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Original Investigation |

The Effect of Multispot Laser Panretinal Photocoagulation on Retinal Sensitivity and Driving Eligibility in Patients With Diabetic Retinopathy

Mala Subash, BM, FRCOphth1; Oliver Comyn, MD(Res), FRCOphth1; Ahmed Samy, MSc, FRCS(Glasgow)1; Dania Qatarneh, FRCOphth1; Serafeim Antonakis, MD, MA1; Manjit Mehat, MBChB, MSc1; James Tee, MA, FRCOphth1; Tatiana Mansour, MD1; Wen Xing, MSc1; Catey Bunce, DSc1; Ananth Viswanathan, MD, PhD, FRCOphth1; Gary Rubin, PhD1; Richard Weleber, MD2; Tunde Peto, MD, PhD1; Louisa Wickham, FRCOphth1; Michel Michaelides, MD, FRCOphth1
[+] Author Affiliations
1National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital National Health Service Foundation Trust and University College London Institute of Ophthalmology, London, England
2Casey Eye Institute, Oregon Health and Science University, Portland
JAMA Ophthalmol. 2016;134(6):666-672. doi:10.1001/jamaophthalmol.2016.0629.
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Importance  Panretinal photocoagulation (PRP) for proliferative diabetic retinopathy (PDR) may lead to peripheral field loss that prevents driving. Anti–vascular endothelial growth factor agents are proposed as treatments for PDR that spare peripheral vision. If multispot lasers cause less visual field loss, continuing to perform PRP may be justified.

Objective  To assess the effect of bilateral multispot laser PRP on retinal sensitivity and driving visual fields in PDR.

Design, Setting, and Participants  This prospective nonrandomized interventional cohort analysis performed at a tertiary referral center included 43 laser-naive patients with PDR that required bilateral PRP. Participants were recruited from June 27, 2012, to October 14, 2013. At baseline and 6-month follow-up, patients underwent detailed static and kinetic perimetry, microperimetry, optical coherence tomography, wide-field color fundus photography, and fluorescein angiography. Quantitative change in retinal sensitivity was assessed by comparing the mean global retinal sensitivity before and after laser treatment and by comparing the modeled hill of vision by deriving a volumetric measure. Final follow-up was completed on May 21, 2014.

Interventions  Multispot laser treatment was applied using standard parameters, until neovascularization regressed or complete retinal coverage was achieved.

Main Outcomes and Measures  Participants who passed the Esterman binocular visual field test for driving in the United Kingdom (at least 120° horizontal field with no significant defects within the central 20°) and full-field and macular retinal sensitivity.

Results  Of the 43 patients (17 men; 26 women; mean [SD] age, 46.6 [13.3] years), 38 (88%) completed the study. Before treatment, 41 of 43 patients (95%) passed the Esterman visual field test for driving; after completion of laser treatment, 35 of 38 patients (92%) passed. The mean (SD) change in retinal sensitivity on static perimetry was −1.4 (3.7) (95% CI, −2.7 to −0.1) dB OD and −2.4 (2.9) (95% CI, −3.4 to −1.4) dB OS. Mean (SD) 4° macular sensitivity decreased by 3.0 (5.2) dB OD and 2.6 (5.4) dB OS.

Conclusions and Relevance  This prospective study investigating the effects of multispot laser PRP on retinal sensitivity demonstrates a high likelihood of retaining eligibility to drive based on adequate visual field. A mild loss of retinal sensitivity was detected at 6 months after completion of laser treatment. Further change to visual fields may have occurred with longer follow-up. This study provides information that might be used to counsel patients requiring PRP and informs the debate regarding the role of anti–vascular endothelial growth factor therapy in patients with PDR who might otherwise receive laser treatment.

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