Why do we use lasers in diabetic maculopathy? Part 2 of 2
In my last blog post we talked about why we use lasers in proliferative diabetic retinopathy.
In this blog post we will talk about laser treatment of diabetic maculopathy.
Diabetic maculopathy describes a condition where high sugar levels in diabetes mellitus damage the blood vessels of the retina of the eye. If this damage occurs in the central part of the retina or macula, then patients can lose central vision.
Diabetic maculopathy is the leading cause of vision loss in the working population of the Western World and represents a significant health issue.
The main treatment for diabetic maculopathy was laser treatment for many years.
Recently diabetic maculopathy has been more successfully treated by medicines that block vascular endothelial growth factor (VEGF) known as anti-VEGFs such as Avastin, Lucentis and Eylea – you may note that these medicines also treat wet age related macular degeneration.
Why do we use laser for diabetic maculopathy?
I have already mentioned in my previous blog post that lasers and eyes are compatible. The laser used in proliferative diabetic retinopathy is high energy and burns the peripheral retina to scar it. In diabetic maculopathy, we use much lower laser energy to gently heat it.
Because we are applying laser to the central retina – the area that is responsible for the majority of our useful vision – we must be very careful to preserve its function. If we apply too much energy then we will risk scarring the macula and end up creating the visual loss we were trying to save.
Very good research studies have shown that laser treatment for diabetic maculopathy prevents visual loss compared to patients who do not receive treatment. It is not very good at improving vision however.
How does it laser treatment for diabetic maculopathy work?
This is still poorly understood. One theory is that it heats up the retinal pigment cells (the layer that nourishes the retina) encouraging these cells to pump away the excess fluid seen in diabetic maculopathy.
Does laser treatment for diabetic maculopathy hurt?
The answer is no. The treatment is far shorter than the treatment for proliferative diabetic retinopathy. The energy levels delivered to the retina are also much lower with less discomfort.
If anti-VEGF treatments are available, why do we need laser treatment for diabetic maculopathy?
Intravitreal anti-VEGF medicines have been shown to be effective in improving vision in many patients and they appear to be superior to laser treatment.
However a combination of an anti-VEGF medicine and laser may be more effective than an anti-VEGF on its own in the long run.
Researchers have also looked at different wavelengths of laser light, lower energy levels and pulsing delivery of lasers to improve their effectiveness in the treatment of diabetic maculopathy.
So the age of the laser in diabetic maculopathy is not quite over and you now know why it still has its uses.