AGE-RELATED MACULAR DEGENERATION PREVENTION TRIAL

视网膜相关性黄斑变性（AMD）是导致失明的主要原因 在美国和一些西方国家的成年人中。 大约90%的失明是由于新生血管形式 其余的是由于色素上皮脱落 和地理萎缩。黄斑光凝研究表明， 激光治疗可有效地减少眼睛视力丧失的程度。 患有新生血管性AMD然而，大多数病变不适合激光治疗， 治疗，甚至在治疗的情况下， 从20/250到20/320。目前还没有其他有效的治疗方法 AMD的形式。 预防老年性黄斑变性晚期的视力丧失 深刻的公共卫生影响。如果一次干预只有30% 有效预防脉络膜新生血管（CNV）， 在高危人群中，AMD的法律的失明率可以降低 半黄斑区大玻璃疣的存在是一个强有力的预测， CNV的发展。低强度激光治疗导致高风险 玻璃疣消失在大多数眼睛。对照、先导、临床试验， 激光治疗对CNV发展和视力丧失的影响是 正在对两组患者进行研究：双侧大玻璃疣患者 单侧CNV和第二（对侧）眼大 玻璃疣最初的报告提供的证据表明，CNV率增加， 治疗后的第一年，至少治疗。为 两项小型临床试验显示， 3年时接受治疗的患眼的CNV降低和视力改善的证据， 一项大型试验显示，治疗和未治疗的眼睛之间几乎没有差异 到18个月。 大部分人口可能受益，或受到伤害， 激光治疗要求对治疗进行全面的评估。我们 提出预防黄斑变性的并发症 试验（CAPT），以评估激光治疗的安全性和有效性 预防双侧玻璃疣患者视力丧失。变化 视力将是主要的结果变量。次要结局 测量将是CNV的发生率、色素上皮脱落和 地图状萎缩、对比度阈值变化和临界阈值变化 阅读的点大小。此外，参与的患者将 通过他们在一般和视觉特定质量上的得分来描述 生活评估。

Age-related macular degeneration (AMD) is the leading cause of blindness among adults in the United States and several Western countries. Approximately 90% of the blindness is attributable to the neovascular form of AMD and the remainder is attributable to pigment epithelial detachment and geographic atrophy. The Macular Photocoagulation Study has shown that laser treatment is effective in reducing the extent of vision loss in eyes with neovascular AMD. However, most lesions are not amenable to laser treatment and even with treatment visual acuity deteriorates to an average of 20/250 to 20/320. There are no other proven treatments for the advance forms of AMD. Prevention of vision loss from the advanced forms of AMD would have profound public health implications. If an intervention were only 30% effective in preventing choroidal neovascularization (CNV) within the high-risk population, the rate of legal blindness from AMD could be cut in half. The presence of large drusen in the macula is a strong predictor of the development of CNV. Low intensity laser treatment causes high-risk drusen to disappear in most eyes. Controlled, pilot, clinical trials on the effect of laser treatment on development of CNV and loss of vision are underway on two groups of patients: patients with bilateral large drusen and patients with unilateral CNV and the second (fellow) eye with large drusen. Initial reports provide evidence of an increased rate of CNV in treatment fellow eyes, at lest for the first year after treatment. For eyes of patients with bilateral drusen, two small clinical trials show evidence of decreased CNV and better vision in treated eyes at 3 years and one large trial shows little difference between treated and untreated eyes through 18 months. The large segment of the population that might benefit, or be harmed, by laser treatment mandates a thorough evaluation of the treatment. We propose the Complications of Age-related Macular Degeneration Prevention Trial (CAPT) to assess the safety and effectiveness of laser treatment in preventing loss of vision among patients with bilateral drusen. Change in visual acuity will be the primary outcome variable. Secondary outcome measures will be the incidence of CNV, pigment epithelial detachment and geographic atrophy, change in contrast threshold, and change in critical point size for reading. In addition, the participating patients will be described with by their scores on both general and vision specific quality of life assessments.