Effects of subthreshold nanosecond laser therapy in age-related macular degeneration using artificial intelligence (STAR-AI Study)

Purpose To investigate changes in retinal thickness, drusen volume, and visual acuity following subthreshold nanosecond laser (SNL) treatment in patients with age-related macular degeneration (ARMD). Design Retrospective chart review. Methods Patients with intermediate ARMD treated with a single session of SNL (2RT (R), Ellex R&D Pty Ltd, Adelaide, Australia) were included. Swept-source optical coherence tomography (OCT) imaging (Triton; Topcon Medical Systems, Tokyo, Japan) was performed within 6 months before and after SNL treatment. Retinal layers were segmented using the artificial intelligence-enabled Orion (R) software (Voxeleron LLC, San Francisco, USA). The macular region was analyzed according to the Early Treatment Diabetic Retinopathy Study map. Mean difference and standard deviation in baseline and post-treatment retinal layer thicknesses are reported. Results 37 eyes from 25 patients were included in this study (mean age 74.79.2 years). An average of 51 +/- 6 spots were applied around the macula of each study eye, with a mean spot power of 0.33 +/- 0.04mJ. Increases in total retinal thickness were observed within the outer temporal and inferior sectors (P < 0.05). Within the annulus, there was an increase in thickness of the sub-retinal pigment epithelial (RPE) space [0.88 +/- 2.41 mu m, P = 0.03], defined between the RPE and Bruch's membrane. An increase in thickness of 1.13 +/- 2.55 mu m (P = 0.01) was also noted in the inferior sector of the photoreceptor complex, defined from the inner and outer segment junction to the RPE. Decreases in thickness were observed within the superior sector of the inner nuclear layer (INL) [-1.08 +/- 2.55 mu m, P = 0.01], and within the annulus of the outer nuclear layer (ONL) [-1.44 +/- 3.55 mu m, P = 0.02]. Conclusions At 6 months post-SNL treatment, there were sectoral increases in OPL, photoreceptor complex, and sub-RPE space thicknesses and sectoral decreases in INL and ONL thicknesses. This pilot study demonstrates the utility of OCT combined with artificial intelligence-enabled software to track retinal changes that occur following SNL treatment in intermediate ARMD.