Micropulse laser for managing DME
Despite the evidence demonstrating its efficacy and safety, subthreshold micropulse laser has faced several obstacles to adoption.


Cheryl Guttman Krader
Published: Monday, March 13, 2017

Retina specialists who perform subthreshold micropulse laser treatment may feel as if they are performing ‘retinal homeopathy'IMPEDIMENTS TO GREATER USE Dr. Gerardo suggested that despite the evidence demonstrating its efficacy and safety, subthreshold micropulse laser has faced several obstacles to adoption. First, laser in general is considered less effective than anti-VEGF therapy, and subthreshold micropulse laser treatment is a latecomer to the treatment armamentarium compared with anti-VEGF injections. In addition, the fact that the subthreshold micropulse modality does not produce visible lesions may create skepticism about whether the treatment is really doing anything. “Retina specialists who perform subthreshold micropulse laser treatment may feel as if they are performing ‘retinal homeopathy’,” Dr. Garcia said. Although we do not have a lot of tools to prove it, findings from imaging with scanning laser opthalmoscopy and spectral domain optical coherence tomography provide evidence that subthreshold micropulse laser does cause a biologic effect. (AM J Opthalmolol 2010:150:856-862) The absence of visible lesions with subthreshold micropulse laser treatment also made it difficult to track treated areas using lasers delivering single spots. This issue, however, has been addressed by the introduction of pattern laser delivery systems that provide better spot coverage without overlap while also increasing treatment efficiency.
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