Publications (2)12.27 Total impact
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ABSTRACT: Objective: To evaluate the efficacy and safety of low-intensity laser treatment in the prevention of visual acuity (VA) loss among participants with bilateral large drusen. Design: Multicenter randomized clinical trial. One eye of each participant was assigned to treatment, and the contralateral eye was assigned to observation. Participants: A total of 1052 participants who had >= 10 large (> 125 mu m) drusen and VA :20/40 in each eye enrolled through 22 clinical centers. Intervention: The initial laser treatment protocol specified 60 barely visible burns applied in a grid pattern within an annulus between 1500 and 2500 mu m from the foveal center. At 12 months, eyes assigned to treatment that had sufficient drusen remaining were retreated with 30 burns by targeting drusen within an annulus between 1000 and 2000 mu m from the foveal center. Main Outcome Measure: Proportion of eyes at 5 years with loss of >= 3 lines of VA from baseline. Secondary outcome measures included the development of choroidal neovascularization or geographic atrophy (GA), change in contrast threshold, change in critical print size, and incidence of ocular adverse events. Results: At 5 years, 188 (20.5%) treated eyes and 188 (20.5%) observed eyes had VA scores >= 3 lines worse than at the initial visit (P=1.00). Cumulative 5-year incidence rates for treated and observed eyes were 13.3% and 13.3% (P=0.95) for choroidal neovascularization and 7.4% and 7.8% (P=0.64) for GA, respectively. The contrast threshold doubled in 23.9% of treated eyes and in 20.5% of observed eyes (P=0.40). The critical print size doubled in 29.6% of treated eyes and in 28.4% of observed eyes (P=0.70). Seven treated eyes and 14 observed eyes had an adverse event of a >= 6-line loss in VA in the absence of late age-related macular degeneration or cataract. Conclusion: As applied in the Complications of Age-Related Macular Degeneration Prevention Trial, low-intensity laser treatment did not demonstrate a clinically significant benefit for vision in eyes of people with bilateral large drusen. (c) 2006 by the American Academy of Ophthalmology.
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ABSTRACT: To compare the diagnosis of diabetic macular edema (DME) by stereoscopic slit-lamp biomicroscopic examination of the fundus with a 78-diopter noncontact lens with diagnosis by optical coherence tomography (OCT). Prospective, double-masked, noninterventional diagnostic study. Analysis of slit-lamp biomicroscopic findings compared with OCT measurements. Patients with DME from a private retina practice. Presence or absence of macular thickening. The reference range for this clinic was comparable to reference ranges published from other clinics. The clinical detection of DME was less than detection by OCT. Chance-corrected agreements (kappa statistic) of the 2 methods were 0.63 for the foveal zone and 0.36 to 0.42 for the 4 parafoveal zones. The errors committed in clinical examination were primarily of the type in which clinical examination did not detect DME but OCT did (58%-90%) for the 5 zones analyzed. Reference ranges for OCT seem to be similar for different clinical settings, suggesting the usefulness of OCT in multicenter studies. The current standard of care for DME detection, stereoscopic slit-lamp examination of the fundus, is less sensitive than OCT for detection of DME. Because the principal therapy for DME, focal laser photocoagulation, is mainly sight preserving and not sight restoring, the wider use of OCT may beneficially impact visual disability from DME.