Session Title: AMD III
Session Date/Time: Sunday 20/09/2015 | 11:00-13:00
Paper Time: 11:32
First Author: : J.Luttrull UNITED STATES
Co Author(s): : B. Margolis
PURPOSE:To evaluate the effect of prophylactic SDM treatment on chronic progressive retinal degenerations by retinal function testing
A private vitreoretinal subspecialty practice in Ventura, California, USA.
The records of all patients undergoing SDM for high-risk age-related macular (AMD) and inherited photoreceptor degenerations (IRD) examined by pattern electroretinography (PERG) and automated microperimetry AMP before and after treatment were reviewed.
33 eyes of 20 patients with AMD (high risk drusen and / or geographic pigmentary atrophy) and 7 eyes of 7 patients with IRD (retinitis pigmentosa, 3 eyes; cone-rod degeneration, 3 eyes; Stargardt’s disease,1 eye) were identified for study. Each was treated with 1700-2700 confluent spots of SDM placed in the posterior pole circumscribed by the major vascular arcades including the fovea (“panmacular” treatment). PERG and AMP were performed before, and between 4 days to 4 weeks after treatment. Improvement in macular function by PERG was demonstrated in 36/40 eyes; 29/33 eyes with AMD (P= 0.0035, Wilcoxon signed rank test; and P=0.0116, paired t-test) and 7/7 eyes with IRD (P=0.0107, Fischer Exact and Wilcoxon-Manley-Whitney test). Drusen resolution was noted in some AMD eyes. Microperimetry was unchanged. There were no adverse treatment effects.
Our findings suggest a new and important role for SDM as prophylactic retinal protective therapy in chronic progressive retinal disease. As a sensitive, objective and reliable measure of macular health, PERG allows functional, rather than structural, disease assessment and treatment guidance. As functional abnormalities precede structural degeneration and vision loss, Functionally Guided (Disease) Management (FGM) and early prophylactic treatments such as SDM offer the prospect for improved long-term outcomes compared to the current approach of late, structurally guided management directed by retinal imaging. As an immediate measure of treatment response, PERG permits rapid assessment of new macular treatments. The results of this study may serve as a preliminary benchmark for prospective preventive treatments for retinal and macular disease. Our results show that the beneficial effects of treatment can be detected quickly and reliably. Prospective treatments not demonstrating improved macular function by testing such as PERG may not justify further investigation.