THE IMPACT OF THE MACULAR PHOTOCOAGULATION STUDY RESULTS ON THE TREATMENT OF EXUDATIVE AGE-RELATED MACULAR DEGENERATION

Objective: To determine the percent of cases with all primary forms of exudative age-related macular degeneration that are eligible for trea tment by the Macular Photocoagulation Study (MPS) guidelines in a reti na clinic serving both as a primary care center and as a referral cent er. Design: Fluorescein angiograms of patients with age-related macula r degeneration examined at the Goldschleger Eye Institute, Sheba Medic al Center, Tel Hashomer, Israel, during a 5-year period (1985 to 1990) were randomly selected and reviewed. Angiograms showing all forms of exudative age-related macular degeneration were eligible. The first 10 0 eligible angiograms identified constituted the study series and were classified into four groups: active choroidal neovascularization (CNV ), pigment epithelium detachment, hemorrhage, and disciform scars. The active CNVs were further divided into three subgroups: classic (well defined), occult (poorly defined), and combined. Eligibility for laser treatment was determined exclusively with use of the published MPS re commendations for treatment of extrafoveal, juxtafoveal, and subfoveal membranes. Results: There were 10 cases in the pigment epithelium det achment group, 11 cases in the hemorrhagic group, and 16 cases with di sciform scars. All of these 37 cases were ineligible for treatment by MPS guidelines. Sixty-three eyes had active membranes; 37 were classic CNVs (eight extrafoveal, seven juxtafoveal, and 22 subfoveal). All ex trafoveal and juxtafoveal CNVs were found to be eligible for laser tre atment. Eleven membranes of the subfoveal group were larger than 2 dis c areas, a size for which the MPS did not demonstrate benefit from las er treatment. There were 19 membranes in the strictly occult CNV subgr oup, all of them untreatable by MPS criteria. Seven cases had both occ ult and classic CNV, and all were larger than 3.5 disc areas and there fore ineligible for treatment. Overall, 26 cases were eligible for tre atment by strict MPS criteria; these constitute 26% of the whole serie s and 41% of the active CNV cases in the series. Conclusions: Our resu lts indicate that the MPS guidelines for laser treatment are applicabl e only to a minority of the cases with exudative age-related macular d egeneration presenting to our clinic. Further studies should be conduc ted to identify additional treatment modalities for this common eye di sease.