TY - JOUR
T1 - Subthreshold Nanosecond Laser in Age-Related Macular Degeneration
T2 - Observational Extension Study of the LEAD Clinical Trial
AU - LEAD Study Grp
AU - Guymer, Robyn H.
AU - Chen, Fred K.
AU - Hodgson, Lauren A. B.
AU - Caruso, Emily
AU - Harper, Colin A.
AU - Wickremashinghe, Sanjeewa S.
AU - Cohn, Amy C.
AU - Sivarajah, Pyrawy
AU - Tindill, Nicole
AU - Luu, Chi D.
AU - Wu, Zhichao
PY - 2021/12
Y1 - 2021/12
N2 - Purpose: To evaluate the long-term effect of subthreshold nanosecond laser (SNL) treatment on progression to late age-related macular degeneration (AMD).Design: Observational extension study of a randomized, sham-controlled trial.Participants: Two hundred twelve participants with bilateral large drusen.Methods: The Laser Intervention in the Early Stages of AMD (LEAD) study was a 36-month trial where participants were randomized to receive SNL or sham treatment in 1 eye at 6-monthly intervals up to 30 months. After the completion of the LEAD study, the 2 largest recruiting sites offered remaining participants an opportunity to enroll in a 24-month observational extension study. This study thus examined all participants from these 2 sites who were enrolled in the LEAD study at baseline, including the additional observational data.Main Outcome Measures: Time to develop late AMD, defined on multimodal imaging, between those randomized the SNL or sham treatment.Results: Overall, no significant difference was found in the rate of progression over a 60-month period in those randomized to the SNL compared with the sham group (adjusted hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.36-1.09; P = 0.098), similar to the findings at 36 months in the LEAD Study. However, evidence of treatment effect modification continued to emerge based on the coexistence of reticular pseudodrusen (RPD; P = 0.007, adjusted interaction). Namely, progression was slowed significantly with SNL treatment for those without coexistent RPD (adjusted HR, 0.34; 95% CI, 0.16-0.71; P = 0.004), but it was not significantly different for those with RPD (adjusted HR, 1.81; 95% CI, 0.67-4.88; P = 0.239).Conclusions: A 24-month observational extension study to the LEAD Study confirmed that SNL treatment did not significantly reduce the overall rate of progression to late AMD in a cohort with intermediate AMD. However, the persistence of a potential beneficial treatment effect in those without coexistent RPD over a longer follow-up duration of an additional 24 months without additional treatment is encouraging. These findings provide further justification for future trials to examine the potential value of SNL treatment for slowing progression in intermediate AMD. (C) 2021 by the American Academy of Ophthalmology
AB - Purpose: To evaluate the long-term effect of subthreshold nanosecond laser (SNL) treatment on progression to late age-related macular degeneration (AMD).Design: Observational extension study of a randomized, sham-controlled trial.Participants: Two hundred twelve participants with bilateral large drusen.Methods: The Laser Intervention in the Early Stages of AMD (LEAD) study was a 36-month trial where participants were randomized to receive SNL or sham treatment in 1 eye at 6-monthly intervals up to 30 months. After the completion of the LEAD study, the 2 largest recruiting sites offered remaining participants an opportunity to enroll in a 24-month observational extension study. This study thus examined all participants from these 2 sites who were enrolled in the LEAD study at baseline, including the additional observational data.Main Outcome Measures: Time to develop late AMD, defined on multimodal imaging, between those randomized the SNL or sham treatment.Results: Overall, no significant difference was found in the rate of progression over a 60-month period in those randomized to the SNL compared with the sham group (adjusted hazard ratio [HR], 0.63; 95% confidence interval [CI], 0.36-1.09; P = 0.098), similar to the findings at 36 months in the LEAD Study. However, evidence of treatment effect modification continued to emerge based on the coexistence of reticular pseudodrusen (RPD; P = 0.007, adjusted interaction). Namely, progression was slowed significantly with SNL treatment for those without coexistent RPD (adjusted HR, 0.34; 95% CI, 0.16-0.71; P = 0.004), but it was not significantly different for those with RPD (adjusted HR, 1.81; 95% CI, 0.67-4.88; P = 0.239).Conclusions: A 24-month observational extension study to the LEAD Study confirmed that SNL treatment did not significantly reduce the overall rate of progression to late AMD in a cohort with intermediate AMD. However, the persistence of a potential beneficial treatment effect in those without coexistent RPD over a longer follow-up duration of an additional 24 months without additional treatment is encouraging. These findings provide further justification for future trials to examine the potential value of SNL treatment for slowing progression in intermediate AMD. (C) 2021 by the American Academy of Ophthalmology
KW - Age-related macular degeneration
KW - Atrophy
KW - Clinical trial
KW - Drusen
KW - Laser
KW - Nanosecond
KW - Subthreshold
KW - ATROPHY
UR - http://www.scopus.com/inward/record.url?eid=2-s2.0-85105340641&partnerID=MN8TOARS
U2 - 10.1016/j.oret.2021.02.015
DO - 10.1016/j.oret.2021.02.015
M3 - Article
C2 - 33662615
SN - 2468-6530
VL - 5
SP - 1196
EP - 1203
JO - Ophthalmology Retina
JF - Ophthalmology Retina
IS - 12
ER -