Long-Term Visual Function Effects of Pan-Retinal Photocoagulation in Diabetic Retinopathy and Its Impact in Real Life

Overview

Journal Diabetes Metab Syndr Obes

Publisher Dove Medical Press

Specialty Endocrinology

Date 2021 Mar 29

PMID 33776464

Citations 3

Authors

Pedro Manuel Baptista

Ana Ambrosio Marta

Joao Heitor

Diana Jose

Daniel Almeida

Antonio Ribeiro

Irene Barbosa

Affiliations

Soon will be listed here.

Abstract

Purpose: To address the long-term visual function after bilateral pan-retinal photocoagulation (PRP) and its impact in real life, namely on visual field (VF) legal criteria to drive. To determine potential predictors related to clinical factors and treatment strategies.

Patients And Methods: Observational cross-sectional study. Eyes from diabetic patients diagnosed with diabetic retinopathy who underwent bilateral PRP, with or without macular treatments and with visual acuity legal criteria for non-professional driving were randomly assigned. Main outcomes were: demographic and clinical data including best corrected visual acuity; binocular visual field (EBST-Esterman Binocular Suprathreshold Test, Humphrey analyzer3); contrast sensitivity (CS-Metrovision-MonPack3); light scattering in the retina (HD Analyzer, Visiometrics).

Results: Seventy-one diabetic patients included (44 men and 27 women), with a mean age of 62.2±11.8 years. PRP was performed, on average, 9.7±6.9 years before the study. The average EBST Score was 85.8±17.0 and the average CS (2-5cpd) was 19.5±2.9 dB in photopic and 14.2±4.1 dB in mesopic conditions. Through a multivariate regression model, after adjusting to the clinical and demographic factors as possible confounders, we found that treatment factors associated with worse results were the use of Argon laser for the EBST Score, the very confluent PRP for the number of non-viewed points in the central 30°x20° of the EBST and the presence of macular treatments for the CS tests. According to Portuguese law, 79% (n=56) of patients had minimal EBST amplitudes for non-professional driving.

Conclusion: The functional results achieved in our sample are compatible with an active life, allowing most of the patients included to overcome the requirements of Portuguese legislation for driving light vehicles, namely at the level of the binocular visual field. These results highlight the role of PRP in the treatment of diabetic retinopathy in an era with evolving less aggressive laser options.

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References

Mackie S, Walsh G . Contrast and glare sensitivity in diabetic patients with and without pan-retinal photocoagulation. Ophthalmic Physiol Opt. 1998; 18(2):173-81. View

Filek R, Hooper P, Sheidow T, Gonder J, Varma D, Heckler L . Structural and functional changes to the retina and optic nerve following panretinal photocoagulation over a 2-year time period. Eye (Lond). 2017; 31(8):1237-1244. PMC: 5558230. DOI: 10.1038/eye.2017.66. View

Preti R, Vasquez Ramirez L, Monteiro M, Carra M, Pelayes D, Takahashi W . Contrast sensitivity evaluation in high risk proliferative diabetic retinopathy treated with panretinal photocoagulation associated or not with intravitreal bevacizumab injections: a randomised clinical trial. Br J Ophthalmol. 2013; 97(7):885-9. DOI: 10.1136/bjophthalmol-2012-302675. View

Hulbert M, Vernon S . Passing the DVLC field regulations following bilateral pan-retinal photocoagulation in diabetics. Eye (Lond). 1992; 6 ( Pt 5):456-60. DOI: 10.1038/eye.1992.96. View

Yun S, Adelman R . Recent developments in laser treatment of diabetic retinopathy. Middle East Afr J Ophthalmol. 2015; 22(2):157-63. PMC: 4411611. DOI: 10.4103/0974-9233.150633. View

Lin J, Chang J, Smiddy W . Cost Evaluation of Panretinal Photocoagulation versus Intravitreal Ranibizumab for Proliferative Diabetic Retinopathy. Ophthalmology. 2016; 123(9):1912-8. PMC: 4995116. DOI: 10.1016/j.ophtha.2016.05.037. View

Lee R, Wong T, Sabanayagam C . Epidemiology of diabetic retinopathy, diabetic macular edema and related vision loss. Eye Vis (Lond). 2015; 2:17. PMC: 4657234. DOI: 10.1186/s40662-015-0026-2. View

Gross J, Glassman A, Jampol L, Inusah S, Aiello L, Antoszyk A . Panretinal Photocoagulation vs Intravitreous Ranibizumab for Proliferative Diabetic Retinopathy: A Randomized Clinical Trial. JAMA. 2015; 314(20):2137-2146. PMC: 5567801. DOI: 10.1001/jama.2015.15217. View

Subash M, Comyn O, Samy A, Qatarneh D, Antonakis S, Mehat M . The Effect of Multispot Laser Panretinal Photocoagulation on Retinal Sensitivity and Driving Eligibility in Patients With Diabetic Retinopathy. JAMA Ophthalmol. 2016; 134(6):666-72. DOI: 10.1001/jamaophthalmol.2016.0629. View

10.

. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group. Ophthalmology. 1991; 98(5 Suppl):766-85. View

11.

Pearson A, Tanner V, Keightley S, Casswell A . What effect does laser photocoagulation have on driving visual fields in diabetics?. Eye (Lond). 1998; 12 ( Pt 1):64-8. DOI: 10.1038/eye.1998.12. View

12.

Schmidt-Erfurth U, Garcia-Arumi J, Bandello F, Berg K, Chakravarthy U, Gerendas B . Guidelines for the Management of Diabetic Macular Edema by the European Society of Retina Specialists (EURETINA). Ophthalmologica. 2017; 237(4):185-222. DOI: 10.1159/000458539. View

13.

. Preliminary report on effects of photocoagulation therapy. The Diabetic Retinopathy Study Research Group. Am J Ophthalmol. 1976; 81(4):383-96. DOI: 10.1016/0002-9394(76)90292-0. View

14.

Mackie S, Webb L, Hutchison B, Hammer H, Barrie T, Walsh G . How much blame can be placed on laser photocoagulation for failure to attain driving standards?. Eye (Lond). 1995; 9 ( Pt 4):517-25. DOI: 10.1038/eye.1995.118. View

15.

Muqit M, Wakely L, Stanga P, Henson D, Ghanchi F . Effects of conventional argon panretinal laser photocoagulation on retinal nerve fibre layer and driving visual fields in diabetic retinopathy. Eye (Lond). 2009; 24(7):1136-42. DOI: 10.1038/eye.2009.308. View

16.

Nielsen N . The prevalence of glaucoma and ocular hypertension in type 1 and 2 diabetes mellitus. An epidemiological study of diabetes mellitus on the island of Falster, Denmark. Acta Ophthalmol (Copenh). 1983; 61(4):662-72. DOI: 10.1111/j.1755-3768.1983.tb04357.x. View

17.

. Photocoagulation treatment of proliferative diabetic retinopathy: the second report of diabetic retinopathy study findings. Ophthalmology. 1978; 85(1):82-106. DOI: 10.1016/s0161-6420(78)35693-1. View

18.

Buckley S, Jenkins L, Benjamin L . Fields, DVLC and panretinal photocoagulation. Eye (Lond). 1992; 6 ( Pt 6):623-5. DOI: 10.1038/eye.1992.134. View

19.

. Photocoagulation treatment of proliferative diabetic retinopathy. Clinical application of Diabetic Retinopathy Study (DRS) findings, DRS Report Number 8. The Diabetic Retinopathy Study Research Group. Ophthalmology. 1981; 88(7):583-600. View

20.

KHOSLA P, Rao V, Tewari H, Kumar A . Contrast sensitivity in diabetic retinopathy after panretinal photocoagulation. Ophthalmic Surg. 1994; 25(8):516-20. View