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Diabetic Laser Surgery

Diabetic Laser Surgery

Diabetic Retinopathy

Laser Photocoagulation

Nowhere in medicine has laser technology been more beneficial to patients than in the treatment of diabetic retinopathy. Lasers produce a light unique in nature. The light is of specific wavelengths and the light waves vibrate together without interference. This light can be microscopically focused, allowing for precise control in treatment. Patients who need laser surgery are seated at a slit-lamp, just as during an examination, and the beam of laser light is focused through a special contact lens held on the patient's eye by the treating ophthalmologist. Both diabetic macular edema and proliferative diabetic retinopathy are treated by laser photocoagulation. While the machine used is the same, the type of treatment, risks and benefits are quite different.

Laser Treatment For Proliferative Diabetic Retinopathy
While diabetic macular edema is the most common cause of visual loss in diabetes, proliferative diabetic retinopathy is responsible for the most severe loss of vision. Eyes with these new blood vessels are at risk of blindness from bleeding into the vitreous and from retinal detachment. Laser photocoagulation greatly reduces this risk of severe visual loss. Laser treatment reduces severe visual loss in all stages of proliferative diabetic retinopathy, and even before proliferation develops.

Because this type of laser uses larger and more powerful spots than for macular edema, and several thousand may be applied at several sessions, side effects are greater. Therefore, treatment is withheld until the risk of severe visual loss without treatment outweighs the risks and side effects of the treatment. Reduced side vision and impairment of night vision can occur with this treatment though most patients do not complain of these side effects. The most serious side effect is mildly reduced visual acuity which treatment causes in about 10% of patients. However, when compared to a 50% chance of loss of all vision without treatment in severe proliferative retinopathy, the 10% risk of mild loss makes sense.

Laser Treatment For Diabetic Macular Edema
Patients with diabetic macular edema are at risk of losing moderate amounts of vision. Treatment of macular edema rarely improves vision but is successful in preventing visual loss and worsening of vision. Moderate visual loss over two years is reduced from 24% in untreated eyes to 12% in eyes undergoing treatment. This treatment uses a small number (usually less than 100) of small, moderately powerful laser spots directed at the sites of leakage. Complications and side effects are rare. Treatments occur in an office setting, are without pain, take 20 to 30 minutes, and regular activities can be resumed after the treatment. Laser treatment is recommended only when the edema reaches well-defined levels of severity, as treatment before that time has been shown to be no better than deferral of treatment until or if the edema progresses to the more severe stage

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