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Controversies
November 1998

External Beam Radiation Therapy Is Not Effective in the Treatment of Age-related Macular Degeneration

Arch Ophthalmol. 1998;116(11):1509-1511. doi:10.1001/archopht.116.11.1509

THE AUTHORS of multiple recent publications and presentations have suggested that relatively low-dose external beam radiation therapy (EBRT) may be beneficial visually for patients with exudative-hemorrhage (wet) age-related macular degeneration (ARMD) associated with subfoveal choroidal neovascularization (CNV). In my opinion, the reported evidence is not sufficiently compelling for me to recommend this therapy. Let me explain why I believe this to be the case.

Most published information about EBRT for wet ARMD with subfoveal CNV comes from uncontrolled case series reports.15 Although such reports can be used as evidence that low-dose EBRT does not uniformly prevent visual worsening or progression of the macular lesion and that the macular lesion sometimes stabilizes and visual acuity sometimes stabilizes or improves (at least for a relatively short-term posttreatment interval) after EBRT, this evidence is not sufficient for inferring that EBRT is better than, the same as, or worse than the natural history of untreated lesions. This is because such studies leave unanswered the standard biostatistical question, "compared with what?"

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