Laser photocoagulation as treatment of non-exudative age-related macular degeneration: state-of-the-art and future perspectives

Purpose: To give an updated review of laser approaches to non-exudative age-related macular degeneration (AMD). Methods: PubMed and Medline database searches were carried out using the terms “laser” and “photocoagulation” associated with “age-related macular degeneration”, and latest publications up to May 2017 have been reviewed. Moreover, the design of an ongoing single-center, non-randomized, phase I–II, pilot study, the PASCAL-GA trial, coordinated by F. Bandello, MD and G. Querques, MD from the IRCCS Ospedale San Raffaele, is described. Results: Either standard or subthreshold laser strategies have been tried to induce regression of distinct phenotypes of AMD, as reticular pseudodrusen (RPD), nascent geographic atrophy (nGA), and drusen-associated geographic atrophy (DAGA), with heterogeneous results. The aim of the PASCAL-GA protocol is to assess if subthreshold laser can restore the retinal pigment epithelium function in eyes with RPD and nGA offering a protective effect against extensive GA. Conclusions: New-generation medical and surgical approaches, including subthreshold laser photocoagulation, may have some success in downstaging AMD.