Subthreshold Laser Treatment for Reticular Pseudodrusen Secondary to Age-related Macular Degeneration

Not Applicable

Recruiting

• Conditions: Macular Degeneration Intermediate; Laser Burn of Retina; Macular Degeneration, Senile; Macular Degeneration, Dry
• Interventions: Device: Pascal Synthesis 577 sub-threshold laser (Topcon Corporation, Tokyo, Japan); Device: Pascal Synthesis 577 sham (Topcon Corporation, Tokyo, Japan)

• Registration Number: NCT04847635
• Lead Sponsor: Ospedale San Raffaele

Brief Summary

Prospective, randomized, controlled, longitudinal, interventional multicentric study involving patients with reticular pseudodrusen secondary to AMD.

The objective of this study is to establish the effectiveness of subthreshold laser treatment in increase/prevent the decrease of the retinal sensibility in patients with reticular pseudodrusen, and to reduce the progression of RPD to atrophy.

Approximately 50 naïve patients with reticular pseudodrusen who underwent subthreshold laser treatment in perifoveal area. These patients should be randomized in the 2 study arms of the study. Patients will be evaluated at Screening/Baseline and then revaluated and retreated at month 3, 6 and 9. At month 12, all patients will be evaluated with a full ocular examination, visual acuity measurement (VA), optical coherence tomography (OCT) with autofluorescence, OCT-angiography and microperimetry.

The rationale of the study is to prevent the evolution of reticular pseudodrusen to atrophic degeneration.

Detailed Description

Not available

Study Timeline

• Study Start: 2021-03-16
• Study First Submitted: 2021-04-07
• Study First Submitted QC: 2021-04-12
• Study First Posted: 2021-04-19
• Status Verified: 2025-03
• Last Update Submitted: 2025-03-11
• Last Update Posted: 2025-03-12
• Primary Completion: 2026-09-01
• Study Completion: 2026-09-01

Recruitment & Eligibility

• Status: RECRUITING
• Sex: All
• Target Recruitment: 50

Inclusion Criteria

• 50 years or older
• Presence of RPD secondary to AMD
• Best-corrected visual acuity (BCVA) between 20/20 and 20/400 inclusive
• Clear ocular media
• Ability to provide informed consent and attend all study visits

Exclusion Criteria

• Presence of Geographic Atrophy (GA)
• Evidence of choroidal neovascularization in either eye
• Any prior treatment for AMD, aside from antioxidants
• Any corneal opacity, cataract formation and hemorrhage in the vitreous body, which may interfere with viewing by the laser surgeon of the target structures
• Aphakic eye with vitreous in the anterior chamber
• Neovascular Glaucoma
• Glaucoma caused by congenital angle anomalies
• Open angle of less than 90º or extensive peripheral anterior and low synechia, present circumferentially around the corner
• Significant corneal edema or reduced water clarity that obscures the view angle in detail
• Glaucoma secondary to active uveitis
• Any other ocular condition that would progress in the study period and confound visual acuity assessment
• Any ocular or systemic medication known to be toxic to the lens, retina or optic nerve Presence of idiopathic or autoimmune-associated uveitis
• Any intraocular surgery 3 months of entry
• Any prior thermal laser in the macula
• History of vitrectomy, filtering surgery, corneal transplant or retinal detachment surgery
• Previous therapeutic radiation in the ocular region in either eye
• Any treatment with an investigational agent in the previous 60 days before study entry
• Women of child-bearing potential, defined as all women less than 1 year postmenopausal or less than 6 weeks since sterilization (further definition can be found in Section 12.7) at Baseline, unless they are using highly effective methods of contraception during dosing of study treatment.
• Participation in an investigational drug, biologic, or device study within 6 Months prior to Baseline [Note: observational clinical studies solely involving over-the-counter vitamins, supplements, or diets are not exclusionary

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Subthreshold laser group	Pascal Synthesis 577 sub-threshold laser (Topcon Corporation, Tokyo, Japan)	To evaluate the efficacy of Subthreshold laser in the treatment of reticular pseudodrusen.
Sham group	Pascal Synthesis 577 sham (Topcon Corporation, Tokyo, Japan)	The light from the retinal illumination system on the laser device will be used instead of the laser beam in all follow-up evaluations.

Primary Outcome Measures

Name	Time	Method
Changes in the retinal sensitivity - 12 months	12 months	Functional changes in the retinal sensitivity on customized microperimetry from day 0 to month 12 (unit of measure: dB)
Anatomical changes using structural optical coherence tomography (OCT)	12 months	Anatomical changes will be evaluated with retinal thickness (unit of measure: microns)
Rate of Progression	12 months	Rate of progression to advance AMD (GA and/or neovascular AMD)

Secondary Outcome Measures

Name	Time	Method
Changes in the retinal sensitivity - 6 months	6 months	Functional changes in the retinal sensitivity on customized microperimetry from day 0 to month 6 (unit of measure: dB)
Anatomical changes using fundus autofluorescence (FAF)	12 months	Anatomical changes will be evaluated analyzing the development of geographic atrophy using FAF
Anatomical changes using OCT-angiography (OCT-A)	12 months	Anatomical changes will be evaluated analyzing the perfusion density by means of OCT-A
Genetic influence (% of AMD-associated single-nucleotide polymorphism (SNP) in treated patients)	12 months	The % of AMD-associated single-nucleotide polymorphism (SNP) will be evaluated analyzing the % of patients with an AMD-associated SNP in patients showing no progression vs progression to advance AMD (main outcome 3).

Trial Locations

Locations (3)

Giuseppe Querques; 🇮🇹 Milan, Italy

Mariacristina Parravano; 🇮🇹 Rome, Italy

Massimo Nicolò; 🇮🇹 Genova, Italy