Laser Photocoagulation of Subfoveal Neovascular Lesions of Age-Related Macular Degeneration: Updated Findings From Two Clinical Trials
Abstract
OBJECTIVE: To report 3- and 4-year visual outcomes in eyes followed up in two randomized clinical trials of laser photocoagulation for subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration. DESIGN AND MAIN OUTCOME MEASURES: Eyes of consenting patients were assigned randomly to laser treatment or no treatment. Visual acuity, reading speed, and contrast threshold were measured before random assignment, 3 and 6 months later, and at 6-month intervals thereafter. Visual acuities of treated and untreated eyes were compared 4 years after enrollment, in the Subfoveal New CNV Study (eyes without prior laser treatment), and 3 years after enrollment, in the Subfoveal Recurrent CNV Study (eyes with subfoveal recurrent CNV at the periphery of an earlier laser treatment scar). RESULTS: Four years after enrollment in the Subfoveal New CNV Study, 39 (47%) of 83 untreated eyes and 17 (22%) of 77 laser-treated eyes had lost 6 or more lines of visual acuity from baseline levels (P = .002). At the 3-year examination in the Subfoveal Recurrent CNV Study, 21 (36%) of 58 untreated eyes and six (12%) of 49 treated eyes had lost 6 or more lines of visual acuity from baseline levels (P = .009). Comparisons based on contrast threshold and reading speed for enlarged text also favored laser treatment in both trials. CONCLUSIONS: Stronger evidence favoring laser photocoagulation of subfoveal CNV has been provided by continued follow-up of patients enrolled in these two clinical trials. The benefits of laser treatment have persisted through at least 4 years of follow-up in the Subfoveal New CNV Study and 3 years of follow-up in the Subfoveal Recurrent CNV Study.
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At 2 years, visual acuity decreased to 20/200 or worse in 45% to 75% of untreated patients and in 30% to 40% of photodynamic therapy patients.
“Visual acuity decreased to 20/200 or worse at 2 years in 45% to 75% of patients with no treatment and in 30% to 40% with photodynamic therapy”
From Five-Year Outcomes with Anti–Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration (2016) · cites this paper as [31]
Two years after diagnosis, fewer than 10% of untreated patients retained vision of 20/40 or better, and fewer than 15% of photodynamic therapy patients retained 20/40 or better.
“Two years after diagnosis, fewer than 10% of patients retained vision of 20/40 or better with no treatment and fewer than 15% of patients treated with photodynamic therapy retained 20/40 or better.31–33”
From Five-Year Outcomes with Anti–Vascular Endothelial Growth Factor Treatment of Neovascular Age-Related Macular Degeneration (2016) · cites this paper as [31]
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Spaide, R. F., LEYS, A. M., Herrmann-Delemazure, B., Stalmans, P., Tittl, M., Yannuzzi, L. A., Burke, K. M., Fisher, Y. L., Freund, K. B., Guyer, D. R., et al. (1999) · Ophthalmology · doi:10.1016/s0161-6420(99)90524-9 · Cited by 39 · see citing works
Conbercept (KH-902) for the treatment of neovascular age-related macular degeneration
Nguyen, T. T., & Guymer, R. H. (2015) · Expert Review of Clinical Pharmacology · doi:10.1586/17512433.2015.1075879 · Cited by 38 · see citing works
Choroidal neovascular membranes: reproducibility of angiographic interpretation
Friedman, S. M., & Margo, C. E. (2000) · American Journal of Ophthalmology · doi:10.1016/s0002-9394(00)00605-x · Cited by 38 · see citing works
The choroidal rupture: current concepts and insights
Lupidi, M., Muzi, A., Castellucci, G., Kalra, G., Piccolino, F. C., Chhablani, J. K., & Cagini, C. (2021) · Survey of Ophthalmology · doi:10.1016/j.survophthal.2021.01.014 · Cited by 37 · see citing works
- Venue
- Archives of Ophthalmology
- Publisher
- American Medical Association (AMA)
- Published
- 1993-09-01
- Volume
- 111
- Issue
- 9
- Pages
- 1200
- ISSN
- 0003-9950 (ISSN-L)
- OpenAlex
- W4251720370
- Cited by
- 303
- References
- 0
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 1 · 2023: 3 · 2022: 2 · 2021: 2 · 2020: 6 · 2019: 3 · 2018: 7 · 2017: 5 · 2016: 5 · 2015: 8 · 2014: 8 · 2013: 4 · 2012: 7
- FWCI
- 5.91
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of Ophthalmology (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (5u01ey002546-07, 5u01ey002547-07)
- National Eye Institute (EY02547, EY02546, EY02548)
- Topics
- Health Sciences › Medicine › Ophthalmology › Retinal Diseases and Treatments
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Retinal and Macular Surgery
- Health Sciences › Medicine › Ophthalmology › Ocular Diseases and Behçet’s Syndrome
- Keywords
- laser photocoagulation, subfoveal choroidal neovascularization, age-related macular degeneration, visual acuity outcomes, long-term follow-up, recurrent CNVs, contrast threshold, reading speed
- MeSH terms
- Aged, Aged, 80 and over, Choroid, Female, Fluorescein Angiography, Follow-Up Studies, Fovea Centralis, Fundus Oculi, Humans, Macular Degeneration, Male, Middle Aged, Neovascularization, Pathologic, Reading, Recurrence, Sensory Thresholds, Visual Acuity, Contrast Sensitivity, Laser Coagulation
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