Abstract
Purpose:To present the state-of-the-art of subthreshold diode laser micropulse photocoagulation (SDM) as invisible retinal phototherapy for diabetic macular edema (DME).Method:To review the role and evolution of retinal laser treatment for DME.Results:Thermal laser retinal photocoagulation has been the cornerstone of treatment for diabetic macular edema for over four decades. Throughout, laser induced retinal damage produced by conventional photocoagulation has been universally accepted as necessary to produce a therapeutic benefit, despite the inherent risks, adverse effects and limitations of thermally destructive treatment. Recently, SDM, performed as invisible retinal phototherapy for DME, has been found to be effective in the absence of any retinal damage or adverse effect, fundamentally altering our understanding of laser treatment for retinal disease.Summary:The discovery of clinically effective and harmless SDM treatment for DME offers exciting new information that will improve our understanding of laser treatment for retinal disease, expand treatment indications, and improve patient outcomes.
Highlights
Information theory states that the amount of information available from a particular event is directly proportional to the unlikelihood of that event occurring [1]
If using lasers to burn the retina represents the seminal advance in the treatment of retinal disease, learning that those retinal burns are unnecessary may constitute another significant advance, one that may fundamentally alter our understanding of retinal laser treatment for retinal vascular disease and the disease process
While traditional theories of conventional retinal photocoagulation were driven by attempts to explain the necessity and benefits of thermal retinal destruction and subsequent chorioretinal scarring, subthreshold diode micropulse (SDM) theory is consistent with clinical observations, the known cellular effects of lowpower near-infrared lasers, and our current understanding of the pathophysiology of diabetic macular edema (DME) and other retinal vascular disease
Summary
Information theory states that the amount of information available from a particular event is directly proportional to the unlikelihood of that event occurring [1]. Reported in 2005, the clinical results of this new “lowintensity / high-density” MPL paradigm for DME, SDM, were found to be comparable to conventional photocoagulation but without any evidence of laser-induced retinal damage, complication, or adverse effect in any eye at the time of treatment, or any time thereafter by clinical examination, fundus photography, or FFA [4].
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