This Article  • References  • Full text PDF  • Correction  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

Influence on Visual Outcome in Patients With Age-Related Macular Degeneration

Macular Photocoagulation Study Group

Arch Ophthalmol. 1996;114(4):400-412.

Abstract
Objective
To determine whether the presence of occult choroidal neovascularization (CNV) influenced the anatomic and visual acuity outcomes in a randomized clinical trial of krypton red laser photocoagulation to treat juxtafoveal neovascular lesions in age-related macular degeneration.

Design, Setting, and Patients
The fluorescein angiograms obtained at the baseline examination at tertiary retinal referral centers between April 1, 1981, and December 31, 1987, as part of the Macular Photocoagulation Study (MPS) Age-Related Macular Degeneration Study—Krypton Laser were evaluated retrospectively at the MPS Fundus Photograph Reading Center by two senior readers independently (with open adjudication of any differences) from 1992 to 1994. Criteria for classifying classic and occult CNV by the MPS Group were established by 1989, 2 years after the last patient had been assigned randomly to treatment or observation in the krypton laser study.

Main Outcome Measures
Treatment coverage of classic and occult CNV, persistent CNV, recurrent CNV, and visual acuity from scheduled follow-up examinations for up to 5 years were analyzed for the absence or presence of occult CNV at baseline.

Results
The number of eyes with classic CNV but no occult CNV, classic and occult CNV, and occult CNV but no classic CNV were almost identical for the eyes assigned randomly to treatment or observation. Classic CNV almost always was covered completely with intense laser treatment; nevertheless, recurrent CNV developed in more than half of these eyes within 1 year after initial laser treatment. In contrast, in more than half of the eyes with occult CNV, more than 50% of the occult CNV was not covered with heavy laser treatment. Laser treatment was clearly beneficial for eyes with classic CNV but no occult CNV and almost equivalent to no treatment for eyes with classic and occult CNV. The few eyes with occult CNV but no classic CNV precluded conclusions about the value of treatment in this subgroup.

Conclusions
These results strengthen previous reports that laser treatment is beneficial for eyes with juxtafoveal choroidal neovascular lesions when classic CNV is present, even though CNV often recurs. Treatment of classic CNV alone in eyes with classic and occult CNV was not beneficial in this study. Distinguishing classic CNV from occult CNV can aid in the selection of patients who will benefit most from laser treatment.

Author Affiliations
Prepared for the Macular Photocoagulation Study (MPS) Group by Neil M. Bressler, MD; Marta ]. Marsh, MS; Maureen G. Maguire, PhD; Judith Alexander; Deborah A. Phillips; Noreen B. Javornik, MS; Cheryl J. Hiner; Susan B. Bressler, MD; Suresh R. Chandra, MD; Timothy P. Flood, MD; Michael L. Klein, MD; Mary Lou Lewis, MD; Andrew P. Schachat, MD; Lawrence J. Singerman, MD; Thomas S. Stevens, MD; Barbara S. Hawkins, PhD; and Stuart L. Fine, MD. A complete membership listing is given at the end of this article. No member of the MPS Group has any proprietary interest in the development or marketing of any commercially available products used by these studies.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Types of choroidal neovascularisation in newly diagnosed exudative age-related macular degeneration
Cohen et al.
Br J Ophthalmol 2007;91:1173-1176.
ABSTRACT | FULL TEXT  

Lesion morphology in age-related macular degeneration and its therapeutic significance.
Beaumont and Kang
Arch Ophthalmol 2006;124:807-812.
ABSTRACT | FULL TEXT  

A 76-year-old man with macular degeneration.
Arroyo
JAMA 2006;295:2394-2406.
FULL TEXT  

Long term results after transpupillary thermotherapy in eyes with occult choroidal neovascularisation associated with age related macular degeneration: a prospective trial
Stolba et al.
Br J Ophthalmol 2006;90:158-161.
ABSTRACT | FULL TEXT  

A phase I trial of stereotactic external beam radiation for subfoveal choroidal neovascular membranes in age-related macular degeneration
Barak et al.
Br. J. Radiol. 2005;78:827-831.
ABSTRACT | FULL TEXT  

Photodynamic therapy with verteporfin is effective, but how big is its effect? Results of a systematic review
Meads and Hyde
Br J Ophthalmol 2004;88:212-217.
ABSTRACT | FULL TEXT  

Photodynamic Therapy With Verteporfin in Subfoveal Choroidal Neovascularization Secondary to Central Serous Chorioretinopathy
Ergun et al.
Arch Ophthalmol 2004;122:37-41.
ABSTRACT | FULL TEXT  

CNV subtype in first eyes predicts severity of ARM in fellow eyes
Abugreen et al.
Br J Ophthalmol 2003;87:307-311.
ABSTRACT | FULL TEXT  

Visual Outcomes in the Subfoveal Radiotherapy Study: A Randomized Controlled Trial of Teletherapy for Age-Related Macular Degeneration
Hart et al.
Arch Ophthalmol 2002;120:1029-1038.
ABSTRACT | FULL TEXT  

Can {blacktriangledown}verteporfin help in macular degeneration?
DTB 2001;39:30-32.
ABSTRACT | FULL TEXT  

Transpupillary thermotherapy (TTT) for the treatment of choroidal neovascularisation
Newsom et al.
Br J Ophthalmol 2001;85:173-178.
ABSTRACT | FULL TEXT  

Extracts from "Clinical Evidence": Age related macular degeneration
Arnold and Sarks
BMJ 2000;321:741-744.
FULL TEXT  

Long term results of radiotherapy for subfoveal choroidal neovascularisation in age related macular degeneration
Chiquet et al.
Br J Ophthalmol 1999;83:923-928.
ABSTRACT | FULL TEXT  

Radiotherapy for isolated occult subfoveal neovascularisation in age related macular degeneration: a pilot study
Donati et al.
Br J Ophthalmol 1999;83:646-651.
ABSTRACT | FULL TEXT  

Indocyanine green angiographic features prognostic of visual outcome in the natural course of patients with age related macular degeneration
Obana et al.
Br J Ophthalmol 1999;83:429-437.
ABSTRACT | FULL TEXT  

A Model of the Incidence and Consequences of Choroidal Neovascularization Secondary to Age-related Macular Degeneration: Comparative Effects of Current Treatment and Potential Prophylaxis on Visual Outcomes in High-Risk Patients
Lanchoney et al.
Arch Ophthalmol 1998;116:1045-1052.
ABSTRACT | FULL TEXT  

Occult Choroidal Neovascularization in Age-Related Macular Degeneration: A Natural History Study
Stevens et al.
Arch Ophthalmol 1997;115:345-350.
ABSTRACT  

Macular Scatter ('Grid') Laser Treatment of Poorly Demarcated Subfoveal Choroidal Neovascularization in Age-Related Macular Degeneration: Results of a Randomized Pilot Trial
Bressler et al.
Arch Ophthalmol 1996;114:1456-1464.
ABSTRACT  

The Peril of the Pilot Study
Ferris and Murphy
Arch Ophthalmol 1996;114:1506-1507.
ABSTRACT  

Indocyanine Green Angiography: Can It Help Preserve the Vision of Our Patients?
Bressler and Bressler
Arch Ophthalmol 1996;114:747-749.
ABSTRACT