Jeffrey Luttrull: Subthreshold Diode Micropulse Laser

Jeffrey K Luttrull, MD, spoke with MD Magazine about his experiences with the subthreshold diode micropulse laser (SDM) for use of retinal protective therapy on patients with dry AMD. Although the study was retrospective in nature, the findings were extraordinary in that choroidal neovascularization incidences were found to be extremely low.

Jeffrey K Luttrull: My presentation to the ASRS today described my experience with subthreshold diode micropulse laser for dry macular degeneration, and particularly, the incidence of currently a vascularization after treatment. Last year we published a report in IOPS showing that SDM laser was able to improve retinal and visual function in dry macular degeneration. So because we were able to show that treatment indeed the improved visual and retinal function in dry AMD, we were curious whether or not it was also reducing the risk of choroidal neovascularization, which is the main cause of vision loss and macular degeneration.

We ended up with 354 patients - 547 eyes - followed for almost 2 years. We had a follow-up on 98% of the patients treated, and what we found was that the incidence of choroidal neovascularization after treatment was extraordinarily low. Now, this is particularly interesting in that the risk profile of this group was, I believe, the highest ever noted in a study. What we have here and in this group of patients in my practice, which can't necessarily be generalized to anyone else, is the near elimination of the risk of choroidal neovascularization and dry AMD. Obviously, that would be a game-changer, yet completely altering our expectations and approach to the treatment of dry macular degeneration.

Retrospective studies like these don't prove anything, but it's the results are compelling and we fully expect that retrospective studies will be done and that they will corroborate these results. That will have very far-reaching implications, and in many ways, to how we manage patients with dry AMD and other diseases because our management of these patients was led, and the results predicted by, our understanding of the mechanism of action of treatment. We have evidence to show that is equally effective in virtually all chronic progressive retinopathies, including diabetic retinopathy and other diseases.