Vision parameters in krypton and laser photocoagulation of subfoveal neovascular membranes

A prospective study of 78 patients, treated with krypton red laser (KRL) photocoagulation, who had senile macular degeneration (SMD) and subretinal neovascular membranes (SRNVM) located within 200u of the center of the foveal avascular zone (FAZ), was undertaken to determine if complete eradication of the SRNVM would minimize the resultant foveal scar size and retain the maximal useful functional vision as compared to untreated fellow eyes with a disciform scar. The typical patient profile with SMD and subfoveal SRNVM included: average age, 73.6 years; caucasian, 99%; females, 62%; lightly pigmented iris, 70%; hyperopic refractive error, 93%; and evidence of bilateral involvement with either predisciform or disciform lesions, 73%. In comparing eyes treated with KRL having 100% FAZ involvement with fellow untreated eyes having disciform scars, the latter had poorer average visual acuity (44% vs 100% less than or equal to 20/200), scars which were an average of five times larger (8.4 vs 38.6 sq mm) and scotomas which were an average of six times larger (15.7 vs 90 sq cm) as determined by new microcomputer technology. In all bilaterally affected cases, eyes with smaller scars and scotomas required less magnification from a low vision aid to read continuous standardized 1M print. Sixteen of 17 patients (94%) preferred the low vision aid for their treated eye. These preliminary results suggest that treatment of SRNVM within the FAZ using KRL may be successful in arresting the progressive macular hemorrhagic-exudative damage typical of untreated cases which culminate in loss of central visual function. Successful treatment, by preserving areas of paracentral fixation, can enhance the chances of visual rehabilitation using conventional low vision aids.