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Photomedicine and Laser Surgery Volume 26, Number 3, 2008 © Mary Ann Liebert, Inc. Pp. 241–245 DOI: 10.1089/pho.2007.2132 Low-Level Laser Therapy Improves Vision in Patients with Age-Related Macular Degeneration Boris T. Ivandic, M.D.,1 and Tomislav Ivandic, M.D.2 Abstract Objective: The objective of this study of a case series was to examine the effects of low-level laser therapy (LLLT) in patients with age-related macular degeneration (AMD). Background Data: AMD affects a large proportion of the elderly population; current therapeutic options for AMD are limited, however. Patients and Methods: In total, 203 patients (90 men and 113 women; mean age 63.4 5.3 y) with beginning (“dry”) or advanced (“wet”) forms of AMD (n 348 eyes) were included in the study. One hundred ninety- three patients (mean age 64.6 4.3 y; n 328 eyes) with cataracts (n 182 eyes) or without cataracts (n 146 eyes) were treated using LLLT four times (twice per week). A semiconductor laser diode (780 nm, 7.5 mW, 292 Hz, continuous emission) was used for transconjunctival irradiation of the macula for 40 sec (0.3 J/cm2) re- sulting in a total dose of 1.2 J/cm2. Ten patients (n 20 eyes) with AMD received mock treatment and served as controls. Visual acuity was measured at each visit. Data were analyzed retrospectively using a t-test. Results: LLLT significantly improved visual acuity (p 0.00001 versus baseline) in 162/182 (95%) of eyes with cataracts and 142/146 (97%) of eyes without cataracts. The prevalence of metamorphopsia, scotoma, and dyschromatopsia was reduced. In patients with wet AMD, edema and bleeding improved. The improved vi- sion was maintained for 3–36 mo after treatment. Visual acuity in the control group remained unchanged. No adverse effects were observed in those undergoing therapy. Conclusion: In patients with AMD, LLLT significantly improved visual acuity without adverse side effects and may thus help to prevent loss of vision. Introduction AGE-RELATED MACULAR DEGENERATION (AMD) is the pre- dominant cause of irreversible loss of vision in the el- derly. AMD affects 30–50% of individuals 60 years or older.1,2 AMD-related disability and poor quality of life are likely to increase the socio-economic burden in the elderly living in industrialized countries.3 AMD results from defects in the choriocapillaris, Bruch’s membrane, and the retinal pigmented epithelium (RPE) underneath the macula. The epitheliopathy diminishes lysosomal activity and phagocytosis of the outer photore- ceptors and disrupts the transportation of cell debris through the RPE to the choriocapillaris.4 The resulting ac- cumulation of cell debris in Bruch’s membrane leads to thickening and hydrophobic charging of the membrane.5 This suffocates the photoreceptors and promotes fibrovas- cular proliferation and the formation of subretinal exu- dates. Ultimately, the decay of the retina results in loss of vision.6 Current therapeutic approaches aim to stabilize the re- maining vision because photoreceptor function appears to be irreversibly lost. Treatment options, such as photody- namic therapy, laser photocoagulation, transpupillary ther- motherapy, ionizing radiation, and surgery have been ap- plied with limited success in cases of exudative, advanced AMD.7,8 These treatments may also produce collateral dam- age of the foveal neurosensory retina and impair visual func- tion further. At present, antioxidant and mineral dietary sup- plements as well as anti-angiogenetic drugs are being discussed as alternative treatment options.9–12 LLLT represents a novel therapeutic method that, other than surgical laser applications, does not damage tissues. In this study of a case series we investigated the effects of LLLT in patients with AMD of all forms and stages, and varying degrees of vision impairment. 1University of Heidelberg, Otto-Meyerhof Centre, Heidelberg, and 2Medical Centre, Munich, Germany. 241PDF Image | Low-Level Laser Therapy Improves Vision in Macular Degeneration
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