OSLI Retina

September 2019

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602 Ophthalmic Surgery, Lasers & Imaging Retina | Healio.com/OSLIRetina ■ C O R R E S P O N D E N C E ■ Letter to the Editor: Preventing Progression in Nonexudative Age-Related Macular Degeneration With Subthreshold Laser Therapy: A Systematic Review Dear Editor, We have read the manuscript entitled "Prevent- ing Progression in Nonexudative Age-Related Mac- ular Degeneration with Subthreshold Laser Thera- py: A systematic Review" by Eng et al. (Vol. 50, No. 3). I would like to congratulate the authors for this successful systematic review and make some con- tributions. We believe that our insight can maxi- mize the interpretation of their results. In the article, it has been indicated that sub- threshold retinal laser therapy is effective for re- duction of drusen and has the potential to improve vision in patients with nonexudative age-related macular degeneration (AMD). The systematic re- view also showed that the therapy did not appear to show benefit (or harm) associated with the de- velopment of choroidal neovascularization (CNV) or geographic atrophy. After reviewing the nine studies that evaluated the occurrence of CNV cited in the systematic review, it came to our attention that none of them used optical coherence tomogra- phy angiography (OCTA) for their baseline analy- sis and follow-up. We think OCTA imaging should be included in the studies evaluating the occur- rence of CNV. In a recent article, de Oliveira Dias et al. showed that swept-source OCTA identified subclinical macular neovascularization in 14.4% of 160 eyes with nonexudative AMD. In addition, their article showed that the risk of exudation at 1 year increases dramatically by a factor of 15.2 when compared to those without a subclinical CNV. 1 The use of fluorescein angiography, OCT, and fundu- scopic examination, 2 such as the case of the cited studies, could underestimate subclinical and oc- cult CNVs. When designing a study on the laser for intermediate macular degeneration, OCTA should be used to differentiate two groups: those eyes with occult CNV and those without it. Subthreshold la- ser in eyes with occult CNV may have different out- comes, and these eyes may evolve faster to a classic CNV. This may be the reason why previous studies did not meet statistical significance in the preven- tion of wet AMD. Daniela Meizner, MD Andres Lisker, MD A. Itzam Marin, BS Hugo Quiroz-Mercado, MD Asociación Para Evitar La Ceguera en México I.A.P Hospital "Dr. Luis Sánchez Bulnes" Departamento de Investigación Coyoacan, Mexico REFERENCES 1. de Oliveira Dias JR, Zhang Q, Garcia JMB, et al. Natural history of subclinical neovascularization in nonexudative age-related macular degeneration using swept-source OCT angiography. Ophthalmol- ogy. 2018;125(2):255-266. 2. Rosenfeld PJ. Optical coherence tomography and the development of antiangiogenic therapies in neovascular age-related macular de- generation. Invest Ophthalmol Vis Sci. 2016;57(9):14-26. Daniela Meizner, MD, can be reached at Calle Vicente García Torres 46, San Lucas, 04030 Ciudad de México, CDMX; email: daniela.meiz@gmail. com. Disclosures: The authors report no relevant financial disclosures. Reply to Letter to the Editor: Preventing Progression in Nonexudative Age-Related Macular Degenera- tion With Subthreshold Laser Therapy: A Systematic Review We thank the authors of the recent letter for their interest in our manuscript and for taking the time to highlight the value of implementing swept-source optical coherence tomography angiography (OCTA) in future trials that investigate subthreshold laser treatment for nonexudative AMD. The points raised by the authors are important considerations when interpreting the outcome of past age-related macu- lar degeneration (AMD) trials with laser therapy doi: 10.3928/23258160-20190905-12

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