Restorative retinal laser therapy: Present state and future directions

Chhablani, Jay; Roh, Yong Kyun; Jobling, Andrew I; Fletcher, Erica L.; Lek, Jia Jia; Bansal, Pooja; Guymer, Robyn H.; Luttrull, Jeffrey K.

doi:10.1016/j.survophthal.2017.09.008

Cited by 60 publications

(80 citation statements)

References 89 publications

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“…[ 24 – 26 , 31 , 32 , 39 – 46 ] In vivo and in vitro studies demonstrate that SDM/sublethal retinal laser elicits retinal proteomic and systemic immunologic effects described as “protective” and “restorative” to the retina. [ 15 – 38 ] In clinical study, SDM has been found to improve retinal function by electrophysiology, and visual function by microperimetry and contrast visual acuity in dry AMD, inherited retinopathies, and open angle glaucoma. [ 41 – 43 ] In principle, by safely improving retinal function—and thus health—SDM should slow the progression of dry AMD, and thereby reduce the risk of visual loss.…”

Section: Discussionmentioning

confidence: 99%

Low incidence of choroidal neovascularization following subthreshold diode micropulse laser (SDM) in high-risk AMD

Luttrull¹,

Sinclair

Elmann

et al. 2018

PLoS ONE

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PurposeTo determine the incidence of new choroidal neovascularization (CNV) in eyes with dry age-related macular degeneration (AMD) following subthreshold diode micropulse laser (SDM).MethodIn an observational retrospective cohort study, the records of all patients active in the electronic medical records database were reviewed to identify eyes with dry AMD treated with SDM. Identified eyes were classified by simplified AREDS categories, and analyzed for the primary endpoint of new CNV after treatment.ResultsThe EMR revealed SDM was offered to 373/392 (95%) patients with dry AMD and elected by 363/373 (97%) between 2008–2017. Follow up was available for 354/363 patients (547 eyes, 98%) (range 6–108 mos., avg. 22). CNV risk factors included age (median 84 years, 67% > 80); reticular pseudodrusen (214 eyes, 39%); AREDS category (78% category 3 and 4); and fellow eye CNV (128 eyes, 23%). New CNV developed in 9/547 eyes (1.6%, annualized rate 0.87%). Visual acuity was unchanged. There were no adverse treatment effects.SummaryIn a review of a large group of eyes with exceptionally high-risk AMD, SDM was followed by a very low incidence of new CNV. If confirmed by further study, SDM would offer a new and highly effective treatment to reduce the risk of vision loss from AMD.

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Section: Discussionmentioning

confidence: 99%

Low incidence of choroidal neovascularization following subthreshold diode micropulse laser (SDM) in high-risk AMD

Luttrull¹,

Sinclair

Elmann

et al. 2018

PLoS ONE

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“…While conventional retinal photocoagulation is effective, various methods have been explored to attain a therapeutic effect while limiting or avoiding damage to the retinal tissue [8]. Titrating the laser power introduced the concept of subthreshold burns in DME, which reduced tissue damage but nevertheless still produced visible scars to the retina [1,4]. In 1990, Pankratov developed the micropulse diode laser, designed to fire a series of millisecond laser pulses in spaced-out intervals [1,4,12].…”

Section: Historymentioning

confidence: 99%

“…Titrating the laser power introduced the concept of subthreshold burns in DME, which reduced tissue damage but nevertheless still produced visible scars to the retina [1,4]. In 1990, Pankratov developed the micropulse diode laser, designed to fire a series of millisecond laser pulses in spaced-out intervals [1,4,12]. Initial micropulse diode lasers reduced thermal retinal damage and allowed selective treatment to the RPE.…”

Section: Historymentioning

confidence: 99%

“…Although it still remains unclear, there have been numerous theories for the therapeutic effect of conventional retinal photocoagulation. It is postulated that laserinduced retinal destruction reduces the metabolic demand of a hypoxic retina by 1) targeting metabolically active photoreceptors, 2) increasing choroidal retinal oxygenation, 3) upregulating heat-shock proteins (HSPs), and/or 4) altering vasoactive cytokines including VEGF [4,11,13,14]. In particular, focal retinal laser is thought to photocoagulate microaneurysms and lessen macular edema [6,14].…”

Section: Mechanism Of Actionmentioning

confidence: 99%

“…Conventional argon retinal photocoagulation has been universally accepted for over forty years [1][2][3]. It is primarily used for retinal diseases including proliferative diabetic retinopathy (PDR), diabetic macular edema (DME), choroidal neovascularization, macular edema associated with retinal vein occlusion (RVO), and central serous chorioretinopathy (CSCR) [4][5][6][7][8][9][10]. However, the role of conventional laser therapy is limited due to complications such as scar enlargement, visual field scotoma, subretinal fibrosis, and subretinal neovascular membranes [4,8,11].…”

Section: Introductionmentioning

confidence: 99%

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Review of Subthreshold Diode Micropulse Laser Treatment for Retinal Diseases

Benjamin

et al. 2018

CTOY

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Subthreshold Diode Micropulse (SDM) laser is a relatively new treatment modality that confers very little to no anatomical risk to the retina. However, its efficacy is still being studied, and the scenario where SDM is most useful is still being elucidated. This paper reviews articles from 1997 to 2017 and reviews the settings, results, and outcomes of SDM in various clinical settings including diabetic macular edema, branch retinal vein occlusion, central serous Chorioretinopathy, proliferative diabetic retinopathy, and age-related macular degeneration.

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One‐Year Functional and Anatomical Outcomes After Selective Retina Therapy With Real‐Time Feedback‐Controlled Dosimetry in Patients With Intermediate Age‐Related Macular Degeneration: A Pilot Study

2020

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Background and Objectives This pilot study sought to evaluate changes in macular function and drusen volume (DV) after selective retina therapy (SRT) in patients with intermediate age‐related macular degeneration (iAMD). Study Design/Materials and Methods Twenty participants with bilateral iAMD were included in this prospective interventional case series study. After titrating pulse energy by real‐time feedback‐controlled dosimetry, SRT with a wavelength of 527 nm was applied around the macula of one eye of each patient. Changes in best‐corrected visual acuity (BCVA), DV within the central 5‐mm ring (C5), and retinal sensitivity (RS) of the SRT‐treated eyes (treated eyes) and untreated fellow eyes (untreated eyes) were evaluated at baseline and then at 3, 6, 9, and 12 months after treatment using linear mixed models. Results The mean BCVA did not change significantly between baseline and 12 months in both treated and untreated eyes (P = 0.06, P = 0.24, respectively), whereas the BCVA increase rate was faster for treated than for untreated eyes at the 12‐month visit (–0.072 logMAR; 95% confidence interval [CI], −0.085 to −0.059 logMAR; P = 0.006). The mean cube root transformation of DV (cube root DV) within C5 in the untreated eyes increased significantly from 0.278 ± 0.115 at baseline to 0.295 ± 0.132 mm (P = 0.027) at 12 months, whereas the cube root DV change in treated eyes was not significant (P = 0.553). The rate of increase in the cube root DV was lower in treated than in untreated eyes at the 12‐month visit (−0.016 mm; 95% CI, −0.018 to −0.011 mm; P = 0.015). The mean RS was increased from 22.49 ± 2.40 dB to 24.09 ± 2.19 dB (P < 0.001) in the treated eyes, whereas the change of mean RS in the untreated eyes was not significant at the 12‐month visit (P = 0.18). The treated eyes had a higher rate of increase in RS than untreated eyes at the 12‐month visit (1.012 dB; 95% CI, 0.776–1.251 dB; P = 0.037). The RS change was significantly associated with the interaction between SRT treatment and time (P = 0.028), whereas it was not associated with cube root DV change (P = 0.106). No SRT‐related adverse effects were observed in all participants during the 1‐year follow‐up. Conclusion Since SRT improved the mean RS and reduced the rate of change in drusen load in the treated eyes, as compared to the untreated eyes, SRT might slow the progression of iAMD. However, further large randomized clinical trials are necessary to confirm the efficacy of SRT for iAMD. Lasers Surg. Med. © 2020 Wiley Periodicals LLC

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Restorative retinal laser therapy: Present state and future directions

Cited by 60 publications

References 89 publications

Low incidence of choroidal neovascularization following subthreshold diode micropulse laser (SDM) in high-risk AMD

Low incidence of choroidal neovascularization following subthreshold diode micropulse laser (SDM) in high-risk AMD

Review of Subthreshold Diode Micropulse Laser Treatment for Retinal Diseases

One‐Year Functional and Anatomical Outcomes After Selective Retina Therapy With Real‐Time Feedback‐Controlled Dosimetry in Patients With Intermediate Age‐Related Macular Degeneration: A Pilot Study

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