Warrnambool is the first regional city in Australia to receive the revolutionary 2RT laser for the treatment of age-related macular degeneration (AMD) and diabetic CSME (vision-threatening swelling of the macular in diabetes), with the installation of a new laser machine at South West Eye Surgery in Koroit Street.
The sub threshold nanosecond laser, known as 2RT - Retinal Rejuvenation Therapy, is the first laser shown to be able to safely reverse the early signs of AMD and slow down progression to the late stages of the disease, which leads to vision loss and the need for eye injections. The 2RT laser is also able to treat diabetic CSME without the associated collateral damage to adjacent retina as seen with laser retinal photocoagulation.
In AMD, despite the advent of improved screening tools, which has enabled eye physicians to diagnose the disease in its earlier stages, treatment options have remained limited to the late, wet stage of the disease only. Whilst anti-VEGF injections have proven to be a highly effective treatment option in cases of wet AMD, we haven’t been able to treat the large number of patients diagnosed with the disease in its earlier stages. It is estimated that early-intermediate AMD accounts for 85% of all cases of AMD.
Recently, a multi-centre clinical trial at the Centre for Eye Research Australia (CERA), has demonstrated the efficacy of nanosecond laser in slowing the rate of progression from intermediate AMD to late stage AMD in selected patients and therefore reducing the risk of needing life-long eye injections.
The Laser Intervention in Age-Related Macular Degeneration (LEAD) trial enrolled 292 patients with intermediate AMD (bilateral large drusen ≥125 microns. or pigment changes with medium drusen 63-125 microns) and no signs of late AMD over a 36-month period. Patients were randomised to receive 6-monthly treatment with 2RT or sham (placebo) treatment.
The results of the LEAD trial showed that selected people with intermediate AMD without signs of more advanced macular disease demonstrated a 77% reduction in the rate of progression to late stage disease at three years, a highly statistically significant result.
Intermediate AMD is the stage of AMD showing signs of:
Medium drusen (63-125 microns) with pigment, or
Large (>125 microns) drusen
Importantly, there were no reported significant complications or adverse events in this trial, a result that is consistent with all previous pre-clinical and clinical studies dating back to 2010.
Based on the results of this three-year multi-centre trial, 2RT offers the potential to intervene earlier in the treatment of selected patients with intermediate age-related macular degeneration (AMD).
The 3 nanosecond pulse laser energy delivered to the retina with the 2RT laser stimulates a biological healing response that improves the permeability of Bruch’s membrane and thereby restores the transport of fluid across it. As illustrated in the image above, this does not cause photoreceptor damage. By restoring metabolite flow to retinal cells, 2RT may also reduce the production of endothelial growth factors and other precursors of neovascularization.
In Diabetes, conventional treatment for vision threatening macular swelling or CSME consists of regular eye injections. In the past, laser retinal photocoagulation was used but, while this treatment is effective at treating CSME, maintaining vision and reducing macular swelling, the treatment results in collateral damage to the parts of the retina crucial to vision.
2RT is capable of achieving the same degree of clinical efficacy as conventional laser retinal photocoagulation but without damage to the overlying neurosensory retina (specifically, no damage is caused to the photoreceptors or light sensitive cells of the retina).
In addition, a smaller randomized clinical trial has demonstrated the improved safety profile and efficacy of 2RT in patients with CSME compared to traditional retinal photocoagulation.
2RT is therefore an alternative treatment for CSME, particularly in cases where eye injections are not tolerated or where they are ineffective.
2RT - Retinal Rejuvenation Therapy rejuvenates the aged, compromised retinal pigment epithelium (RPE), a layer of support cells behind the macula – without damage to the overlying neurosensory retina, the cells surrounding the RPE that enable vision.
Research conducted by Professor Erica L. Fletcher MScOptom, PhD (Department of Anatomy and Neuroscience, The University of Melbourne, Australia) and colleagues has shown that the integrity of the human RPE remains intact following treatment with 2RT. There was no inducement of CNV or upregulation of vasoproliferative or inflammatory factors (which means there were no changes to cause a risk of progression to wet AMD). An analysis of human retinal structure post-2RT at both clinical and suprathreshold levels demonstrated that the procedure does not alter retinal structure.
Listen to Professor Fletcher speak about 2RT:
It is also important to note that, owing to its unique nanosecond pulse duration and proprietary pixelated beam profile, the results of 2RT as demonstrated by the LEAD trial cannot be extrapolated to other forms of subthreshold laser treatment. 2RT has a uniquely different method of action.
I encourage you to review the information on the 2RT page, by clicking the button below, to better understand the benefits of 2RT Retinal Rejuvenation Therapy.
In AMD, with careful diagnosis and patient selection, the 2RT has the potential to provide an effective treatment for the majority of people with intermediate AMD (ie, those with bilateral large drusen ≥125 microns and/or medium sized drusen 63-125 microns with pigment changes) with no signs of late AMD.
In diabetes, patients with diabetic CSME may be suitable for 2RT, particularly those not responsive to antiVEGF treatment or those who are not compliant with this treatment.
If you are interested in finding out more about 2RT Retinal Rejuvenation, please do not hesitate to contact us at South West Eye Surgery.
Dr Vincent Lee,