Laser Prophylaxis for Dry Age-Related Macular Degeneration: Current Evidence

TL;DR

This paper reviews laser treatment for dry age-related macular degeneration, suggesting it may prevent vision loss if used without causing retinal damage.

Contribution

The paper highlights new evidence that laser prophylaxis without retinal damage could safely slow AMD progression.

Findings

Laser-induced retinal damage may accelerate AMD progression and vision loss.

Avoiding retinal damage allows laser treatment to safely prevent vision loss in high-risk AMD eyes.

Current evidence suggests laser prophylaxis could be a leading approach to reducing AMD-related vision loss.

Abstract

Purpose: To review the role of prophylactic panmacular laser treatment for age-related macular degeneration (AMD). Method: A narrative review of studies employing laser treatment for non-exudative (“dry”) AMD listed in the PubMed database. Results: In multiple published studies, macular laser treatment that causes laser-induced retinal damage (LIRD) has shown either no overall benefit or has accelerated disease progression and vision loss in eyes with dry AMD, particularly in high-risk eyes with more severe pre-treatment disease. Conversely, other studies, including randomized and matched propensity-scored real-world-data (RWD) clinical studies, indicate that avoidance of LIRD may allow laser to be used safely and effectively to prevent vision loss from AMD by slowing disease progression and preventing neovascular conversion without adverse treatment effects, benefiting the highest-risk eyes most. Conclusions: AMD is the leading cause of irreversible vision loss worldwide. Current evidence suggests that laser prophylaxis for dry AMD may hold great promise in preventing age-related vision loss. More studies, especially prospective clinical trials, from more investigators, are needed. If current evidence is confirmed, laser prophylaxis would rise to a preeminent position as the safest, most effective, and most economical and accessible approach to reducing vision loss from AMD.

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