Laser Therapy in the Treatment of Diabetic Retinopathy and Diabetic Macular Edema

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Abstract

Purpose of Review

This review highlights indications and evidence on laser therapy in the management of diabetic retinopathy and diabetic macular edema. Particular focus is placed upon the benefits and limitations of conventional laser photocoagulation versus more modern laser photocoagulation techniques, as well as the role of laser photocoagulation in treatment of diabetic retinopathy and diabetic macular edema with the frequent utilization of pharmacologic, including anti-vascular endothelial growth factor (VEGF), therapy.

Recent Findings

Laser photocoagulation remains the gold-standard therapy for the effective, definitive treatment of PDR, and also is highly effective in the management of DME. However, numerous recent studies have demonstrated the clinical efficacy and improved functional and anatomic outcomes of combination therapy with pharmacologic treatment.

Summary

Continuing innovations in laser technology and improved understanding of laser-retinal interactions and pathophysiology demonstrate that laser therapy will continue to play a critical role in the treatment of diabetic retinopathy and diabetic macular edema for many years to come.

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Most cited references 84

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Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group.

(1985)

Data from the Early Treatment Diabetic Retinopathy Study (ETDRS) show that focal photocoagulation of "clinically significant" diabetic macular edema substantially reduces the risk of visual loss. Focal treatment also increases the chance of visual improvement, decreases the frequency of persistent macular edema, and causes only minor visual field losses. In this randomized clinical trial, which was supported by the National Eye Institute, 754 eyes that had macular edema and mild to moderate diabetic retinopathy were randomly assigned to focal argon laser photocoagulation, while 1,490 such eyes were randomly assigned to deferral of photocoagulation. The beneficial effects of treatment demonstrated in this trial suggest that all eyes with clinically significant diabetic macular edema should be considered for focal photocoagulation. Clinically significant macular edema is defined as retinal thickening that involves or threatens the center of the macula (even if visual acuity is not yet reduced) and is assessed by stereo contact lens biomicroscopy or stereo photography. Follow-up of all ETDRS patients continues without other modifications in the study protocol.

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Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group.

(1991)

The Early Treatment Diabetic Retinopathy Study (ETDRS) enrolled 3711 patients with mild-to-severe nonproliferative or early proliferative diabetic retinopathy in both eyes. One eye of each patient was assigned randomly to early photocoagulation and the other to deferral of photocoagulation. Follow-up examinations were scheduled at least every 4 months and photocoagulation was initiated in eyes assigned to deferral as soon as high-risk proliferative retinopathy was detected. Eyes selected for early photocoagulation received one of four different combinations of scatter (panretinal) and focal treatment. This early treatment, compared with deferral of photocoagulation, was associated with a small reduction in the incidence of severe visual loss (visual acuity less than 5/200 at two consecutive visits), but 5-year rates were low in both the early treatment and deferral groups (2.6% and 3.7%, respectively). Adverse effects of scatter photocoagulation on visual acuity and visual field also were observed. These adverse effects were most evident in the months immediately following treatment and were less in eyes assigned to less extensive scatter photocoagulation. Provided careful follow-up can be maintained, scatter photocoagulation is not recommended for eyes with mild or moderate nonproliferative diabetic retinopathy. When retinopathy is more severe, scatter photocoagulation should be considered and usually should not be delayed if the eye has reached the high-risk proliferative stage. The ETDRS results demonstrate that, for eyes with macular edema, focal photocoagulation is effective in reducing the risk of moderate visual loss but that scatter photocoagulation is not. Focal treatment also increases the chance of visual improvement, decreases the frequency of persistent macular edema, and causes only minor visual field losses. Focal treatment should be considered for eyes with macular edema that involves or threatens the center of the macula.

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Panretinal Photocoagulation vs Intravitreous Ranibizumab for Proliferative Diabetic Retinopathy: A Randomized Clinical Trial.

Jeffrey G Gross, Adam R Glassman, Lee Jampol … (2015)

Panretinal photocoagulation (PRP) is the standard treatment for reducing severe visual loss from proliferative diabetic retinopathy. However, PRP can damage the retina, resulting in peripheral vision loss or worsening diabetic macular edema (DME).

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Author and article information

Contributors

Lesley A. Everett:

ORCID: http://orcid.org/0000-0002-7373-2056

lesleyae@umich.edu

Yannis M. Paulus:

ORCID: http://orcid.org/0000-0002-0615-628X

ypaulus@med.umich.edu

Journal

Journal ID (nlm-ta): Curr Diab Rep

Journal ID (iso-abbrev): Curr Diab Rep

Title: Current Diabetes Reports

Publisher: Springer US (New York )

ISSN (Print): 1534-4827

ISSN (Electronic): 1539-0829

Publication date (Electronic): 6 September 2021

Publication date (Print): 2021

Volume: 21

Issue: 9

Electronic Location Identifier: 35

Affiliations

GRID grid.214458.e, ISNI 0000000086837370, Department of Ophthalmology and Visual Sciences, Kellogg Eye Center, , University of Michigan, ; 1000 Wall Street, Ann Arbor, MI 48105 USA

Author information

Lesley A. Everett http://orcid.org/0000-0002-7373-2056

Yannis M. Paulus http://orcid.org/0000-0002-0615-628X

Article

Publisher ID: 1403

DOI: 10.1007/s11892-021-01403-6

PMC ID: 8420141

PubMed ID: 34487257

SO-VID: e190e1d4-edf7-4105-8acf-bdad65755abf

License:

This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

History

Date accepted : 1 June 2021

Funding

Funded by: FundRef http://dx.doi.org/10.13039/100005242, Heed Ophthalmic Foundation;

Funded by: Vitreoretinal Surgery Foundation

Funded by: FundRef http://dx.doi.org/10.13039/100000053, National Eye Institute;

Award ID: 1K08EY027458

Award ID: 1R41EY031219

Award ID: 1R01EY029489

Award Recipient : Yannis M. Paulus

Funded by: FundRef http://dx.doi.org/10.13039/100001818, Research to Prevent Blindness;

Funded by: FundRef http://dx.doi.org/10.13039/100002089, Fight for Sight;

Funded by: FundRef http://dx.doi.org/10.13039/100007279, Alliance for Vision Research;

Custom metadata

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: diabetic retinopathy,diabetic macular edema,retinal laser therapy,panretinal photocoagulation,focal laser photocoagulation,selective retinal therapy

Data availability:

ScienceOpen disciplines: Endocrinology & Diabetes

Keywords: diabetic retinopathy, diabetic macular edema, retinal laser therapy, panretinal photocoagulation, focal laser photocoagulation, selective retinal therapy

Laser Therapy in the Treatment of Diabetic Retinopathy and Diabetic Macular Edema

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Abstract

Purpose of Review

Recent Findings

Summary

Related collections

Journal of the ASEAN Federation of Endocrine Societies

Most cited references 84

Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group.

Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group.

Panretinal Photocoagulation vs Intravitreous Ranibizumab for Proliferative Diabetic Retinopathy: A Randomized Clinical Trial.

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