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7. Diabetic Macular Edema and Diode Subthreshold Micropulse Laser

Author

Lois, Noemi, primary, Campbell, Christina, additional, Waugh, Norman, additional, Azuara-Blanco, Augusto, additional, Maredza, Mandy, additional, Mistry, Hema, additional, McAuley, Danny, additional, Acharya, Nachiketa, additional, Aslam, Tariq M., additional, Bailey, Clare, additional, Chong, Victor, additional, Downey, Louise, additional, Eleftheriadis, Haralabos, additional, Fatum, Samia, additional, George, Sheena, additional, Ghanchi, Faruque, additional, Groppe, Markus, additional, Hamilton, Robin, additional, Menon, Geeta, additional, Saad, Ahmed, additional, Sivaprasad, Sobha, additional, Shiew, Marianne, additional, Steel, David H., additional, Talks, James Stephen, additional, Doherty, Paul, additional, McDowell, Cliona, additional, and Clarke, Mike, additional

Published
2023
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8. Diabetic macular edema and diode subthreshold micropulse laser: A randomized double-masked noninferiority clinical trial

Author

Lois, Noemi, Campbell, Christina, Waugh, Norman, Azuara-Blanco, Augusto, Maredza, Mandy, Mistry, Hema, McAuley, Danny, Acharya, Nachiketa, Aslam, Tariq M., Bailey, Clare, Chong, Victor, Downey, Louise, Eleftheriadis, Haralabos, Fatum, Samia, George, Sheena, Ghanchi, Faruque, Groppe, Markus, Hamilton, Robin, Menon, Geeta, Saad, Ahmed, Sivaprasad, Sobha, Shiew, Marianne, Steel, David H., Talks, James Stephen, Doherty, Paul, McDowell, Cliona, and Clarke, Mike

Subjects
SDG 3 - Good Health and Well-being
Abstract

PurposeTo determine clinical effectiveness, safety, and cost-effectiveness of subthreshold micropulse laser (SML), compared with standard laser (SL), for diabetic macular edema (DME) with central retinal thickness (CRT) < 400 μm.DesignPragmatic, multicenter, allocation-concealed, double-masked, randomized, noninferiority trial.ParticipantsAdults with center-involved DME < 400 μm and best-corrected visual acuity (BCVA) of > 24 Early Treatment Diabetic Retinopathy Study (ETDRS) letters in one/both eyes.MethodsRandomization 1:1 to 577 nm SML or SL treatment. Retreatments were allowed. Rescue with intravitreal anti–vascular endothelial growth factor therapies or steroids was permitted if 10 or more ETDRS letter loss occurred, CRT increased > 400 μm, or both.Main Outcome MeasuresPrimary outcome was mean change in BCVA in the study eye at 24 months (noninferiority margin 5 ETDRS letters). Secondary outcomes were mean change from baseline to month 24 in binocular BCVA; CRT and mean deviation of Humphrey 10-2 visual field in the study eye; percentage meeting driving standards; EuroQoL EQ-5D-5L, 25-item National Eye Institute Visual Function Questionnaire (NEI-VFQ-25), and Vision and Quality of Life Index (VisQoL) scores; cost per quality-adjusted life-years (QALYs) gained; adverse effects; and number of laser and rescue treatments.ResultsThe study recruited fully (n = 266); 87% of SML-treated and 86% of SL-treated patients had primary outcome data. Mean ± standard deviation BCVA change from baseline to month 24 was –2.43 ± 8.20 letters and –0.45 ± 6.72 letters in the SML and SL groups, respectively. Subthreshold micropulse laser therapy was deemed not only noninferior but also equivalent to SL therapy because the 95% confidence interval (CI; –3.9 to –0.04 letters) lay wholly within both upper and lower margins of the permitted maximum difference (5 ETDRS letters). No statistically significant difference was found in binocular BCVA (0.32 ETDRS letters; 95% CI, –0.99 to 1.64 ETDRS letters; P = 0.63); CRT (–0.64 μm; 95% CI, –14.25 to 12.98 μm; P = 0.93); mean deviation of the visual field (0.39 decibels (dB); 95% CI, –0.23 to 1.02 dB; P = 0.21); meeting driving standards (percentage point difference, 1.6%; 95% CI, –25.3% to 28.5%; P = 0.91); adverse effects (risk ratio, 0.28; 95% CI, 0.06–1.34; P = 0.11); rescue treatments (percentage point difference, –2.8%; 95% CI, –13.1% to 7.5%; P = 0.59); or EQ-5D, NEI-VFQ-25, or VisQoL scores. Number of laser treatments was higher in the SML group (0.48; 95% CI, 0.18–0.79; P = 0.002). Base-case analysis indicated no differences in costs or QALYs.ConclusionsSubthreshold micropulse laser therapy was equivalent to SL therapy, requiring slightly higher laser treatments.

Published
2023

9. Diabetic macular oedema and diode subthreshold micropulse laser (DIAMONDS): study protocol for a randomised controlled trial

Author

Lois, Noemi, Gardner, Evie, Waugh, Norman, Azuara-Blanco, Augusto, Mistry, Hema, McAuley, Danny, Acharya, Nachiketa, Aslam, Tariq M., Bailey, Clare, Chong, Victor, Downey, Louise, Eleftheriadis, Haralabos, Fatum, Samia, George, Sheena, Ghanchi, Faruque, Groppe, Markus, Hamilton, Robin, Menon, Geeta, Saad, Ahmed, Sivaprasad, Sobha, Shiew, Marianne, Steel, David H., Talks, James Stephen, Adams, Catherine, Campbell, Christina, Mills, Matthew, Clarke, Mike, and On behalf of the DIAMONDS Study Group

Published
2019
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10. Standard threshold laser versus subthreshold micropulse laser for adults with diabetic macular oedema: the DIAMONDS non-inferiority RCT

Author

Lois, Noemi, primary, Campbell, Christina, additional, Waugh, Norman, additional, Azuara-Blanco, Augusto, additional, Maredza, Mandy, additional, Mistry, Hema, additional, McAuley, Danny, additional, Acharya, Nachiketa, additional, Aslam, Tariq M, additional, Bailey, Clare, additional, Chong, Victor, additional, Downey, Louise, additional, Eleftheriadis, Haralabos, additional, Fatum, Samia, additional, George, Sheena, additional, Ghanchi, Faruque, additional, Groppe, Markus, additional, Hamilton, Robin, additional, Menon, Geeta, additional, Saad, Ahmed, additional, Sivaprasad, Sobha, additional, Shiew, Marianne, additional, Steel, David H, additional, Talks, James Stephen, additional, Doherty, Paul, additional, McDowell, Clíona, additional, and Clarke, Mike, additional

Published
2022
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11. Standard threshold laser versus subthreshold micropulse laser for adults with diabetic macular oedema: the DIAMONDS non-inferiority RCT: the DIAMONDS non-inferiority RCT

Author

Lois, Noemi, Campbell, Christina, Waugh, Norman, Azuara-Blanco, Augusto, Maredza, Mandy, Mistry, Hema, McAuley, Danny, Acharya, Nachiketa, Aslam, Tariq M, Bailey, Clare, Chong, Victor, Downey, Louise, Eleftheriadis, Haralabos, Fatum, Samia, George, Sheena, Ghanchi, Faruque, Groppe, Markus, Hamilton, Robin, Menon, Geeta, Saad, Ahmed, Sivaprasad, Sobha, Shiew, Marianne, Steel, David H, Talks, James Stephen, Doherty, Paul, McDowell, Clíona, and Clarke, Mike

Subjects
Adult, Macular Edema/surgery, SDG 3 - Good Health and Well-being, Lasers, Quality of Life, Diabetes Mellitus, Humans, Laser Coagulation/adverse effects, Diabetic Retinopathy/surgery, Ranibizumab/adverse effects, Endothelial Growth Factors/therapeutic use, Bevacizumab/adverse effects
Abstract

BackgroundThe National Institute for Health and Care Excellence recommends macular laser to treat diabetic macular oedema with a central retinal subfield thickness of ObjectivesDetermining the clinical effectiveness, safety and cost-effectiveness of subthreshold micropulse laser compared with standard threshold macular laser to treat diabetic macular oedema with a central retinal subfield thickness of DesignA pragmatic, multicentre, allocation-concealed, double-masked, randomised, non-inferiority, clinical trial.SettingHospital eye services in the UK.ParticipantsAdults with diabetes and centre-involving diabetic macular oedema with a central retinal subfield thickness of 24 Early Treatment Diabetic Retinopathy Study letters (Snellen equivalent > 20/320) in one/both eyes.InterventionsParticipants were randomised 1 : 1 to receive 577 nm subthreshold micropulse laser or standard threshold macular laser (e.g. argon laser, frequency-doubled neodymium-doped yttrium aluminium garnet 532 nm laser); laser treatments could be repeated as needed. Rescue therapy with intravitreal anti-vascular endothelial growth factor therapies or steroids was allowed if a loss of ≥ 10 Early Treatment Diabetic Retinopathy Study letters between visits occurred and/or central retinal subfield thickness increased to > 400 µm.Main outcome measuresThe primary outcome was the mean change in best-corrected visual acuity in the study eye at 24 months (non-inferiority margin 5 Early Treatment Diabetic Retinopathy Study letters). Secondary outcomes included the mean change from baseline to 24 months in the following: binocular best-corrected visual acuity; central retinal subfield thickness; the mean deviation of the Humphrey 10–2 visual field in the study eye; the percentage of people meeting driving standards; and the EuroQol-5 Dimensions, five-level version, National Eye Institute Visual Function Questionnaire – 25 and Vision and Quality of Life Index scores. Other secondary outcomes were the cost per quality-adjusted life-years gained, adverse effects, number of laser treatments and additional rescue treatments.ResultsThe DIAMONDS trial recruited fully (n = 266); 87% of participants in the subthreshold micropulse laser group and 86% of participants in the standard threshold macular laser group had primary outcome data. Groups were balanced regarding baseline characteristics. Mean best-corrected visual acuity change in the study eye from baseline to month 24 was –2.43 letters (standard deviation 8.20 letters) in the subthreshold micropulse laser group and –0.45 letters (standard deviation 6.72 letters) in the standard threshold macular laser group. Subthreshold micropulse laser was deemed to be not only non-inferior but also equivalent to standard threshold macular laser as the 95% confidence interval (–3.9 to –0.04 letters) lay wholly within both the upper and lower margins of the permitted maximum difference (5 Early Treatment Diabetic Retinopathy Study letters). There was no statistically significant difference between groups in any of the secondary outcomes investigated with the exception of the number of laser treatments performed, which was slightly higher in the subthreshold micropulse laser group (mean difference 0.48, 95% confidence interval 0.18 to 0.79; p = 0.002). Base-case analysis indicated no significant difference in the cost per quality-adjusted life-years between groups.Future workA trial in people with ≥ 400 µm diabetic macular oedema comparing anti-vascular endothelial growth factor therapy alone with anti-vascular endothelial growth factor therapy and macular laser applied at the time when central retinal subfield thickness has decreased to LimitationsThe majority of participants enrolled had poorly controlled diabetes.ConclusionsSubthreshold micropulse laser was equivalent to standard threshold macular laser but required a slightly higher number of laser treatments.

Published
2022

14. A Screening Tool for Self-Evaluation of Risk for Age-Related Macular Degeneration: Validation in a Spanish Population

Author

García-Layana, Alfredo, primary, López-Gálvez, Maribel, additional, García-Arumí, José, additional, Arias, Luis, additional, Gea-Sánchez, Alfredo, additional, Marín-Méndez, Juan J., additional, Sayar-Beristain, Onintza, additional, Sedano-Gil, Germán, additional, Aslam, Tariq M., additional, Minnella, Angelo M., additional, Ibáñez, Isabel López, additional, de Dios Hernández, José M., additional, and Seddon, Johanna M., additional

Published
2022
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18. Reply

Author

Lois, Noemi, primary, Saad, Ahmed, additional, Vaideanu-Collins, Daniela, additional, Azuara-Blanco, Augusto, additional, Styles, Caroline, additional, McNally, Christine, additional, Jackson, Andrew, additional, Rice, Rachael, additional, Bailey, Clare, additional, McAuley, Danny, additional, Steel, David H., additional, Barbour, Clair, additional, Bell, Leontia, additional, Ghanchi, Faruque D., additional, Madanat, Zeid, additional, Menon, Geeta, additional, Chandran, Manju, additional, Mathews, Sely, additional, Galal, Mohammed, additional, Eleftheriadis, Haralabos, additional, Efraimidis, Stefanos, additional, Cook, Jonathan, additional, Wang, Ariel, additional, Sones, William, additional, Prior, Lindsay, additional, Acharya, Nachiketa, additional, Lois, Noemi, additional, Waugh, Norman, additional, Mistry, Hema, additional, Maredza, Mandy, additional, Fatum, Samia, additional, Savage, Janette, additional, Sivaprasad, Sobha, additional, Aldington, Stephen, additional, Scanlon, Peter H., additional, Ivanova, Katerina, additional, Aslam, Tariq M., additional, Ali, Zaria, additional, and Chong, Victor, additional

Published
2021
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19. Evaluation of a New Model of Care for People with Complications of Diabetic Retinopathy

Author

Lois, Noemi, primary, Cook, Jonathan A., additional, Wang, Ariel, additional, Aldington, Stephen, additional, Mistry, Hema, additional, Maredza, Mandy, additional, McAuley, Danny, additional, Aslam, Tariq, additional, Bailey, Clare, additional, Chong, Victor, additional, Ganchi, Faruque, additional, Scanlon, Peter, additional, Sivaprasad, Sobha, additional, Steel, David H., additional, Styles, Caroline, additional, Azuara-Blanco, Augusto, additional, Prior, Lindsay, additional, Waugh, Norman, additional, Saad, Ahmed, additional, Vaideanu-Collins, Daniela, additional, McNally, Christine, additional, Jackson, Andrew, additional, Rice, Rachael, additional, Barbour, Clair, additional, Bell, Leontia, additional, Ghanchi, Faruque D., additional, Madanat, Zeid, additional, Menon, Geeta, additional, Chandran, Manju, additional, Mathews, Sely, additional, Galal, Mohammed, additional, Eleftheriadis, Haralabos, additional, Efraimidis, Stefanos, additional, Cook, Jonathan, additional, Sones, William, additional, Acharya, Nachiketa, additional, Lois, Noemi, additional, Fatum, Samia, additional, Savage, Janette, additional, Scanlon, Peter H., additional, Ivanova, Katerina, additional, Aslam, Tariq M., additional, and Ali, Zaria, additional

Published
2021
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26. DIAbetic macular oedema aNd diode subthreshold micropulse laser (DIAMONDS) : Ppotocol for a randomised clinical trial

Author

Lois, Noemi, Gardner, Evie, Waugh, Norman, Azuara-Blanco, Augusto, Mistry, Hema, McAuley, Danny, Acharya, Nachiketa, Aslam, Tariq M., Bailey, Clare, Chong, Victor, Downey, Louise, Eleftheriadis, Haralabos, Fatum, Samia, George, Sheena, Ghanchi, Faruque, Groppe, Markus, Hamilton, Robin, Menon, Geeta, Saad, Ahmed, Sivaprasad, Sobha, Shiew, Marianne, Steel, David H., Talks, James Stephen, Adams, Catherine, Campbell, Christina, Mills, Matthew, Clarke, Mike, and HASH(0x5651c9f3bac8)

Subjects
genetic structures, RE
Abstract

Background\ud \ud In the UK, macular laser is the treatment of choice for people with diabetic macular oedema with central retinal subfield thickness (CST)

Published
2019

28. Effect of axial length on retinal vascular network geometry

Author

Patton, Niall, Maini, Rishma, MacGillivary, Tom, Aslam, Tariq M., Deary, Ian J., and Dhillon, Baljean

Subjects
Retina -- Physiological aspects, Arteriovenous malformations -- Development and progression, Arteriovenous malformations -- Risk factors, Health
Published
2005

33. OSCA: a comprehensive open-access system of analysis of posterior capsular opacification

Author

Rose Christopher J, Patton Niall, and Aslam Tariq M

Subjects
Ophthalmology, RE1-994
Abstract

Abstract Background This paper presents and tests a comprehensive computerised system of analysis of digital images of posterior capsule opacification (PCO). It updates and expands significantly on a previous presentation to include facilities for selecting user defined central areas and for registering and subsequent merging of images for artefact removal. Also, the program is compiled and thus eliminates the need for specialised additional software. The system is referred to in this paper as the open-access systematic capsule assessment (OSCA). The system is designed to be evidence based, objective and openly available, improving on current systems of analysis. Methods Principal features of the OSCA system of analysis are discussed. Flash artefacts are automatically located in two PCO images and the images merged to produce a composite free from these artefacts. For this to be possible the second image has to be manipulated with a registration technique to bring it into alignment with the first. Further image processing and analysis steps use a location-sensitive entropy based texture analysis of PCO. Validity of measuring PCO progression of the whole new system is assessed along with visual significance of scores. Reliability of the system is assessed. Results Analysis of PCO by the system shows ability to detect early progression of PCO, as well as detection of more visually significant PCO. Images with no clinical PCO produce very low scores in the analysis. Reliability of the system of analysis is demonstrated. Conclusion This system of PCO analysis is evidence-based, objective and clinically useful. It incorporates flash detection and removal as well as location sensitive texture analysis. It provides features and benefits not previously available to most researchers or clinicians. Substantial evidence is provided for this system's validity and reliability.

Published
2006
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34. A freely accessible, evidence based, objective system of analysis of posterior capsular opacification ; Evidence for its validity and reliability

Author

Patton Niall, Aslam Tariq M, and Graham Jim

Subjects
Ophthalmology, RE1-994
Abstract

Abstract Background The aim of this study was to develop a system of computerised analysis of digital images of posterior capsule opacification (PCO) that is evidence based, objective and freely available. The paper will present evidence for the reliability and validity of the developed system. Methods The system of PCO analysis was developed considering current published evidence on visual significance of PCO and additional investigative analysis of PCO images. Details of the image processing and analysis steps are discussed and a final system that measures an entropy score weighted toward proximity to central areas is described. In order to assess validity, the systems ability to measure PCO progression is assessed along with the visual significance of its final computerised scores. Reliability of the system is also assessed. Results The final system runs successfully and is simple to use. Analyses of PCO by the system show an ability to detect early progression of PCO as well as detection of visually significant PCO. Images with no clinical PCO produce very low scores in the analysis. Reliability of the system of analysis is shown to be satisfactory. Conclusion This paper presents a system of PCO analysis that is evidence based, objective and clinically useful. Substantial evidence is provided for its validity and reliability.

Published
2005
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35. Methods of assessment of patients for Nd:YAG laser capsulotomy that correlate with final visual improvement

Author

Aslam Tariq M and Patton Niall

Subjects
Ophthalmology, RE1-994
Abstract

Abstract Background This paper attempts to clarify the usefulness of various simple pre-operative measures in estimating the potential for a visually successful capsulotomy. Methods 24 patients attending for capsulotomy had pre-operative measures of glare with BAT tester, visibility of posterior pole and grading of posterior capsular pearls and fibrosis seen at slit lamp. Visual function was measured before and after standardised capsulotomy. Correlations of the various preoperative measures with eventual visual function improvements were calculated. Results Pearls at slit lamp and poor posterior pole visualisation were all correlated with improvements in visual acuity and contrast sensitivity after capsulotomy. Amount of fibrosis visible at slit lamp and glare assessment were not correlated with vision improvements after laser. Conclusion Of the various measures that are taken prior to Nd : YAG capsulotomy, some correlate with eventual visual improvement but for others no clinical utility was found. Practitioners should note these findings as they are especially of use in more questionable or high-risk cases to help determine whether referral for PCO treatment by Nd: YAG capsulotomy is likely to benefit the patient.

Published
2004
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36. Does a small central Nd:YAG posterior capsulotomy improve peripheral fundal visualisation for the Vitreoretinal surgeon?

Author

Bennett Harry G, Aslam Tariq M, Patton Niall, and Dhillon Baljean

Subjects
Ophthalmology, RE1-994
Abstract

Abstract Background To evaluate the effect of Nd:YAG capsulotomy for posterior capsular opacification (PCO) on visualisation of the peripheral fundus with scleral indentation. Methods Patients undergoing Nd:YAG capsulotomy for PCO were examined pre- and four weeks post- Nd:YAG capsulotomy. In order to give a quantitative measure of visualisation of the peripheral retina, a novel scalar measurement was developed. Changes in the degree of visualisation following Nd:YAG capsulotomy were calculated. Results There was a significant improvement in fundal visualisation of the retinal periphery with scleral indentation following Nd:YAG capsulotomy (p = 0.001). Conclusion Peripheral fundal visualisation with scleral indentation improves following a small central Nd:YAG capsulotomy. This finding is important in relation to the detection of peripheral pseudophakic retinal breaks, particularly in those patients deemed at high risk following Nd:YAG capsulotomy.

Published
2004
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37. Long-term Prevalence of Pseudophakic Photic Phenomena

Author

Aslam, Tariq M., Gupta, Manish, Gilmour, David, Patton, Niall, and Dhillon, Baljean

Subjects
Health
Abstract

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.ajo.2006.10.031 Byline: Tariq M. Aslam (a), Manish Gupta (a), David Gilmour (b), Niall Patton (a), Baljean Dhillon (a) Abstract: To describe the types and prevalence of long-term, established pseudophakic dysphotopsia in a typical population more than a year after cataract extraction. Author Affiliation: (a) Princess Alexandra Eye Pavilion, Edinburgh, United Kingdom (b) St James University Hospital, Leeds, United Kingdom Article History: Accepted 14 October 2006

Published
2007

40. Swept‐source optical coherence tomography angiography features of sub‐retinal fibrosis in neovascular age‐related macular degeneration.

Author

Balaskas, Konstantinos, Ali, Zaria C., Saddik, Tarik, Gemenetzi, Maria, Patel, Praveen, and Aslam, Tariq M.

Subjects
OPTICAL coherence tomography, RETINAL degeneration, FIBROSIS, VISUAL acuity
Abstract

Importance: The study highlights the role of optical coherence angiography in the management of patients with neovascular age‐related macular degeneration (nAMD) who have developed sub‐retinal fibrosis. Background: Development of sub‐retinal fibrosis in the context of nAMD is known to adversely affect visual function. The aim of this study is to assess structure and flow features obtained through swept‐source optical coherence tomography angiography (OCTA) in patients with sub‐retinal fibrosis and associate these with visual acuity (VA). Design: Institutional retrospective cohort study. Participants: A total 39 eyes of 39 patients with nAMD with sub‐retinal fibrosis imaged with OCTA were included in this study. Methods: Patients underwent swept‐source OCTA. Thickness of sub‐retinal hyper‐reflective material (SHRM) and presence and configuration of a choroidal neovascular membrane were recorded in each case. Main Outcome Measures: A univariate multiple regression was performed seeking associations between VA and structural and flow OCTA features. Results: Average VA on the date of OCTA was 53 ± 22 ETDRS letters. Average thickness of centre‐involving SHRM was 157 ± 73 μm. A choroidal neovascular membrane was detectable in 26 cases and not detectable in 13. VA was independently influenced by thickness of SHRM (P = 0.034) and presence of a detectable choroidal neovascular membrane (P = 0.02) on OCTA. Conclusions and Relevance: Poorer VA in patients with nAMD and sub‐retinal fibrosis is associated with presence of a detectable neovascular membrane on OCTA. The role of OCTA to guide nuanced management decisions in this patient population may be significant. [ABSTRACT FROM AUTHOR]

Published
2019
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