LASER TREATMENT IN SUBJECTS WITH HIGH-RISK CLINICAL-FEATURES OF AGE-RELATED MACULAR DEGENERATION - POSTERIOR POLE APPEARANCE AND RETINAL FUNCTION

Objectives: To verify that a few laser lesions in the posterior pole c an cause drusen to resolve in patients with age-related macular degene ration, and to document central retinal sensitivity as drusen resolve. Design: In a pilot study, 12 patients considered to be at high risk f or sight-threatening complications from age-related macular degenerati on were treated with 12 argon laser lesions in the posterior pole, wit h review for 12 to 24 months. Results: Choroidal neovascularization de veloped in 1 patient 8 months after treatment, with consequent loss of central vision. In 9 of the remaining 11 patients, highrisk character istics of drusen were reduced. Four patients had retinal pigment epith elial depigmentation, and all maintained 20/40 visual acuity at 12 mon ths. One patient lost 3 lines of vision due to geographic atrophy afte r 12 months. Scotopic retinal threshold was elevated before treatment in 8 patients, compared with an age-matched comparison group. Of these , 4 patients underwent retesting 3 to 6 months after treatment, and al l had improved thresholds, but only 1 patient sustained the improvemen t at 12 months. At 12 months, 3 of the 8 patients showed an improvemen t in their mean retinal threshold. Of those in whom the mean retinal t hreshold worsened, the mean elevation in threshold was not more than 0 .6 log units. Conclusions: A few laser lesions in the posterior pole l eads to resolution of drusen. There does not appear to be an increased risk for choroidal neovascularization. Retinal threshold measurements show no indication of geographic atrophy at 1 year, but cannot be exc luded as a late outcome. Laser treatment may reduce the risk for profo und sight-threatening lesions in age-related macular degeneration.