![]() ![]() How Does Retinal Laser Therapy Treat Diabetic Eye Disease? Since it represents a critical and highly effective therapy for the treatment and prevention of blinding eye disease, this article provides an update on the current role and considerations for retinal laser therapy in diabetic retinopathy in the age of pharmacologic, including anti-VEGF, treatments. Laser technology has improved and evolved over the last several decades in order to maintain important therapeutic treatment effects, while minimizing collateral tissue damage, complications, and patient discomfort. Retinal laser therapy also has an important role in some patients for the treatment of DME, often resulting in highly effective treatment of visually significant macular edema without the requirement of frequent recurrent intravitreal anti-VEGF injections or associated endophthalmitis risk. However, there is significant controversy about the use of anti-VEGF agents as a mainstay of PDR treatment, given the risk of progressive disease, tractional retinal detachment, or neovascular glaucoma if treatment is interrupted or if a patient is lost to follow up as can frequently occur in patients with DM. More recently, it has been used by some providers in combination with intravitreal injections of anti-vascular endothelial growth factor (VEGF) agents for the management of PDR. Since the discovery and implementation of argon laser with emission in the blue and green spectrum range by Bridges in 1964, retinal laser therapy has been utilized as the standard of care for PDR. Similarly, the use of retinal laser therapy for other indications, such as for choroidal neovascularization, choroidal tumors, and the treatment of retinal tears or holes, is reviewed elsewhere. Although a comprehensive review of the history and development of ophthalmic lasers is beyond the scope of this article, this information is summarized in several recent reviews. This article focuses on the use of peripheral scatter retinal laser (e.g., panretinal photocoagulation, or PRP) to treat PDR and the use of macular focal or grid laser photocoagulation to treat DME. Diabetes is the leading cause of new cases of blindness in adults in the USA. The purpose of this review is to specifically highlight the indications and evidence for the role of laser therapy in the management of diabetic retinopathy and diabetic macular edema. Retinal laser therapy is used for the management of these conditions in an ambulatory clinic setting, as well as in the operating room as part of the surgical management for complex conditions like tractional retinal detachments in diabetic retinopathy. Laser (Light Amplification by Stimulated Emission of Radiation) therapy is utilized widely in nearly all fields of medicine including ophthalmology, particularly in the treatment of retinal vascular diseases such as proliferative diabetic retinopathy (PDR), diabetic macular edema (DME), retinal vein occlusions, central serous chorioretinopathy, choroidal neovascularization, and vascular tumors. ![]()
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