A laser is a very focused beam of light that is used to treat a variety of eye disorders. The term LASER  is actually an acronym coined from Light Amplification by Stimulated Emission of Radiation. Some of the uses for lasers in ophthalmology are (i) to reshape cornea to reduce nearsightedness or astigmatism (LASIK), (ii) to treat glaucoma (both laser trabeculoplasty and peripheral iridotomy), and (iii) to treat posterior capsule opacification after previous cataract surgery (YAG laser capsulotomy).

Laser treatment has revolutionized the treatment of a number of retinal disorders including diabetic retinopathy, age-related macular degeneration, and retinal tears among others. For individuals with diabetes, laser treatment can significantly reduce the risk of visual loss both from leaking blood vessels causing retinal swelling, and from abnormal blood vessel growth (neovascularization). For patients with macular degeneration, laser treatment can eradicate abnormal blood vessels growing under the retina (choroidal neovascularization) and thus reduce the risk of visual loss. Finally, laser treatment around retinal tears significantly reduces the chance of a retinal detachment occurring.

Laser treatment is almost always performed as an out-patient procedure.  The patient sits comfortably on one side of the slit lamp (the microscope used to examine the eyes) while the treating physician is on the other side. Usually, a contact lens is placed on the eye to focus the laser after numbing eye drops have been instilled. The treating physician then maneuvers a joystick which aims the laser in the desired location. The physician then steps on a foot pedal or pushes a button to activate the laser. The laser burst lasts only 1/10th of a second and is usually accompanied by a clicking sound from the laser machinery. The individual being treated may see a bright flash of light. Laser treatment of the macula (the central retina) is usually completely painless. Laser treatment to the peripheral retina usually requires a greater number of larger laser spots resulting in some discomfort (often described as a toothache-like pain). If a large amount of laser treatment is anticipated, the patient may opt to have the eye anesthetized by an injection of numbing medicine around the eye. The results of laser treatment vary depending on the condition being treated and its severity. For many conditions, laser treatment is most effective at preventing visual loss and is best applied before visual loss has occurred (especially diabetic retinopathy).

Dr. Melki has extensive experience in the use of lasers to treat retinal problems. If you or a someone you know has a retinal problem, please call us to arrange a comprehensive evaluation at either of our convenient locations.

Macular Degeneration Update

Age Related Macular Degeneration (AMD) & latest Treatment with Intraviteal injections of LUCENTIS & AVASTIN (anti VEGF). Exudative age related macular degeneration (wet ARMD) continues to be a common blinding retinal disorder. Laser treatment for wet ARMD often is not possible or worsens the patient's vision. Unfortunately, the majority of leakages are occult or poorly defined choroidal neovascular membranes (CNVM) which are located under the center of the macula. These lesions respond the poorest to traditional laser therapy. The new treatments of anti-VEGF for exemple LUCENTIS or  AVASTIN, might have a great benefit to patients with leakage located directly under the macula. So far, Dr. T.S. Melki has performed over 500 of these injections (2007).

Limited Retinal Translocation can move the retina inferiorly so that small classic (well defined) submacular CNVM can be moved "out" of the central macula prior to laser. Retinal surgeons now have the technical capability to perform translocation surgery. The CNVM can then be treated post-operatively while hopefully preserving the central macula. Limited retinal translocation is a  reasonable procedure to consider for small classic submacular CNVM in a attempt to prevent further vision loss. Significant complications can occur following retinal translocation surgery.

Photodynamic Therapy (PDT) will allow for the treatment of subfoveal CNVM with less damage to the overlying retina. Hopefully, patients will experience less vision loss following PDT treatment. PDT requires the injection of a photosensitive dye prior to laser therapy. The preliminary results for PDT are encouraging when the majority of the leakage is classic (well defined). Unfortunately, in the same clinical trial, PDT was not proven visually beneficial in patients when the majority of the lesion was occult (poorly defined). Dr. T.S. Melki currently (2007) rarely offers this therapy option.

Transpupillary Thermotherapy (TTT) is an alternative therapy for patients with occult (poorly defined) subfoveal leakage. TTT utilizes the diode laser with an enlarged spot size and extended treatment time to treat subfoveal CNVM with less overlying retinal damage. TTT avoids the use and expense of the dye used in PDT. The preliminary results for TTT indicate the ability to stabilize vision loss in the majority of patients treated. TTT is already FDA approved. A large clinical trial of TTT is currently being organized. We are  currently utilizing TTT in our offices for patients with otherwise untreatable subfoveal occult leakage.

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