Lasers have played a critical role in treating the eye for over 50 years. Less than three years after lasers were first developed in 1960, they were described as a therapy for the eye. From that initial description, lasers have proven effective at treating numerous eye diseases including diabetes, macular degeneration, retinal vein occlusion, sickle cell, retinopathy of prematurity, radiation retinopathy, retinal tears, glaucoma and eye cancers. Initial laser therapies involved hundreds to thousands of individually placed points on the eye that could result in scarring, pain and reduced vision. Recently, there have been significant advances in laser therapies that treat the eye with less side effects, less pain, less scarring, and more rapid results.
Pattern-scanning laser (PASCAL) was a significant improvement, whereas rather than giving one long laser burn, the doctor can rapidly give up to 56 shorter laser treatments. This was shown to reduce treatment time, side effects, and patient pain from 5.1 to 1.4 on a scale from 0 to 10. Systems have also been developed which allow doctors to input pictures of your eyes and select exact laser therapy spots on a computer screen (Navilas).
Even shorter laser therapy was developed – called micropulse laser and selective retinal therapy – which can selectively treat only the layer of the eye directly beneath the nerves without affecting the nerves themselves, and thus, are painless. In addition, the rapid speed allows for treatment of the entire eye in less than a second. For example, the macula, or central vision, can be treated in 4.5 milliseconds. This speed, precision and specificity were impossible with previous longer laser pulses.
Real-time laser feedback has also been described using ultra-fast imaging to stop the laser therapy when the desired clinical treatment is reached. This builds additional safety and feedback where they previously did not exist. Combination of even shorter laser (nanosecond pulse duration, or one billionth of a second) combined with ultrasound has been developed and is called photo-mediated ultrasound therapy (PUT). PUT can precisely and permanently remove blood vessels without damaging surrounding tissue.
Lasers have and will continue to play a very important role in the treatment of eye diseases. Newer lasers have improved therapy while decreasing side effects, pain, and treatment time. Larger studies of these new laser therapies are being conducted around the world to demonstrate their effectiveness, and studies to date have shown significant promise. The American Academy of Ophthalmology has created a website to provide up-to-date improvement in eye laser therapies at goo.gl/G9V6op.
Lasers have and will continue to play a very important role in the treatment of eye diseases.
