The Evolution of Retinal Laser Technology and Retinal Photocoagulation as Therapeutic Modality

Abstract

The effect of thermal insult to ocular tissue was first recorded in Western literature over two millennia ago. During the early scientific period and the ensuing eras, our understanding of this phenomenon, as well as our ability to accurately deliver dose-controlled therapeutic thermal energy to retinal tissue, have improved greatly. Since their commercial introduction in 1970, ophthalmic photocoagulation laser systems have been playing a cardinal role in the treatment and/or management of various ocular pathologies, predominantly though not limited to, retinal pathologies. Seminal studies, such as the Diabetic Retinopathy Study (DRS) and Early Treatment Diabetic Retinopathy Study (ETDRS), have solidified the role of such tools in the ophthalmologist’s therapeutic armamentarium; and to this day, as either stand-alone treatment or in combination with pharmacological agents, retinal laser therapy is recognised as the ‘gold standard’ for treating diabetic macular oedema (DME) and proliferative diabetic retinopathy (PDR). The continuous elucidation of the role that the retinal pigmented epithelium (RPE) plays in the emergence of retinal pathologies has prompted researchers and clinicians to further investigate selective RPE treatments – featuring significantly reduced or altogether devoid of collateral thermal damage to inner neural retinal structures with limited regenerative capacity. The convergence of electronic dosimetry, diagnostics imaging and new therapeutic laser modalities into a singular entity may serve as the technological platform for successfully employing such therapies in the near future.