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and thus contributes to the development of atrophic AMD. Genes in different pathways influence progression to different stages of AMD. The genes CFH, C3, CFB, and ARMS2/HTRA1 have been associated with progression from intermediate drusen to large drusen, and from large drusen to GA or NV 23. By altering gene expression PBM can influence factors involved in progression of AMD such as VEGF and inflammatory cytokinins. Recently there has been interest in tissue sparing or sub threshold laser at 577nm and 810 nm to produce therapeutic effects without clinical evidence of intra retinal damage 24. It has been proposed that the benefits might be due to the up- and down- regulation of angiogenic growth factors (e.g., VEGF) 25 26 27 28 mediated by the biological reaction of RPE cells that have been only sub lethally injured. We feel that the same benefits to cellular function can occur with PBM and that there is no damage to any cells with the low powered LED light sources used in our study. We used fixation stability, a novel testing parameter as one of our primary outcome measures and although there were changes both in the BCEA and PRL location after the treatment these were not statistically significant, however correlation analysis between visual acuity and fixation stability was improved after the treatment – further evidence of a treatment effect. See figure 4 Average ETDRS visual acuity was statistically significantly improved immediately following the treatment and this improvement remained at statistically significant levels at 12 months although some decline in the ETDRS log MAR score is evident after 4 months. This would suggest that some patients would benefit from re-treatment somewhere after the 4-month interval. This happened to be the case in one subject with advanced geographic atrophy in both eyes with a decline in visual acuity of four lines in the 12 months prior to enrollment in her better eye. She regained over 3 lines of visual acuity immediately following the treatment (log MAR 0.66 improving to log MAR 0.34) but when assessed at 6 months had lost any gain from her treatment (log MAR 0.7). Many patients with progressing Geographic Atrophy loose vision rapidly. She was re-treated with a non-study protocol over a ten-day period. She regained 2 lines of vision (log MAR 0.54) following this secondary treatment. As this subject was re-treated which constituted a protocol violation all data on this subject was excluded from analysis. See figure 5 The treatment appears to have revitalized, rejuvenated and improved the function of these compromised retinal cells on the border of the geographic atrophy with an immediate improvement in visual acuity however the time this effect lasted for was less than 6 months. This could be further evaluated in the future utilizing both Auto fluorescence and Geographic Atrophy area mapping, both of which are now readily available with newer OCT scanning devices but that were not available to us at the study inception.PDF Image | dry Age-related Macular Degeneration Photobiomodulation
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