD.These findings were:Independent of increases or decreases in drusen volume in either the treated or untreated eye.Independant of the predicted risk allelle progression rates to AAMD.
The findings in this 10 year prospective pilot study do not permit statistical analysis due to the small cohort.Nevertheless, at 10 years' followup, the baseline vision in at least one eye was maintained in 91% of the cohort surpassing the expected natural history findings reported for a similar period. The delay in the progression of drusen to AAMD exceeded the predicted progression expected from the presence, in varying degrees, in our cohort, of the two major risk alleles for AAMD - CFH and ARMS2. We urge substantiation of our findings of a potential treatment for drusen, prior to their progression to AAMD, with a larger cohort analysis.
This is an abstract that was submitted for the 2017 ARVO Annual Meeting, held in Baltimore, MD, May 7-11, 2017.
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