What is retinal laser surgery?
A laser is a concentrated beam of light that can be focused very precisely on diseased tissue. Different lasers are absorbed by different types of body tissue. Retinal lasers have been specially designed to be able to pass through non-retinal tissue (the lens and cornea) without damaging them. Lasers have become a commonly used and very powerful tool in the treatment of retinal disease. With the help of various lenses, laser beams can be focused on the retina for non-invasive surgical treatment.

 

How does laser surgery work?
Retinal disease is primarily treated using a thermal laser. The light energy is absorbed by specific tissue at the back of the eye and is converted to heat with this type of laser. The heat causes a very small area of damage to the retina. As the eye heals from this small area of damage the scar helps to correct the underlying retinal disease. Thermal laser can be used to seal retinal tears, close leaking blood vessels or to break down abnormal tissue or blood vessels.

 

How is retinal laser surgery performed?
Laser surgery is non-invasive and is commonly performed in the office. The laser can be delivered to the retina in a number of different ways depending on what part of the retina needs to be treated. A microscope and lens system, similar to the one used to examine your eye is often used (figure 1). Alternatively an indirect delivery system consisting of a laser system mounted on the retinal surgeon's head can be used.

 

What happens during laser treatment?
• Your pupils will be dilated
• Local anesthetic (freezing drops) will be placed in your eye.
• If an indirect laser is used you will be positioned so that that you're lying flat for the laser surgery.
• If a microscope is used, a special contact lens will be placed on your eye to hold your lids apart and focus the laser.
• During treatment, you will see bright flashes of light.
• The treatment usually takes 5 - 10 minutes.

 

Does laser surgery hurt?
Laser treatment is almost always painless. Most people find the bright lights more uncomfortable than the actual energy from the laser. If you need more extensive laser, sometimes you will have discomfort during the laser treatment.

 

How should I prepare for laser treatment?
• Because your eye(s) will be dilated, someone should accompany you.
• Take your eye drops and all medications as usual.
• Bring a dark pair of sunglasses to wear after your treatment

 

What to expect after laser surgery?
• Pain: Most patients have little if any pain following retinal laser surgery. Patients who require more extensive laser may have an ache inside the eye or around the eye. If you have discomfort after the surgery, rest and take Tylenol, ibuprofen, or another over the counter pain reliever.
• Blurred vision: It is common to have blurry vision for the first few hours after laser surgery.
• Activity- For some laser you need to restrict your activity. Your doctor will instruct you about any activities that you should limit.
• Call immediately if you are experiencing increasing pain or decreased vision.

 

What retinal diseases are treated with laser surgery?

 

Retinal Tear
Laser is used to create tiny burns around the retinal tears. The healing that occurs after the laser burns essentially spot-welds the retina down and prevents the tear from causing a retinal detachment. If not treated, fluid can leak through these tears and cause the retina to detach, leading to vision loss.

 

Macular Edema
Most commonly seen in Diabetic Retinopathy and Retinal Vein Occlusions. Macular edema often develops because fluid and blood leak from damaged blood vessels near the center of the vision. Very gentle laser is used to seal up the leaking blood vessels and can help prevent vision loss.

 

Retinal Neovascularization
Most commonly seen in Diabetic Retinopathy, Retinal Vein Occlusions, and Retinal Artery Occlusions. In these conditions, because of the lack of normal amounts of oxygen in the eye, abnormal blood vessels can grow inside the eye (neovascularization). These new blood vessels are very problematic because they tend to bleed and can cause severe vision loss or blindness. Because of the severe nature of retinal neovascularization, a more extensive laser treatment, called Pan Retinal Photocoagulation, is needed. Laser treatment is then scattered into many points (often times over 1,000 laser spots) in order to stop the abnormal blood vessels from growing (figure 2).

 

Choroidal Neovascularization
Most commonly seen in Wet Macular Degeneration and Ocular Histoplasmosis Syndrome. Because of the damage to the back of the eye with these conditions, abnormal blood vessels can grow under the retina in some people. These abnormal blood vessels can bleed and cause permanent vision loss. Sometimes these abnormal blood vessels can be treated with laser treatment to destroy them.

Figure 1. When a microscope is used to treat the retina a small contact lens is placed on the eye to focus the laser.
Figure 2. Appearance of laser burns after pan retinal photocoagulation for diabetic retinopathy.
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