Nanosecond‐laser application in intermediate <scp>AMD</scp>: 12‐month results of fundus appearance and macular function

Guymer, Robyn H.; Brassington, Kate; Dimitrov, Peter; Makeyeva, Galina; Plunkett, Malcolm; Xia, Wie; Chauhan, Deepender; Vingrys, Algis J.; Luu, Chi D

doi:10.1111/ceo.12247

Cited by 73 publications

(70 citation statements)

References 32 publications

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“…22,23,[25][26][27]29 When used at an energy setting similar to that used in the clinical trials for AMD, nanosecond pulsed laser treatment has been found to preserve retinal integrity in humans and mice. [28][29][30] In the present study, using both a clinically equivalent, subthreshold laser dose (0.065 mJ) and an in vivo fundus-OCT imaging method, we showed for the first time, to our knowledge, that retinal structure directly below the sites of laser treatment is normal. Specifically, at both 7 and 90 days after treatment there were no changes in outer nuclear layer thickness, the inner segment/outer segment/RPE complex, or in total retinal thickness directly under the laser treatment sites.…”

Section: Neuronal Integrity Is Preserved Directly Under Sites Treatedmentioning

confidence: 69%

“…For the subthreshold setting, the nanosecond pulsed laser was applied at 0.065 mJ (irradiance: 52 mJ/cm 2 ) across five spots, which was calculated to be similar to clinical doses used in the human eye for the intervention in early AMD. 28,29 For the assessment of a suprathreshold energy setting, a single laser spot was applied at a dose of 0.5 mJ (irradiance: 398 mJ/cm 2 ), which is greater than the dose previously shown to result in retinal photoreceptor death. 29 …”

Section: Nanosecond Pulsed Laser Applicationmentioning

confidence: 99%

“…29 This effect may be one of the therapeutic mechanisms of nanosecond laser treatment, as Bruch's membrane has been found to thicken in the early stages of AMD, reducing the flow of nutrients between the choroid and photoreceptors. 4,5,28,[40][41][42] However, given that one of the detrimental side effects of CW photocoagulation laser treatments may be damage to Bruch's membrane and secondary CNV, [17][18][19][20] we investigated Bruch's membrane directly adjacent to sites of laser treatment. In the present study, Bruch's membrane was investigated 7 days following laser treatment, at a time when photocoagulation lasers at high-energy settings have been found to induce breaks in Bruch's membrane and CNV as based on animal models of this condition.…”

Section: Effects Of Nanosecond Laser Treatment On the Rpe And Bruch'smentioning

confidence: 99%

“…Recently, a pilot study has shown that low-energy, clinically appropriate nanosecond pulsed laser treatment may be useful for reducing drusen load in patients with AMD. [28][29][30] In mice, a clinically equivalent nanosecond laser treatment has been found to induce thinning of Bruch's membrane, which is thickened in early AMD, by modulating RPE gene expression, while producing no photoreceptor death. 29 While such short-pulse, subthreshold, lowenergy treatments may eventually prove advantageous in treating AMD, the safety and specific effects of nanosecond laser treatment on retinal, RPE, and choroidal tissues requires further investigation.…”

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confidence: 99%

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Nanosecond Laser Treatment for Age-Related Macular Degeneration Does Not Induce Focal Vision Loss or New Vessel Growth in the Retina

Vessey

Jobling

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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PURPOSE. Subthreshold, nanosecond pulsed laser treatment shows promise as a treatment for age-related macular degeneration (AMD); however, the safety profile needs to be robustly examined. The aim of this study was to investigate the effects of laser treatment in humans and mice. METHODS.Patients with AMD were treated with nanosecond pulsed laser at subthreshold (no visible retinal effect) energy doses (0.15-0.45 mJ) and retinal sensitivity was assessed with microperimetry. Adult C57BL6J mice were treated at subthreshold (0.065 mJ) and suprathreshold (photoreceptor loss, 0.5 mJ) energy settings. The retinal and vascular responses were analyzed by fundus imaging, histologic assessment, and quantitative PCR.RESULTS. Microperimetry analysis showed laser treatment had no effect on retinal sensitivity under treated areas in patients 6 months to 7 years after treatment. In mice, subthreshold laser treatment induced RPE loss at 5 hours, and by 7 days the RPE had retiled. Fundus imaging showed reduced RPE pigmentation but no change in retinal thickness up to 3 months. Electron microscopy revealed changes in melanosomes in the RPE, but Bruch's membrane was intact across the laser regions. Histologic analysis showed normal vasculature and no neovascularization. Suprathreshold laser treatment did not induce changes in angiogenic genes associated with neovascularization. Instead pigment epithelium-derived factor, an antiangiogenic factor, was upregulated.CONCLUSIONS. In humans, low-energy, nanosecond pulsed laser treatment is not damaging to local retinal sensitivity. In mice, treatment does not damage Bruch's membrane or induce neovascularization, highlighting a reduced side effect profile of this nanosecond laser when used in a subthreshold manner.

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Section: Neuronal Integrity Is Preserved Directly Under Sites Treatedmentioning

confidence: 69%

Section: Nanosecond Pulsed Laser Applicationmentioning

confidence: 99%

Section: Effects Of Nanosecond Laser Treatment On the Rpe And Bruch'smentioning

confidence: 99%

mentioning

confidence: 99%

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Nanosecond Laser Treatment for Age-Related Macular Degeneration Does Not Induce Focal Vision Loss or New Vessel Growth in the Retina

Vessey

Jobling

et al. 2018

Invest. Ophthalmol. Vis. Sci.

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“…In two further trials carried out on patients with early AMD problems were identified with both the laser system and the trial design. The Australian trial 92 initially only delivered 12 lesions at clock hours around the macula. They noted clearance of drusen but no measurable change in visual acuity.…”

Section: Introductionmentioning

confidence: 99%

The 2014 Bowman Lecture—Bowman’s and Bruch’s: a tale of two membranes during the laser revolution

Marshall

2015

Eye

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Laser treatment of drusen to prevent progression to advanced age-related macular degeneration

Virgili

Michelessi

Parodi

et al. 2015

Cochrane Database of Systematic Reviews

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Background Drusen are amorphous yellowish deposits beneath the sensory retina. People with drusen, particularly large drusen, are at higher risk of developing age-related macular degeneration (AMD). The most common complication in AMD is choroidal neovascularisation (CNV), the growth of new blood vessels in the centre of the macula. The risk of CNV is higher among people who are already affected by CNV in one eye. It has been observed clinically that laser photocoagulation of drusen leads to their disappearance and may prevent the occurrence of advanced disease (CNV or geographic atrophy) associated with visual loss. Objectives To examine the effectiveness and adverse effects of laser photocoagulation of drusen in AMD. Search methods We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (2015, Issue 7), Ovid MEDLINE, Ovid MEDLINE In-Process and Other Non-Indexed Citations, Ovid MEDLINE Daily, Ovid OLDMEDLINE (January 1946 to August 2015), EMBASE (January 1980 to August 2015), Latin American and Caribbean Health Sciences Literature Database (LILACS) (January 1982 to August 2015), the ISRCTN registry (www.isrctn.com/editAdvancedSearch), ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en). We did not use any date or language restrictions in the electronic searches for trials. We last searched the electronic databases on 3 August 2015. Selection criteria Randomised controlled trials (RCTs) of laser treatment of drusen in AMD in which laser treatment had been compared with no intervention or sham treatment. Two types of trials were included. Some trials studied one eye of each participant (unilateral studies); other studies recruited participants with bilateral drusen and randomised one eye to photocoagulation or control and the fellow eye to the other group. Data collection and analysis Two review authors independently selected studies and extracted data. We pooled data from unilateral and bilateral studies using a random-effects model. For the bilateral studies, we estimated the within-person correlation coefficient from one study and assumed it was valid for the others. Main results The update of this review found two additional studies, totaling 11 studies that randomised 2159 participants (3580 eyes) and followed them up to two years, of which six studies (1454 participants) included people with one eye randomised to treatment and one to control. Studies were conducted in Australia, Europe and North America. Overall, the risk of bias in the included studies was low, particularly for the larger studies and for the primary outcome development of CNV. Photocoagulation did not reduce the development of CNV at two years’ follow-up (odds ratio (OR) 1.07, 95% confidence interval (CI) 0.79 to 1.46, 11 studies, 2159 participants (3580 eyes), high quality evidence). This estimate means that, given an overall occurrence of CNV of 8.3% in the control group, we est...

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Nanosecond‐laser application in intermediate AMD: 12‐month results of fundus appearance and macular function

Abstract: A single unilateral application of nanosecond laser to the macula produced bilateral improvements in macula appearance and function. The nanosecond retinal rejuvenation therapy laser warrants ongoing evaluation as an early intervention for AMD.

Cited by 73 publications

References 32 publications

Nanosecond Laser Treatment for Age-Related Macular Degeneration Does Not Induce Focal Vision Loss or New Vessel Growth in the Retina

Nanosecond Laser Treatment for Age-Related Macular Degeneration Does Not Induce Focal Vision Loss or New Vessel Growth in the Retina

The 2014 Bowman Lecture—Bowman’s and Bruch’s: a tale of two membranes during the laser revolution

Laser treatment of drusen to prevent progression to advanced age-related macular degeneration

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