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Tag Archives: Laser

Two Lasers for Diabetic Retinopathy

Laser Treatment for Diabetic Retinopathy

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!

 

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Laser and anti-VEGF Best Treats Diabetic Macular Edema

Laser and anti-VEGF Best Treatment for Diabetic Macular Edema

Treating diabetic retinopathy with both laser and anti-VEGF injections may be the best way to treat patients with diabetic macular edema.  Diabetic macular edema is the most common “side effect” of diabetic retinopathy and is the leading cause of vision loss in patients with diabetes.

The results of a large, multicenter, randomized clinical trial compared several permutations of laser and the anti-VEGF drug, Lucentis.  Intraocular steroids were included as well.

To date, standard treatment, or the standard of care, includes treating the retina with laser photocoagulation to retard the loss of vision.  Not all patients can be treated with this modality and intravitreal injections of anti-VEGF and also of steroids have been found to be useful treatment for those in whom laser is not applicable (myself included).

Whether or not a patient receives laser or injections, the treatment of diabetic macular edema is akin to “weeding” a garden.  The treatments are not a cure, and just like weeding a garden, the “leakage” may be controlled for a time, but only to return.

In short, diabetic macular edema recurs and requires retreatment.

The study found that injections of Lucentis/ranibizumab followed by either prompt or deferred laser for 6 months, was superior to laser treatment alone.   The study also found that this combination was superior to a similar combination treatment with intraocular steroids.

In addition, intravitreal injections of anti-VEGF and laser (immediate +/- deferred) led to the most improvement in vision, resolution of macular edema and, over a two year period, required fewer treatments!

What Does This Mean?

Diabetic macular edema is often difficult to treat.  The number of tools we have to treat the disease was quite limited until the introduction of intraocular steroids and anti-VEGF.  Over the past few years, because of these additional modalities, we have been able to help more patients than with just laser alone.

This new study not only validates the use of anti-VEGF medications, but also hints that anti-VEGF may be superior to steroids.  More studies will tell.

Most importantly, however, the study describes a treatment regimen that leads to improvement, stabilization and reduction in the number of treatments!

This means better vision and fewer office visits, right?

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offices

Currently, I see patients with retinal diseases; macular degeneration, retinal detachment, macular holes, macular pucker within several different practices.....it's a different arrangement, but it allows more continuous care with many eye specialists. In addition, I am very accessible via the web. To schedule your own appointment, call any of the numbers below.

Capital Eye Consultants
Randall V. Wong, M.D.
Contact: Brigitte O’Brien

A: 3025 Hamaker Court, Suite 101 • Fairfax, Virginia 22031
Ph: 703.876.9630
F: 703.876.0163
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Dressler Ophthalmology Associates, PLC
Randall V. Wong, M.D.
Contact: Andrea Armstrong (Surgery/Web)
Chrissy Megargee (Web)

A: 3930 Pender Drive, Suite 10 • Fairfax, Virginia 22030
Ph: 703.273.2398
F: 703.273.0239
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