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GREEN OR YELLOW LASER TREATMENT FOR DIABETIC MACULAR EDEMA: Exploratory Assessment Within the Diabetic Retinopathy Clinical Research Network

Bressler, Susan B. MD*; Almukhtar, Talat MBChB, MPH; Aiello, Lloyd P. MD; Bressler, Neil M. MD*; Ferris, Frederick L. III MD§; Glassman, Adam R. MS; Greven, Craig M. MD; for the Diabetic Retinopathy Clinical Research Network

doi: 10.1097/IAE.0b013e318295f744
Original Study

Purpose: Explore differences in green compared with yellow focal/grid laser treatment on functional and anatomical endpoints in eyes with diabetic macular edema.

Methods: Data from two randomized clinical trials were evaluated for differences in visual acuity and optical coherence tomography parameters for eyes assigned to sham injection + prompt laser, ranibizumab + prompt laser, or prompt laser only: among subgroups of eyes treated exclusively and electively with either green or yellow laser.

Results: In the sham injection + prompt laser group, the mean visual acuity letter score change for eyes receiving green and yellow laser treatment, respectively, was +2.4 ± 14 and +5.1 ± 13 at the 52-week visit (P = 0.06) and +2.4 ± 15 and +6.0 ± 13 at the 104-week visit (P = 0.13), with no corresponding evidence of differences in optical coherence tomography thickness. When comparing wavelength groups in the ranibizumab + prompt laser and prompt laser-only groups, meaningful differences in visual acuity and optical coherence tomography thickness were not detected at 1 year or 2 years.

Conclusion: A trend toward improved vision outcome with yellow laser observed in one trial was not corroborated by anatomical outcomes or by the other trial. In this study, without random assignment to different wavelengths controlling for bias and confounding, it is not possible to determine whether one wavelength is better than the other.

In Brief

An exploratory assessment of visual acuity and optical coherence tomography outcomes in eyes with diabetic macular edema, treated with green or yellow laser, did not show consistent differences favoring one wavelength over another. These results may be because of factors other than wavelength, especially considering that wavelength assignment was not randomly allocated.

Author Information

*Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland;

Jaeb Center for Health Research, Tampa, Florida;

Department of Ophthalmology, Beetham Eye Institute, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts;

§Division of Epidemiology and Clinical Applications, National Eye Institute and the National Institutes of Health, Bethesda, Maryland; and

Department of Ophthalmology, Wake Forest University Eye Center, Winston-Salem, North Carolina.

Reprint requests: Talat Almukhtar, MBChB, MPH, Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647; e-mail:

Supported by the National Eye Institute and the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Department of Health and Human Services EY14231, EY14229, EY18817 through cooperative agreements.

The funding organization (National Institutes of Health) participated in oversight of the conduct of the study and review of the article but not directly in the design or conduct of the study or in the collection, management, analysis, or interpretation of the data or in the preparation of the article. Genentech provided ranibizumab for the study. In addition, Genentech provided funds to to defray the study's clinical site costs. As described in the Diabetic Retinopathy Clinical Research Network ( Industry Collaboration Guidelines (available at:, the had complete control over the design of the protocol, ownership of the data, and all editorial content of presentations and publications related to the protocol. A complete list of all investigator financial disclosures can be found at Writing committee financial disclosures: N. M. Bressler: Grants to investigators at The Johns Hopkins University are negotiated and administered by the institution (such as the School of Medicine) that receives the grants, typically through the Office of Research Administration. Individual investigators who participate in the sponsored projects are not directly compensated by the sponsor but may receive salary or other support from the institution to support their effort on the projects. Dr. N. M. Bressler is the Principal Investigator of grants at The Johns Hopkins University sponsored by the following entities (not including the National Institutes of Health): Abbott Medical Optics, Allergan, Bausch & Lomb, Bristol-Meyer-Squibb, Carl Zeiss Meditec, EMMES Corporation, ForSight Labs, LLC Genentech, Genzyme Corporation, Lumenis, Notal Vision, Novartis, and Regeneron. A complete list of all investigator financial disclosures can be found at

None of the authors have any financial/conflicting interests to disclose.

A published list of the Diabetic Retinopathy Clinical Research Network investigators and staff participating in this protocol can be found in Ophthalmology 2010;117:1064–1077.e35 with a current list available at

© 2013 by Ophthalmic Communications Society, Inc.