22 Jun Two Lasers for Diabetic Retinopathy
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There are two different laser treatments to treat diabetic retinopathy. One laser treatment is used to treat diabetic macular edema, the most common “complication” of diabetic retinopathy. The second laser treatment is used to treat proliferative diabetic retinopathy (aka PDR), yet far fewer people develop this potentially blinding stage of the disease.
Same Laser Used for Both Treatments
Macular edema is treated with “focal” laser treatment. The laser is used to treat/burn/cauterize those areas of blood vessels that are leaking near the macula. The treatment is focused to treat certain specific areas, hence “focal” laser.
Proliferative diabetic retinopathy (PDR) is treated with “scatter” or “pan-retinal” photocoagulation (PRP). The peripheral retina is “scattered” with laser burns.
Some Patients Need Both Laser Treatments
The timing of the treatment can be crucial. Treating the PDR (proliferative diabetic retinopathy) before the macular swelling is controlled, or treated, can lead to progressive loss of vision because the PRP (used to treat PDR) can worse the macular edema.
I prefer treating and controlling the macular swelling first, before treating the neovascular disease (PDR). Depending upon the situation, however, I don’t always have this luxury as sometimes the PDR is so advanced that we can not wait.
Remember, the neovascularization can cause blindness.
What Does This Mean? In most cases, patients need only one or the other treatment. Macular edema is treated with focal laser and PDR is treated with PRP. In the unlikely situation where patients need both…
When possible, I’ll treat the macular edema with focal and wait several weeks, or months, to treat with scatter laser. I don’t want the macular edema to worsen.
Macular fluid causes decreased vision (patients can tell). Worsening macular edema means lousy vision….and anxious patients.
Avastin, however, has improved my ability to treat those patients with both macular and proliferative disease. Avastin (or Lucentis) allows me to treat both the PDR and macular edema…it buys me time!
Dan
Posted at 14:09h, 29 Junedear dr.
can you treat the proliferative disease with Avastin only ? many thanks. Dan
Randall V. Wong, M.D.
Posted at 09:30h, 01 JulyDear Dan,
Yes, but only to a limited extent. First, it is unclear how long the Avastin works in blocking the VEGF in proliferative disease. It seems to need to be repeated every few months. I have one patient requiring injection every few weeks.
The laser, however, can be a more permanent “fix.”
Randy
Joshua
Posted at 23:39h, 25 NovemberDr Wong,
Obviously I hope never to get PDR, but how bad are the side effects in terms of the loss of peripheral? I see terrible visial models that show a photoshopped veiw of a scene with the areas around a maculaer area in gray, as if people were looking through a tunnel. It seems obviously the saving of the macula and central vision to be paramount, but it also seems quite a terrible thing to not have much side vision since our ability to see at night requires it. Thanks!
Randall V. Wong, M.D.
Posted at 08:41h, 26 NovemberDear Joshua,
Having performed PRP on thousands…I can count on one hand the number patients that have complained about a change in their peripheral vision. Usually patients complain of difficulty switching from light to dark and vice versa and NOT loss of peripheral vision.
r
Joshua
Posted at 15:47h, 26 NovemberThanks for the response, so in your opinion, is it a matter of them not complaining because they are thankful for the saving of their central vision and they already knew peripheral would be diminished, or is it a matter of the laser destroying less of the retina then one might expect. and simply not affecting the side vision as drastically? My assumption was scotoma were created, much like any drop out or infarct, resulting greyed out areas around the macula. Obviously I am not well versed in PDR treatment, but I assumed any focal or grid laser would cause these disturbances in vision. Thanks for clarifying and I am sorry for so many questions. ;-).