Risk Of Visual Loss Research Articles

Bilateral anterior ischemic optic neuropathy after bilateral neck dissection

The risk of visual loss after nonocular surgeries is very low, between 0.2% and 4.5%. According to the American Society of Anesthesiologists, ischemic optic neuropathy has been reported mostly after spinal surgery (54.2%), followed by cardiac surgery and radical neck dissection (13.3%). It may occur in association with some conditions that include systemic hypotension, acute blood loss and hypovolemia. A 46-year-old woman, whose diagnosis was laryngeal squamous cell carcinoma, complained of visual loss in her right eye two days after surgery (laryngectomy with bilateral radical neck dissection and left jugular ligature) and one day later in her left eye. The diagnosis was nonarteritic anterior ischemic optic neuropathy. Anterior ischemic optic neuropathy related to nonocular surgery is usually bilateral and its prognosis is very poor, resulting in blindness or severe visual loss. Although rare, patients should be warned about this complication, which has a profound impact on quality of life, since no therapeutic measure, including correction of hypotension and anemia, seems to improve the prognosis of this complication.

Laser in situ keratomileusis versus long-term contact lens wear: Decision analysis

To compare the risk for vision loss from laser in situ keratomileusis (LASIK) versus long-term contact lens wear using decision analysis. Oregon Health & Science University, Portland, Oregon, USA. Based on previously published data, a decision tree was constructed using Markov modeling to calculate the probability of vision loss from LASIK versus contact lenses over time. An outcome variable, visual acuity-adjusted life-year (VALY), was defined to account for timing and severity of vision loss. The VALYs were tallied over a 30-year simulation to determine whether the risk for vision loss with contacts exceeded that with LASIK. Sensitivity analyses were performed to test the effect of changes in key variables including probability of contact lens-related keratitis, probability of ectasia after LASIK, and probability of early post-LASIK vision loss. The model's conclusions were highly sensitive to changes in several variables tested, especially risk for post-LASIK ectasia, risk for early vision loss after LASIK, and risk for contact lens-related keratitis (which correlated with type of lenses worn). Rigid gas-permeable lenses were safer than LASIK in every analysis. The safety of LASIK exceeded that for daily-wear soft lenses only when assumptions were most favorable to LASIK, whereas the safety of LASIK always exceeded that for extended-wear lenses except when assumptions were least favorable to LASIK. This decision analysis found that the risk for vision loss associated with LASIK and with long-term contact lens wear might be closer than generally assumed.

Verteporfin PDT for subfoveal occult CNV in AMD: two-year results of a randomized trial

ABSTRACTObjective: To determine whether verteporfin photodynamic therapy (PDT) can safely reduce the risk of vision loss in patients with subfoveal occult with no classic choroidal neovascularization (CNV) due to age-related macular degeneration.Research design and methods: Eligible patients were ≥50 years of age with lesion size ≤6 disc areas and best-corrected vision 20/40–20/200. A total of 364 patients with occult with no classic CNV were randomly assigned 2 : 1 to verteporfin PDT (n = 244) or placebo (n = 120). The primary outcome measures were loss of ≥15 and ≥30 letters of visual acuity (VA) from baseline at 12 and 24 months.Results: A total of 37% and 47% of verteporfin-treated patients versus 45% and 53% of placebo recipients lost ≥15 letters of VA at month 12 and month 24, respectively; 16% and 23% of verteporfin-treated patients versus 17% and 25% of placebo recipients lost ≥30 letters at month 12 and month 24, respectively. These differences were not statistically significant. Four (1.6%) verteporfin-treated patients and one placebo patient (who received verteporfin in error) experienced an acute severe VA decrease; all five patients recovered some degree of vision. No unexpected ocular or systemic adverse events were identified.Conclusions: Verteporfin PDT in the treatment of occult with no classic CNV was safe and well-tolerated. The differences between the two groups in the primary efficacy variables were not significant. Baseline characteristics and patient selection methods may have contributed to the small treatment effect.Trial registration: ClinicalTrials.gov identifier: NCT00121407.

Fluorescein Angiography and Visual Acuity in Active Uveitis with Behçet Disease

Purpose: To determine the association of fluorescein angiography characteristics with visual acuity and visual loss during medical treatment in patients with Behçet uveitis. Methods: Ninety-three eyes from 69 Behçet patients with active panuveitis underwent fluorescein angiography, and the characteristic findings by angiography were determined. The patients were followed with immunomodulatory treatment. Results: Diffuse vascular leakage (73.4%), diffuse macular leakage (66.0%), and disc leakage (52.7%) were the predominant angiographic findings on fluorescein angiography. Multivariate logistic regression analysis revealed that a macular window defect and disc neovascularization on fluorescein angiography were associated with poor visual acuity (≤ 20/200) (p < .05). The presence of macular ischemia on fluorescein angiography was significantly associated with the risk of visual loss (≤ 20/200) at 48 months post-treatment (p < .05). Conclusions: These results suggest that fluorescein angiography may be helpful for predicting visual prognosis for Behçet patients with panuveitis.

Monitoring the Progressing Glaucoma Patient – What Are the Challenges?

Diagnosing glaucoma progression is complex. It is essential to assess both structure and function to detect progression. Establishing a reliable baseline is crucial in this process. A functional baseline requires repeated visual field testing. Documentation of the optic disc appearance is necessary for the acquisition of the structural baseline. This can be achieved by the complementary modes of both clinical and imaging devicebased optic disc documentation. Imaging-based methods to assess progression and rate of progression are likely to prove important in the future, but currently more guidance for their use in clinical practice is required. Rate of progression provides important information about the risk of vision loss. Guidelines therefore recommend determining the rate of progression for the individual patient when planning management. Adherence issues need to be addressed before changing treatment strategy, since poor compliance may play a considerable role in the progression of disease in many patients. In conclusion, we must strive to improve the management of glaucoma to limit the impact disease progression has on the patient’s quality of life.

Anterior Ischaemic Optic Neuropathy (AION) Associated with Post Dialysis Hypotension

Three patients on haemodialysis presented with acute painless visual loss. From each, a comprehensive medical and ophthalmic history was taken and each underwent a complete ophthalmic examination. Visual evaluation was carried out by recording Snellen visual acuities, Ishihara colour test scores, the presence of a relative afferent pupillary defect (RAPD) and visual fields with either Goldmann or Humphrey perimetry. Review of renal case notes was performed and appropriate laboratory investigations including imaging were carried out to investigate the cause of disc swelling in all cases. All cases presented with acute painless visual loss, a RAPD, disc swelling, impaired colour vision and a visual field defect. All cases had a history of post-dialysis hypotension. In 2 cases, post-dialysis hypotension was documented just prior to the development of anterior ischaemic optic neuropathy (AION) suggesting a causal relationship. Falls in mean arterial pressure (MAP) of 31 and 22 mmHg were recorded. None of the cases had other well documented risk factors for AION such as diabetes or hypercholesterolaemia. One case had crowded discs. Two cases had bilateral involvement. Two cases were treated with corticosteroids and 1 with aspirin. Visual improvement was noted in 1 case coincident with corticosteroid treatment. Common risk factors in all 3 cases were anaemia and post-dialysis hypotension. In conclusion, patients undergoing haemodialysis may be at risk of AION particularly if they are anaemic and develop post-dialysis hypotension. They should be informed of a small and unpredictable risk of visual loss.

Management of the Progressing Glaucoma Patient

The objective of glaucoma therapy is to preserve the patient’s vision at moderate cost. Life expectancy, stage of disease and progression rate, jointly, are considered the pivotal standard of assessment of the glaucoma patient, and correct therapeutic management is fundamental. Decreasing the progression rate of functional damage is the only strategy to reach the therapy objective in glaucoma today. From this point of view, ocular hypotensive therapy represents the only available instrument to reduce the risk of progression, minimising the risk of visual loss for each patient. Decreasing intraocular pressure should be considered the instrument by which the clinician can reduce the speed of a patient’s disease progression. The choice of aggressive or less aggressive treatment can be made on a case-by-case basis to slow down the progression rate of the disease to a secure level for the patient’s individual risk profile. In conclusion, the management of the glaucoma patient should be based on perimetric data, which should be considered as the way to judge the efficacy of the ocular hypotensive therapy.

Is reduction in the risk of vision loss the only benefit of photodynamic therapy in predominantly classic subfoveal choroidal neovascularization?

To emphasize the effect of photodynamic therapy (PDT) on the size and progression of the neovascular lesion (NL) and evolution of the disciform scar (DS) in predominantly classic subfoveal choroidal neovascularization (SFCNV). A retrospective study of 62 eyes treated with PDT for SFCNV was performed. The greatest linear dimension (GLD) before and at last follow-up after treatment and the size of the DS post-PDT were analyzed. A subgroup of patients with DS in their fellow eye at presentation without prior PDT was also studied. The size of the scar in these eyes was compared to that following PDT. After an average follow-up at 9 months, the size of the NL was stabilized or reduced in 64% of the study eyes with absence of fluorescein leakage in 45%. Only 3 eyes (5%) developed DS. At presentation, 14 patients already had DS in their fellow eye, the size of which was significantly larger than that post-PDT (p = 0.044). It was also significantly larger than that of the potential scar in the study eyes of the same subgroup of patients (p = 0.002) and of the rest of the patients (p = 0.0001). This study demonstrates a beneficial effect for PDT on the size of the NL and DS in SFCNV, which might be of great significance, particularly when PDT fails to prevent severe vision loss.

Risk Factors for Microbial Keratitis with Contemporary Contact Lenses: A Case-Control Study

To assess the relative risks (RR) of microbial keratitis (MK) for contemporary contact lens (CL) types and wearing schedules. A 2-year prospective case-control study begun in December 2003. Cases were 367 CL wearers attending Moorfields Eye Hospital with proven or presumed MK. Controls were 1069 hospital controls, who were CL wearers with a disorder unrelated to CL wear, and 639 population-based controls who were CL wearers randomly selected from the Moorfields catchment area. Hospital patients completed a self-administered questionnaire; population-based controls were interviewed by telephone. Multivariate analysis was done both for all cases of MK, and for the moderate and severe MK subgroups alone. The RR for developing MK, and vision loss, for all lens types compared with planned replacement soft lenses (the referent). Compared with planned replacement soft lenses (the referent), the RR of MK was significantly increased with daily disposable (DD) CLs (RR, 1.56x [95% confidence interval (CI), 1.1-2.1]; P = 0.009) and differed between different brands of DD lens, was reduced for rigid lenses (RR, 0.16x [95% CI, 0.06-0.4]; P<0.001), and no different for silicone hydrogel or other types of soft lens. Although the risk of MK was higher overall among DD lens users, the risk of vision loss was less than for planned replacement soft CL users (P = 0.05); no DD lens users lost vision to the level of >or=20/40. The RR for overnight wear, for any lens type, was 5.4 times higher (95% CI, 3.3-10.9; P<0.001). Comparison of the DD soft CL types with planned replacement soft lenses (the referent), showed significant differences between brands for the risk of MK. The risk of MK has not been reduced in users of DD and silicone hydrogel CLs. However, vision loss is less likely to occur in DD than in reusable soft CL users. Different brands of CL may be associated with significantly different risks of keratitis; understanding these differences should lead to the development of safer soft lenses. These findings suggest that lens/ocular surface interactions may be more important in the development of corneal infection than oxygen levels and CL case contamination.

Clinical Course of Retrobulbar Hemangioblastomas in von Hippel–Lindau Disease

To report clinical findings of rare retrobulbar optic nerve hemangioblastomas associated with von Hippel-Lindau disease (VHL). Retrospective observational case series. Nine patients with VHL. The clinical course and magnetic resonance imaging findings of patients with VHL and hemangioblastomas affecting the anterior visual pathway from the intraorbital optic nerve to the optic chiasm are reviewed. Clinical course of retrobulbar optic nerve hemangioblastomas. The mean age of VHL diagnosis was 24+/-14 years, and mean follow-up was 5+/-4 years. All had other CNS lesions and retinal hemangioblastomas. Approximately 50% (5/9) had a previous enucleation or had visual acuity loss (4/9), some due to other VHL ocular complications. Four patients underwent surgical resection of an intracranial hemangioblastoma. Growth patterns and pathology are similar to those of other hemangioblastomas in the CNS. Although these lesions are rare, patients with VHL who present with signs of optic neuropathy should be evaluated for anterior visual pathway hemangioblastomas impinging on the optic nerve from the orbit to the chiasm. On neuroimaging, the hemangioblastomas may demonstrate chiasmal or optic tract edema, associated cysts, and T(2) flow voids. Lesions may remain radiologically and clinically stable, evolve radiographically with no visual or neurological progression, or progress clinically and radiographically. Patients at risk for visual loss should be considered for surgical resection. Close coordination among neuroradiology, neurosurgery, and ophthalmology patient care teams is advised for optimal management of these patients.

World Glaucoma Day, 6 March 2008: tackling the glaucoma pandemic

World Glaucoma Day, 6 March 2008: tackling the glaucoma pandemic

Photodynamic therapy combined with intravitreal injection of triamcinolone acetonide for choroidal neovascularization

The aim of this research was to evaluate the efficacy and safety of photodynamic therapy (PDT) combined with intravitreal injection of triamcinolone acetonide (TA) in the treatment of choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD) and pathological myopia. PDT combined with intravitreal injection of TA was performed on 16 eyes of 16 patients with CNV diagnosed by visual acuity, fluorescein fundus angiography (FFA) and optical coherent tomography (OCT), including 14 eyes secondary to age-related macular degeneration and two eyes secondary to pathological myopia. TA was injected intravitreally 72 h post PDT on 12 eyes and from three months to one year (mean nine months) post PDT on four eyes respectively. All the patients were followed up for 3 to 18 months (mean 18.6 months). Best-corrected visual acuity, intraocular pressure, retinal thickness and FFA were observed. The visual acuity was improved in seven eyes (43.8%) of all the 16 eyes and stable in nine eyes (56.2%), respectively. FFA revealed complete or partial closure of CNV in all patients. OCT showed that the macular edema disappeared or was alleviated. Transient intraocular pressure elevation occurred in one patient (6.25%) of all the 16 eyes and intraocular pressure returned to the normal after a transient treatment with antiglaucoma medication. The mean number of PDTs during the first year was 1.1. PDT combined with intravitreal injection of TA for CNV is safe and effective. It can reduce the risk of visual loss and the treatment frequency.

Cytomegalovirus retinitis

Cytomegalovirus (CMV) retinitis is the most common ocular opportunistic infection affecting patients with AIDS, despite the fact that the use of highly active antiretroviral therapy (HAART) has reduced its incidence by 80%. Treatment with HAART has decreased the risk of retinitis progression, retinal detachment and visual loss in patients with CMV retinitis. HAART-induced immune recovery has been associated with an approximately 50% reduction in the risk of visual loss in eyes of patients with CMV retinitis. However, immune recovery uveitis, an ocular complication seen in the era of HAART, may increase the risk of visual loss. Furthermore, among patients with AIDS and without CMV retinitis followed in the era of HAART, the development of CMV retinitis over time has been reported to account for approximately 40% of incident vision loss and, thus, continues to be the leading cause of visual loss among patients with AIDS.

Pars Plana Vitrectomy and Epiretinal Membrane Peeling for Vitreoretinal Traction Associated with Combined Hamartoma of the Retina and Retinal Pigment Epithelium (CHRRPE)

Combined hamartoma of the retina and retinal pigment epithelium (CHRRPE) are rare, benign tumours that typically appear slightly elevated and are characterised by varying amounts of pigmentation, vascular tortuosity, and epiretinal membrane formation that can be related to macular distortion. The importance of changes at the vitreoretinal interface in this condition as a risk for visual loss was early recognised but controversy exists concerning the benefits of surgical removal of the tractional component. We describe 2 cases of CHRRPE who demonstrated significant visual acuity improvement after pars plana vitrectomy and epiretinal membrane peeling. A 12-year-old girl and a 14-year-old boy presented with progressive unilateral visual loss related with a CHRRPE. In both instances the hamartoma was associated with a thickened posterior hyaloid and epiretinal membrane inducing considerable vitreomacular traction as shown by optical coherence tomography (OCT). Best-corrected pre-operative visual acuity was 0.2 in both cases. Vitrectomy and epiretinal membrane peeling were performed in both cases. Relief of vitreomacular traction and macular distortion was achieved and documented on OCT. Visual acuity at the latest follow up was 0.5 and 0.8, respectively. Surgical dissection can be effective in the treatment of vitreomacular traction associated with CHRRPE with a good functional and anatomical outcome.

HPLC Measurement of Ocular Carotenoid Levels in Human Donor Eyes in the Lutein Supplementation Era

A substantial proportion of the population at risk for visual loss from age-related macular degeneration consumes supplements containing high doses of lutein, but clinical studies to date have shown only modest and variable increases in macular carotenoid pigments in response to supplementation. To determine whether lutein supplementation can indeed alter ocular carotenoid levels, the authors chemically measured levels of lutein, zeaxanthin, and their metabolites in the macula, peripheral retina, and lens of 228 eyes from 147 human donors and correlated these results with retrospective supplement histories from families of selected members of the study population. Lenses and circular punches of macula (4-mm diameter) and equatorial peripheral retina (8-mm diameter) were dissected from donor eyes free of ocular disease procured from the local eye bank. The amounts of lutein, zeaxanthin, meso-zeaxanthin, and 3'-oxolutein were determined by HPLC with photodiode array and mass spectral detection. Eighteen percent of eyes from donors age 48 and older had unusually high levels (66.3 +/- 15.1 ng) of macular carotenoids that were three times the rest of the older population's mean level (23.0 + 12.1 ng; P < 0.001). Carotenoid levels in these outliers were also unusually high in the lens and in the peripheral retina. Similar outliers were not present in donors younger than 48. Most of these outliers regularly consumed high-dose lutein supplements before death. Lutein supplementation was uncommon in older donors whose macular carotenoids were in the normal range. The presence of unusually high levels of macular carotenoids in older donors who were regularly consuming high-dose lutein supplements supports the hypothesis that long-term lutein supplementation can raise levels of macular pigment. Elevated carotenoid levels in the peripheral retina and lens in these same donors could have important implications for understanding why some clinical methods of macular pigment measurement have had difficulty detecting robust and consistent responses in carotenoid supplementation trials.

The American Society of Anesthesiologists Postoperative Visual Loss Registry

Postoperative visual loss after prone spine surgery is increasingly reported in association with ischemic optic neuropathy, but its etiology is unknown. To describe the clinical characteristics of these patients, the authors analyzed a retrospectively collected series of 93 spine surgery cases voluntarily submitted to the American Society of Anesthesiologists Postoperative Visual Loss Registry on standardized data forms. Ischemic optic neuropathy was associated with 83 of 93 spine surgery cases. The mean age of the patients was 50 +/- 14 yr, and most patients were relatively healthy. Mayfield pins supported the head in 16 of 83 cases. The mean anesthetic duration was 9.8 +/- 3.1 h, and the median estimated blood loss was 2.0 l (range, 0.1-25 l). Bilateral disease was present in 55 patients, with complete visual loss in the affected eye(s) in 47. Ischemic optic neuropathy cases had significantly higher anesthetic duration, blood loss, percentage of patients in Mayfield pins, and percentage of patients with bilateral disease compared with the remaining 10 cases of visual loss diagnosed with central retinal artery occlusion (P < 0.05), suggesting they are of different etiology. Ischemic optic neuropathy was the most common cause of visual loss after spine surgery in the Registry, and most patients were relatively healthy. Blood loss of 1,000 ml or greater or anesthetic duration of 6 h or longer was present in 96% of these cases. For patients undergoing lengthy spine surgery in the prone position, the risk of visual loss should be considered in the preoperative discussion with patients.

Optic disc pit: primary diagnosis in a child

Congenital abnormalities of the optic nerve head are commonly detected by optometrists in practice. While some severe abnormalities can lead to poor visual acuity and are associated with other ocular and systemic disorders, others such as pits of the optic disc are predominantly benign with a latent risk of visual loss. This report details the primary diagnosis of unilateral optic disc pit in a seven‐year‐old patient.

Preventing reactivation of ocular histoplasmosis: Guidance for patients at risk

Background Ocular histoplasmosis syndrome (OHS), a significant cause of vision loss in young and middle-aged adults, is associated with the fungus Histoplasma capsulatum (Hc). There is considerable evidence that recurrent reactivation of perimacular ocular histoplasmosis lesions is an important cause of disease progression and that vision loss is at least, in part, a consequence of host sensitivity to fungal antigen. Methods The etiology and pathogenesis of OHS is reviewed and specific recommendations are made for patients with OHS that may decrease the risk of reactivation of ocular histoplasmosis lesions and slow disease progression. Conclusion Patients with perimacular chorioretinal scars secondary to OHS should be informed by the clinician that they are at risk for vision loss; they should be told the symptoms of choroidal neovascularization and how to self-monitor their vision with an Amsler grid. We recommend they also be instructed on how to decrease their risk of reinfection by Hc. Aggressive treatment of dermatomycoses, onychomycosis, vaginal candidiasis, and other chronic fungal infections may decrease the risk of reactivation of ocular lesions. Patients with OHS who are considering LASIK surgery should be informed that the procedure may trigger choroidal neovascularization.

Improved Safety in Contemporary LASIK

To examine the risk of serious visual loss in contemporary LASIK. Retrospective, noncomparative, consecutive case series combined with a structured literature review and comparison with historical controls. One thousand consecutive cases of LASIK performed from January 2000 to January 2004 by 1 surgeon. One thousand nine hundred eighty-two cases with 6-month review data in postmillennial Food and Drug Administration (FDA) trials of LASIK for myopia and astigmatism and 5203 patients with 6 month review data in similar premillennial FDA trials. LASIK was performed with the Hansatome microkeratome and a VISX Star (S2, S3, or S4) laser. There were 899 myopic treatments (spherical equivalent < or =-10.5 diopters [D]; average -4.2 D; standard deviations [SD] D = 1.9 D; astigmatism < or =4.75 D), 87 hyperopic treatments (spherical equivalent < or =+4.25 D; average +2.4 D; SD = 0.9 D; astigmatism < or =3.5 D), and 14 treatments for mixed astigmatism (< or =4.5 D). Outcome data were obtained from a review of case notes and compared with historical data from FDA trials. Best-spectacle corrected visual acuity (BSCVA) preoperatively and at final review was compared in our case series with reference to the United Kingdom driving standard (BSCVA> or =20/30). Subsidiary outcome measures included duration of follow-up, intraoperative, and postoperative complication rates. Six-month postoperative data on standard safety criteria (numbers of patients losing > or =2 lines BSCVA, BSCVA <20/40, and final BSCVA <20/25 for patients with preoperative BSCVA > or =20/20) were examined in FDA trials. In our clinical series, no case with a preoperative BSCVA of 20/20 or better had a final BSCVA of <20/30 at final review (97.5% confidence interval [CI], 0%-0.37%); 4 eyes had a BSCVA <20/25 (0.41%; 95%CI, 0.11%-1.02%). The median interval between surgery and final review was 2 months (range, 1-45 months). In FDA studies recruiting pre-2000, 1.4% of patients lost > or =2 lines of BSCVA versus 0.6% in postmillennial studies (P = 0.005); 0.45% of patients in premillennial studies lost BSCVA to <20/40 compared with no patients in postmillennial studies (P = 0.001); and 1.68% of patients in premillennial studies with a preoperative BSCVA > or =20/20 had a postoperative BSCVA <20/25 compared with 0.16% in postmillennial studies (P< or =0.001). Compared with premillennial results, the risk of visual loss is significantly reduced in contemporary LASIK.

Laser prophylaxis for age-related macular degeneration

Background: Age-related macular degeneration (AMD) is the most common cause of severe and irreversible vision loss among people 50 years of age or older in many Western countries. Most of the available treatments for AMD are intended for the late stage, specifically for choroidal neovascularization (CNV). Effective preventive treatments could have an even greater impact on the vision of the millions of people at risk for vision loss from AMD. Drusen are typically the earliest lesions seen in patients with AMD and precede the development of CNV. In 1973, Gass noted the disappearance of drusen in eyes that received laser photocoagulation, which led to the hypothesis that laser-induced drusen reduction could alter the natural course of AMD. Methods: We reviewed relevant articles found through a search of MEDLINE through February 2005 by means of the following key words, alone or in combination: drusen, laser, photocoagulation, age-related macular degeneration, macula and choroidal neovascularization. Results: Reports ranging from individual cases and case series to randomized controlled pilot studies have described various laser treatment protocols and their effects on eyes with high-risk drusen but no neovascular changes. These reports provide evidence that laser photocoagulation can induce drusen reduction. Although some investigators have reported a corresponding improvement in visual function, others have found no change or even worsening.The results in several of the larger randomized controlled studies suggest that CNV may occur at an increased rate in laser-treated eyes with high-risk drusen in patients who have neovascular AMD in the other eye. The long-term effects of laser treatment in patients with high-risk drusen in both eyes and no neovascular changes have yet to be determined. Interpretation: The outcome of clinical trials such as the Prophylactic Treatment of Age-Related Macular Degeneration and the Complications of Age-Related Macular Degeneration Prevention Trial will help to determine the role of laser prophylaxis in patients with AMD.