Background: Age-related macular degeneration (AMD) is a common eye disease that can cause blindness in older adults. The "wet" form of AMD, called neovascular AMD, happens when abnormal blood vessels grow under the retina and leak fluid. The current standard treatment requires repeated eye injections of anti-VEGF drugs, often every month or every few months. This frequent injection schedule is a heavy burden for patients and many cannot keep up with the treatment plan. Purpose: This study tests whether a single session of low-intensity laser applied to the diseased area, given just before the anti-VEGF injection, can help the drug reach the target more effectively. If this works, patients may need far fewer injections over time. Intervention: Participants will be randomly assigned to one of two groups. The experimental group will receive the laser treatment followed by an anti-VEGF injection within 6 hours. The control group will receive the anti-VEGF injection alone, according to the current standard regimen. Four different anti-VEGF drugs are allowed in this study: conbercept, aflibercept, ranibizumab, and faricimab. Participants: The study plans to enroll at least 240 patients with active neovascular AMD across five hospitals in China. All participants must be at least 50 years old and meet specific eligibility criteria. Follow-up: All participants will be followed for 24 months with monthly clinic visits. The study will record the total number of injections received, changes in vision, fluid status on eye scans, and any side effects. Primary Outcome: The main measure is the total number of anti-VEGF injections each participant needs over the 24-month period. The study will compare the experimental group and the control group to see whether the laser-enhanced approach reduces the injection frequency.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
NONE
Enrollment
240
577-nm yellow laser photocoagulation with a spot size of 200 μm, exposure time of 0.1-0.2 seconds, applied to the active macular neovascularization lesion located ≥ 300 μm from the foveal centre, with laser power adjusted to produce grade II to mild III burns. Laser is performed within one week after randomization and repeated when signs of active disease recur during follow-up.
Intravitreal injection of anti-VEGF agents, including conbercept, aflibercept, ranibizumab, or faricimab. The specific drug is selected based on stratification and clinical indication. Injection is administered under sterile conditions using standard aseptic technique, with needle insertion 3.5-4 mm posterior to the limbus.
Total Number of Anti-VEGF Injections Over 24 Months
The total number of intravitreal anti-VEGF injections administered to each participant during the 24-month follow-up period, compared between the LEAP group and the conventional treatment group.
Time frame: 24 months
Change in Best-Corrected Visual Acuity
Change in BCVA from baseline to 24 months, measured using the ETDRS logarithmic visual acuity chart at 4 meters.
Time frame: Baseline to 24 months
Incidence of Subretinal or Intraretinal Fluid
Presence or absence of subretinal fluid and/or intraretinal fluid on optical coherence tomography (OCT) during follow-up.
Time frame: 24 months
Total Number of Injections by Drug Subgroup
Comparison of the total number of anti-VEGF injections over 24 months among the four drug subgroups (conbercept, aflibercept, ranibizumab, faricimab), analyzed using a stratified Poisson regression model with interaction test between drug type and treatment regimen.
Time frame: 24 months
Change in NEI-VFQ-25 Composite Score
Change from baseline to 24 months in the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) composite score. The NEI-VFQ-25 is a 25-item questionnaire assessing vision-related quality of life. Composite scores range from 0 to 100, with higher scores indicating better vision-related functioning.
Time frame: Baseline to 24 months
Change in EQ-5D-5L Utility Index
Change from baseline to 24 months in the EuroQol Five-Dimension Five-Level (EQ-5D-5L) utility index. The EQ-5D-5L assesses health-related quality of life across five dimensions. The utility index ranges from -0.594 to 1.000 (using the Chinese value set), with higher scores indicating better health utility. If a secondary score (EQ-VAS) is also collected, it will be reported separately.
Time frame: Baseline to 24 months
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