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Visual Outcome After Laser Photocoagulation for Subfoveal Choroidal Neovascularization Secondary to Age-Related Macular Degeneration: The Influence of Initial Lesion Size and Initial Visual Acuity

Visual Outcome After Laser Photocoagulation for Subfoveal Choroidal Neovascularization Secondary... Abstract Objective: To provide detailed information specific to the initial visual acuity and initial lesion size on the outcome of patients with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration. Design and Patients: The 189 eyes assigned to laser photocoagulation and the 184 eyes assigned to observation in the Subfoveal New CNV Study were divided into nine subgroups based on initial visual acuity and initial lesion size. Main Outcome Measures: The pattern of visual acuity loss for both treated and untreated eyes through 4 years of follow-up was compared among the subgroups. Reading speed and contrast thresholds also were examined. Results: Four patterns (A, B, C, D) of visual acuity loss in treated eyes relative to untreated eyes were identified. Eyes in group A (small lesion and moderate or poor initial visual acuity or medium lesion and poor visual acuity) had the best visual outcome with treatment; treated eyes were better throughout follow-up. Eyes in group B (small lesion and good initial visual acuity or medium lesion and moderate or good visual acuity) had substantial treatment benefit by 12 months, but were worse immediately after treatment. Eyes in group C (large lesion and poor initial visual acuity) had a small treatment benefit throughout follow-up. Eyes in group D (large lesion and moderate or good visual acuity) had the worst visual outcome with treatment; treated eyes were substantially worse for the first 18 months and were not appreciably better through 4 years of follow-up. Conclusions: Recommendations for treatment of subfoveal CNV should take account of the initial visual acuity and lesion size. Eyes in group D are poor candidates for laser treatment. References 1. Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal neovascular lesions in age-related macular degeneration: results of a randomized clinical trial . Arch Ophthalmol . 1991;109:1220-1231.Crossref 2. Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal neovascular lesions of age-related macular degeneration: updated findings from two clinical trials . Arch Ophthalmol . 1993;111:1200-1209.Crossref 3. Macular Photocoagulation Study Group. MPS Manual of Procedures . Spring-field, Va: National Technical Information Service; January 1991. NTIS accession No. PB91-207903. 4. Macular Photocoagulation Study Group. Subfoveal neovascular lesions in age-related macular degeneration: guidelines for evaluation and treatment in the Macular Photocoagulation Study . Arch Ophthalmol . 1991;109:1242-1257.Crossref 5. Bailey IL, Lovie JE. New design principles for visual acuity letter charts . Am J Optom Physiol Optics . 1976;53:740-745.Crossref 6. Pelli DG, Robson JG, Wilkins AJ. The design of a new letter chart for measuring contrast sensitivity . Clin Vis Sci . 1988;2:187-199. 7. Hillis A, Maguire M, Hawkins BS, Newhouse MM. The Markov process as a general method for nonparametric analysis of right-censored medical data . J Chron Dis . 1986;39:595-604.Crossref 8. Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal recurrent neovascular lesions in age-related macular degeneration: results of a clinical trial . Arch Ophthalmol . 1991;109:1232-1241.Crossref 9. Alexander MF, Maguire MG, Lietman TM, Snyder JR, Elman MJ, Fine SL. Assessment of visual function in patients with age-related macular degeneration and low visual acuity . Arch Ophthalmol . 1988;106:1543-1547.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Visual Outcome After Laser Photocoagulation for Subfoveal Choroidal Neovascularization Secondary to Age-Related Macular Degeneration: The Influence of Initial Lesion Size and Initial Visual Acuity

Archives of Ophthalmology , Volume 112 (4) – Apr 1, 1994
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References (9)

Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1994.01090160056023
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To provide detailed information specific to the initial visual acuity and initial lesion size on the outcome of patients with subfoveal choroidal neovascularization (CNV) secondary to age-related macular degeneration. Design and Patients: The 189 eyes assigned to laser photocoagulation and the 184 eyes assigned to observation in the Subfoveal New CNV Study were divided into nine subgroups based on initial visual acuity and initial lesion size. Main Outcome Measures: The pattern of visual acuity loss for both treated and untreated eyes through 4 years of follow-up was compared among the subgroups. Reading speed and contrast thresholds also were examined. Results: Four patterns (A, B, C, D) of visual acuity loss in treated eyes relative to untreated eyes were identified. Eyes in group A (small lesion and moderate or poor initial visual acuity or medium lesion and poor visual acuity) had the best visual outcome with treatment; treated eyes were better throughout follow-up. Eyes in group B (small lesion and good initial visual acuity or medium lesion and moderate or good visual acuity) had substantial treatment benefit by 12 months, but were worse immediately after treatment. Eyes in group C (large lesion and poor initial visual acuity) had a small treatment benefit throughout follow-up. Eyes in group D (large lesion and moderate or good visual acuity) had the worst visual outcome with treatment; treated eyes were substantially worse for the first 18 months and were not appreciably better through 4 years of follow-up. Conclusions: Recommendations for treatment of subfoveal CNV should take account of the initial visual acuity and lesion size. Eyes in group D are poor candidates for laser treatment. References 1. Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal neovascular lesions in age-related macular degeneration: results of a randomized clinical trial . Arch Ophthalmol . 1991;109:1220-1231.Crossref 2. Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal neovascular lesions of age-related macular degeneration: updated findings from two clinical trials . Arch Ophthalmol . 1993;111:1200-1209.Crossref 3. Macular Photocoagulation Study Group. MPS Manual of Procedures . Spring-field, Va: National Technical Information Service; January 1991. NTIS accession No. PB91-207903. 4. Macular Photocoagulation Study Group. Subfoveal neovascular lesions in age-related macular degeneration: guidelines for evaluation and treatment in the Macular Photocoagulation Study . Arch Ophthalmol . 1991;109:1242-1257.Crossref 5. Bailey IL, Lovie JE. New design principles for visual acuity letter charts . Am J Optom Physiol Optics . 1976;53:740-745.Crossref 6. Pelli DG, Robson JG, Wilkins AJ. The design of a new letter chart for measuring contrast sensitivity . Clin Vis Sci . 1988;2:187-199. 7. Hillis A, Maguire M, Hawkins BS, Newhouse MM. The Markov process as a general method for nonparametric analysis of right-censored medical data . J Chron Dis . 1986;39:595-604.Crossref 8. Macular Photocoagulation Study Group. Laser photocoagulation of subfoveal recurrent neovascular lesions in age-related macular degeneration: results of a clinical trial . Arch Ophthalmol . 1991;109:1232-1241.Crossref 9. Alexander MF, Maguire MG, Lietman TM, Snyder JR, Elman MJ, Fine SL. Assessment of visual function in patients with age-related macular degeneration and low visual acuity . Arch Ophthalmol . 1988;106:1543-1547.Crossref

Journal

Archives of Ophthalmology – American Medical Association

Published: Apr 1, 1994

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