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VOLUME 7 NUMBER 3 • SEPTEMBER 2010
SA JOURNAL OF DIABETES & VASCULAR DISEASE
Keep and Copy Series
Focal laser for focal maculopathy may sometimes restore some lost vi-
sion.
WHAT TO EXPECT DURING TREATMENT
Your treatment will be performed in a specially equipped laser room. Your
pupils will be dilated in order for your doctor to see your retina well. Topi-
cal local anaesthetic drops will be instilled into your eye. In the majority of
patients this is enough anaesthesia, but a small percentage of patients,
who have a lower pain threshold, may need a regional local anaesthetic
injection for scatter laser treatment. The laser can be performed in one
of two ways:
•
Most commonly you will be seated at a slit lamp and a contact lens
will be placed on the cornea (front of the eye). This keeps the eye
open and stabilises the eye and also helps to focus the laser beam
on the retina.
•
Sometimes your doctor might prefer to have you lie down on a bed
and use an indirect ophthalmoscope (attached to the doctor’s head)
to deliver the laser beam. This method is useful when the doctor’s
view of the retina is slightly obscured by cataract or blood, but is
a more difficult technique to master. It can only be used for scatter
laser and not for focal or grid laser.
Focal or grid laser is usually done in one sitting, but scatter laser might
be accomplished over a few sessions.
WHAT TO EXPECT AFTER TREATMENT
The vision will be blurred immediately after the treatment, but should
recover to the pre-treatment level over time. You should plan to have
someone drive you home and you should relax for the rest of the day.
Remember to bring a pair of dark glasses, as your pupils will remain
dilated for a few hours making your eyes very sensitive to light. Most
patients resume normal activities within a day or two. Regular follow-up
visits are required.
HOW WELL DOES IT WORK?
Laser is unlikely to restore vision already lost, but when performed in a
timely manner:
•
focal laser, targeting specific blood vessels, is effective in reducing
the risk of vision loss in people with macular oedema
•
scatter laser, treating the peripheral ischaemic retina, reduces the
risk for severe vision loss by 50 to 60% over six years in people with
high risk of vision loss. Studies suggest that up to 90% of cases of le-
gal blindness caused by proliferative retinopathy could be prevented
by prompt scatter laser.
WHAT ARE THE RISKS?
Laser burns and destroys part of the retina and can result in some per-
manent vision loss, which is unavoidable. Panretinal/scatter treatment
may cause mild loss of central vision (due to increased macular oedema),
reduced night vision, reduced peripheral vision and decreased ability to
focus. This is mild compared to the vision loss that may be caused by
untreated retinopathy.
Rare complications of laser treatment, which may cause severe loss
of vision, include:
•
bleeding in the eye/vitreous haemorrhage (as part of scar formation)
•
tractional retinal detachment (as part of scar formation)
•
accidental laser burn of the fovea (centre of the macula).
WHAT IF I DECIDE NOT TO HAVE THE TREATMENT?
Untreated retinopathy invariably leads to severe loss of vision.
