Encircling Laser Prophylaxis for Retinal Detachment in Stickler Syndrome: The Impact on Visual Field

It is our purpose to address concerns regarding visual field loss as a barrier to optimal performance of encircling laser retinopexy as a prophylaxis for retinal detachment, especially when extended posteriorly, as in prophylaxis for retinal detachment in Stickler syndrome (SS).

We retrospectively analyzed visual field and visual acuity changes after encircling laser prophylaxis extending to the posterior edge of the vortex vein ampullae (ora secunda cerclage/Stickler syndrome, OSC/SS) in our first four SS patients who underwent such prophylaxis. We then used disability tables and validated patient questionnaires to characterize the extent of visual disability and/or symptoms resulting from such encircling prophylaxis.

The reduction in peripheral visual field from OSC/SS posterior prophylaxis (to an average diameter of approximately 100 degrees in five treated eyes) was a far smaller percentage impairment (0-21% by various estimations) than the 85% impairment from loss of both visual acuity and visual field after RD in the primary eye of a typical SS patient prior to fellow eye prophylaxis. Turano and NEI VFQ-25 Questionnaires both indicated that everyday mobility and travel visual tasks were not significantly affected by the laser prophylaxis.

Encircling laser retinopexy, extending posteriorly to and between the vortex vein ampullae, did not cause significant visual disability or any symptomatic visual field loss in an initial cohort of four patients with SS. Nor did we encounter any symptomatic visual field loss in 22 patients so treated subsequently. OSC/SS encircling laser prophylaxis safety and effectiveness is now being prospectively studied in a larger clinical trial (NCT07146516).