Laser treatment in Age-related Macular Degeneration

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Summary of Evidence

Subthreshold nanosecond laser in intermediate AMD

In patient with intermediate AMD, subthreshold nanosecond laser (SNL) did not significantly slow progression rate to late AMD. A post hoc analysis however showed SNL may slow progression in patients without coexistent reticular pseudodrusen, and may be inappropriate in patients with the latter.(LEAD, 2019).{Guymer RH, Wu Z, Hodgson LAB, Caruso E, Brassington KH, Tindill N, Aung KZ, McGuinness MB, Fletcher EL, Chen FK, Chakravarthy U, Arnold JJ, Heriot WJ, Durkin SR, Lek JJ, Harper CA, Wickremasinghe SS, Sandhu SS, Baglin EK, Sharangan P, Braat S, Luu CD; Laser Intervention in Early Stages of Age-Related Macular Degeneration Study Group. Subthreshold Nanosecond Laser Intervention in Age-Related Macular Degeneration: The LEAD Randomized Controlled Clinical Trial. Ophthalmology. 2019 Jun;126(6):829-838.}

Evidence

1. Background

2. Subthreshold nanosecond laser

2.1 Intermediate AMD

Clinical Trial

2019 Guymer et.al. (LEAD)

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2019
Clinical Trial

In patient with intermediate AMD, subthreshold nanosecond laser (SNL) did not significantly slow progression rate to late AMD. A post hoc analysis however showed SNL may slow progression in patients without coexistent reticular pseudodrusen, and may be inappropriate in patients with the latter. {Guymer RH, Wu Z, Hodgson LAB, Caruso E, Brassington KH, Tindill N, Aung KZ, McGuinness MB, Fletcher EL, Chen FK, Chakravarthy U, Arnold JJ, Heriot WJ, Durkin SR, Lek JJ, Harper CA, Wickremasinghe SS, Sandhu SS, Baglin EK, Sharangan P, Braat S, Luu CD; Laser Intervention in Early Stages of Age-Related Macular Degeneration Study Group. Subthreshold Nanosecond Laser Intervention in Age-Related Macular Degeneration: The LEAD Randomized Controlled Clinical Trial. Ophthalmology. 2019 Jun;126(6):829-838.}

  • Randomized controlled trial of subthreshold nanosecond laser vs sham in intermediate AMD (292 patients)
  • Findings (3-years):
    • Progression to late AMD was not slowed significantly with SNL treatment compared with sham.
    • A post hoc analysis however showed progression was slowed in participants without coexistent reticular pseudodrusen at baseline, and an increased progression rate in participants with reticular pseudodrusen.
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