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Laser
Laser is an intense light source that is used to burn, cut or dissolve tissue.  In the retina, laser has various clinical purposes including: sealing retinal tears, destroying leaking or new blood vessels (neovascularization) and  treating macular degeneration and diabetic retinopathy.

Laser for retinal tears (retinopexy)

Occasionally, someone will develop a tear or hole in nerve tissue of the retina.  Symptoms include flashing lights, and or floaters.  Some tears or holes can occur in the absence of any symptoms.  The most dreaded consequence of a retinal tear or hole is a detachment of the retina where the nerve tissue falls away from the back wall of the eye.  This may perceived as a dark "curtain" or "shade" in your peripheral vision.  This is a blinding condition that necessitates repair in an operating room in most cases.  Detachment of the retina due to a hole or tear can usually be prevented by performing laser surgery.  We essentially surround the retinal defect with laser to induce greater adhesion of the retina to the back wall of the eye.  This helps prevent fluid that normally is in the open cavity of the eye (the vitreous cavity) from flowing through the tear or hole and "dissecting" the retina off the back wall of the eye.  Usually this can be accomplished in the office with topical anesthetic drops.  Some patients do report having an ache following the procedure, but this usually subsides with over-the-counter pain medications.  During the first few days following the procedure it is best to avoid any strenuous activity until the laser has taken effect.  Your retina specialist will schedule a follow up visit to inspect and ensure the laser has matured enough to accomplish its desired goal.  It is important to immediately report any sudden appearance of new floaters or a dark "curtain" to your retina doctor.  The risk of the laser procedure includes mild irritation most often.  Rarely, a patient will experience a retinal detachment despite having laser, but this is usually due to the formation of new tears.  Other rare complications include misdirection of the laser, or pupillary abnormalities.
 


Illustration of laser being applied to a retinal tear

Overview of diabetic retinopathy

Diabetes causes damage to vessels throughout the body.  Vision loss due to diabetic blood vessel damage can occur in two major ways.  Both ways affect the retina, the nerve tissue that lines the back wall of the eye.  In the first way blood vessels that are normally present can be damaged so that they begin to leak fluid into the retina causing it to swell and malfunction.  In the second way, damaged blood vessels are unable to bring the necessary nutrients and oxygen to the retina nerve tissue.  The eye then signals the body to produce new vessels (neovascularization) within the eye to overcome this problem.  However, while important in the heart, kidney, and brain, abnormal vessels growing in the eye have detrimental effects leading to bleeding, retinal detachment, glaucoma, and ultimately, loss of the eye.  Both of these complications (retinal edema and new vessel growth) from diabetes can be treated with laser therapy by an experienced retinal specialist.  

Laser for diabetic retinal edema

Diabetes causes damage to blood vessels throughout the body.  Loss of vision can occur due to leakage of fluid from damaged blood vessels within the retina (the thin layer of nerve tissue that lines the back wall of the eye).  The excess fluid within the retina causes it to swell (retinal edema) and malfunction so that light images cannot be interpreted as sharply by the brain.  Thus the vision becomes blurred.   Areas of leakage within the retina can be treated with laser therapy in an effort to decrease the vision loss. The procedure is done in the office while the patient is seated at a microscope.  The retina specialist will use a special contact lens that is temporarily placed on the eye for the procedure.  Most procedures last less than 5 minutes.  The surgeon maintains control of the laser throughout the procedure so there is very little risk of subjecting the fovea (the most sensitive part of the retina) to laser.  Patients usually feel no sensation at all except for noticing the flash of the laser.  The vision may be transiently blurred following the procedure due to a "dazzling" effect from the bright lights.  This returns to normal within a few minutes.  Occasionally the laser will be used in combination with other forms of treatment.  Your retina specialist will decided this based on the specific location and degree of the retinal swelling.  A follow up appointment will be made to ascertain the response to the therapy.     

Laser for proliferative diabetic retinopathy
 

The second way diabetes can cause vision loss is through the proliferation (growth) of new vessels.  Laser therapy is used to decrease the body's tendency to grow new vessels in the eye.  This helps reduce the chance of vision loss from bleeding, retinal detachment, and glaucoma.  It is accomplished in the office with the use of topical or regional anesthesia.  Some experience a minor ache around the eye which can be treated easily with over the counter pain medications.  Patients are asked to return in 4 to 6 weeks to evaluate the response to the laser therapy.  
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