Effect of Subthreshold Nanosecond Laser on Loss of OCT Outer Retinal Bands in Age-Related Macular Degeneration: A LEAD Study Report

IF 3.2 Q1 OPHTHALMOLOGY

Ophthalmology science Pub Date : 2025-06-03 DOI:10.1016/j.xops.2025.100839

Robyn H. Guymer MBBS, PhD , Joseph P.M. Blair PhD , Sandro De Zanet PhD , Stefanos Apostolopoulos PhD , Carlos Ciller PhD , Zhichao Wu BAppSc(Optom), PhD

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Abstract

Purpose

To evaluate the effect of subthreshold nanosecond laser (SNL) treatment on the rate of loss of the OCT outer retinal bands in intermediate age-related macular degeneration (AMD).

Design

Post hoc analysis of the Laser Intervention in the Early Stages of AMD (LEAD) study.

Participants

A subset of 285 of 292 individuals in the LEAD study with bilateral large drusen without signs of multimodal imaging-defined late AMD at baseline, seen at 1 follow-up visit where neovascular AMD (nAMD) was absent.

Methods

Participants were randomized to receive SNL or sham treatment in 1 study eye at 6-monthly intervals and were reviewed for up to 36 months. OCT scans from all visits without nAMD were automatically segmented to examine between-group differences in the rate of change in external limiting membrane (ELM), ellipsoid zone (EZ), and retinal pigment epithelium (RPE) loss in the entire central 5-mm diameter region, or only nondrusen areas in this region.

Main Outcome Measures

Between-group differences in the rate of ELM, EZ, and RPE loss.

Results

Overall, there was no significant between-group difference in the rate of change in the loss of all OCT outer retinal band parameters (P ≥ 0.206). However, there was evidence of significant treatment effect modification based on the coexistence of reticular pseudodrusen (RPD) in the study eye when evaluating the rate of RPE loss in the entire central 5-mm diameter region, and for the rate of ELM, EZ, and RPE loss when considering only nondrusen areas in this region (P ≤ 0.006). In eyes without coexistent RPD, there was a significant slowing of the loss of all OCT outer retinal band parameters with SNL treatment (P ≤ 0.038 for all), whereas there was no significant between-group difference in all parameters in eyes with coexistent RPD (P ≥ 0.153 for all).

Conclusions

Subthreshold nanosecond laser treatment slowed the progressive loss of the OCT outer retinal bands in intermediate AMD in eyes without coexistent RPD. This study also showed for the first time the responsiveness of these novel outcome measures to treatment.

Financial Disclosure

Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.

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阈下纳秒激光对老年性黄斑变性视网膜OCT外带丢失的影响：一项LEAD研究报告

目的探讨阈下纳秒激光（SNL）治疗对中度年龄相关性黄斑变性（AMD）视网膜OCT外带丧失率的影响。设计：激光介入早期AMD （LEAD）研究的事后分析。参与者：在LEAD研究中，292例患者中有285例为双侧大结节，基线时无多模态影像学定义的晚期AMD征象，随访1次，无新生血管性AMD （nAMD）。方法每隔6个月，研究对象被随机分为1只眼接受SNL或假治疗，随访时间长达36个月。所有没有nAMD的患者的OCT扫描被自动分割，以检查整个中心5毫米直径区域的外限制膜（ELM）、椭球区（EZ）和视网膜色素上皮（RPE）损失的变化率在组间的差异，或仅在该区域的非结节区。主要观察指标ELM、EZ和RPE损失率组间差异。结果两组间OCT视网膜外带参数丢失变化率差异无统计学意义（P≥0.206）。然而，当评估整个中心5 mm直径区域的RPE损失率时，基于研究眼中网状假性结节（RPD）的共存，以及仅考虑该区域非结节区域的ELM、EZ和RPE损失率时，有证据表明治疗效果有显著改变（P≤0.006）。在无共存RPD的眼中，SNL治疗显著减缓了所有OCT视网膜外带参数的丢失（P≤0.038），而在共存RPD的眼中，所有参数的组间差异无统计学意义（P≥0.153）。结论亚阈值纳秒激光治疗可减缓中度黄斑变性眼OCT视网膜外带的进展性丧失。这项研究还首次显示了这些新的结果测量对治疗的反应性。财务披露专有或商业披露可在本文末尾的脚注和披露中找到。

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