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Importance The effect of sub‐threshold nano‐second laser (SNL) treatment on retinal function remains unknown. Background: SNL treatment has been studied as a potential intervention in intermediate age‐related macular degeneration (iAMD). This study investigated the longitudinal effect of SNL treatment on retinal function. Design This was a sub‐study of the LEAD trial; a 36‐month, multi‐centre, randomized and sham‐controlled trial. Participants: Subjects with iAMD. Methods: Eligible participants were assigned randomly to receive SNL or sham treatment to the study eye at 6‐monthly visits. Multi‐focal electro‐retinography (mfERG) was performed at each study visit from a study site. The mfERG responses were grouped into three regions (central, middle and outer rings) and compared between the SNL and sham group. Main Outcome Measures: mfERG P1 response amplitude and implicit time. Results: Data were collected from 50 subjects (26 in the SNL group, 24 in the sham group). At baseline, the P1 amplitudes of both the study eyes and the fellow eyes were similar between the groups at all rings. In the sham group, the P1 amplitude gradually decreased over time (P <.05). In the SNL group, there was an improvement in P1 amplitude which became statistically significant at the 36‐month visit, detected in both the treated and fellow eyes at the central (P =.005) and middle ring (P =.007) but not at the outer ring (P =.070). No difference in P1 implicit time detected between the groups (P >.05). Conclusions and Relevance: SNL treatment improved electro‐physiological function. mfERG could be useful for monitoring AMD progression and evaluating the efficacy of SNL treatment. [ABSTRACT FROM AUTHOR]

Importance: Detection of early onset neovascular age‐related macular degeneration (AMD) is critical to protecting vision. Background: To describe the development and validation of a deep‐learning algorithm (DLA) for the detection of neovascular age‐related macular degeneration. Design: Development and validation of a DLA using retrospective datasets. Participants: We developed and trained the DLA using 56 113 retinal images and an additional 86 162 images from an independent dataset to externally validate the DLA. All images were non‐stereoscopic and retrospectively collected. Methods: The internal validation dataset was derived from real‐world clinical settings in China. Gold standard grading was assigned when consensus was reached by three individual ophthalmologists. The DLA classified 31 247 images as gradable and 24 866 as ungradable (poor quality or poor field definition). These ungradable images were used to create a classification model for image quality. Efficiency and diagnostic accuracy were tested using 86 162 images derived from the Melbourne Collaborative Cohort Study. Neovascular AMD and/or ungradable outcome in one or both eyes was considered referable. Main Outcome Measures: Area under the receiver operating characteristic curve (AUC), sensitivity and specificity. Results: In the internal validation dataset, the AUC, sensitivity and specificity of the DLA for neovascular AMD was 0.995, 96.7%, 96.4%, respectively. Testing against the independent external dataset achieved an AUC, sensitivity and specificity of 0.967, 100% and 93.4%, respectively. More than 60% of false positive cases displayed other macular pathologies. Amongst the false negative cases (internal validation dataset only), over half (57.2%) proved to be undetected detachment of the neurosensory retina or RPE layer. Conclusions and Relevance: This DLA shows robust performance for the detection of neovascular AMD amongst retinal images from a multi‐ethnic sample and under different imaging protocols. Further research is warranted to investigate where this technology could be best utilized within screening and research settings. [ABSTRACT FROM AUTHOR]

Background A novel, ultra-low energy nanosecond laser (retinal rejuvenation therapy) has been developed with the aim to slow progression of early age-related macular degeneration ( AMD). The safety, changes in fundus characteristics and macular function in a cohort of participants with bilateral intermediate AMD are reported. Design Prospective non-randomised, pilot intervention study. Participants or Samples Subjects with bilateral intermediate AMD ( n = 50, aged 50-75 years). Methods Ultra-low energy laser pulses applied in 12 spots around the macula of one eye (0.15-0.45 mJ), using 400 μm diameter spot, 3 nanosecond pulse length, 532 nm wavelength and energy titrated to each patient. Main Outcome Measures Best corrected visual acuity, drusen area and macular sensitivity (flicker perimetry) at baseline and at 3, 6 and 12 months post-laser. Results Treatment was painless with no clinically visible lesions. No participant developed choroidal neovascularization, while two with thin central retinal thickness at baseline developed atrophy at 12-month follow up. Drusen area was reduced in 44% of treated eyes and 22% of untreated fellow eyes, with changes in drusen and function not being coincident. Improvement in flicker threshold within the central 3° was observed in both the treated and untreated fellow eyes at 3 months post-laser. Of the 11 eyes at greatest risk of progression (flicker defect >15 d B), seven improved sufficiently to be taken out of this high-risk category. Conclusions A single unilateral application of nanosecond laser to the macula produced bilateral improvements in macula appearance and function. The nanosecond retinal rejuvenation therapy laser warrants ongoing evaluation as an early intervention for AMD. [ABSTRACT FROM AUTHOR]