With the introduction of anti- VEGF, the surgeon’s approach towards retinal disease has changed. However, when it comes to diabetic eye disease such as diabetic macular edema (DME) and diabetic retinopathy especially the proliferative retinopathy type, laser is still considered as one of the best options.
History and Background
The Early Treatment Diabetic Retinopathy Study was the first investigation, which provided a treatment paradigm using laser in DME. The trail found that panretinal photocoagulation reduced the incidence of severe vision loss from proliferative retinopathy by 50% and macular grid, reducing the incidence of moderate vision loss from clinically significant macular edema by 50%.
The diabetic retinopathy clinical research network found that over the period of 2 years, grid laser photocoagulation was more effective and associated with a fewer adverse effects than 1- or 4- mg doses of triamcinolone for most patients with DME. While focal laser is applied for leaking microaneurysms, grid pattern photocoagulation is used for diffusing leakage.
Subthreshold Laser
Laser treatment in Mississauga, ON delivers same therapeutic benefits with no visible damage, therefore it allows for re-treatments closer to the fovea. The subthreshold treatment strategies incorporate higher density of laser spots than conventional focal and grid macular laser treatments. Three types of subthreshold laser are MicroPulse, selective retinal therapy and endpoint management. Researchers are exploring specific indications for subthreshold treatment, which includes DME and its efficacy has been suggested in central serous retinopathy, macular edema from retinal vein occlusion and drusen.
Treatment Burden
With the development of more and more treatment strategies, major focus is on ways for extending the time between treatments. A considerable difference can be observed when a person receiving intravitreal injection therapy every month is able to extend it to a 6 or 8 week interval. If the clinicians can do anything for minimizing the treatment regimen’s effect on patient’s life, it can be meaningful. The doctors need to come up with a treatment plan, which includes a schedule of injections and laser to save patients from the risk of repeated injections and extend the interval between office visits.
