You have come to the right place if you want to know about retina laser treatment for ‘prevention’ of retinal detachment.
High risk eyes are candidates for preventive treatment.
Retina Laser Treatment is highly effective in preventing retinal detachment in high-risk eyes. Eyes known to have a substantial risk for retinal detachment include the fellow eye or second eye of someone who has experienced retinal detachment in the other eye.
Any one who has had cataract surgery has a modestly increased risk of retinal detachment over someone who hasn’t and their risk increases slightly if they have had a secondary laser procedure known as YAG capsulotomy, to improve vision.
Extremely nearsighted (myopic) eyes and eyes with lattice degeneration are also conditions which increase the risk of retinal detachment.
Marfan’s syndrome is a condition associated with cataracts and high myopia complicated by subluxation of the lens (the lens moves off-center, disrupting vision). Lens removal for this problem is curative but adds another risk factor to an eye already at risk of retinal detachment.
Stickler’s syndrome is a dominantly inherited condition in which retinal detachment commonly occurs in young adult life often in both eyes.
Evolution of prophylaxis retina laser treatment
Laser surgery in ophthalmology revolutionized the treatment of many eye conditions from the cornea to the retina in the last few decades.
The indirect ophthalmoscope (IDO) method of laser delivery became available in the 1990s finally providing the retina surgeon with the ideal surgical instrument to apply laser treatment to the peripheral retina to prevent retinal detachment.
Photo by National Eye Institute
Before the IDO laser delivery, prophylaxis laser photocoagulation against retinal detachment was only possible by the slitlamp method of delivery. The slitlamp delivery system was limited and the results of the procedure were not effective in the long term.
Photo by National Eye Institute
Unlike the slitlamp delivery instrument, the IDO laser instrument allows the surgeon a wide field of view into the far periphery, excellent depth perception, no glare and the ability of the surgeon to indent the eye for maximum view.
These IDO features let the surgeon place laser treatment in the peripheral area of retina where an estimated 95% retinal breaks and tears which cause retinal detachment occur.
Proper IDO Laser Cerclage nearly eliminates future tear occurrence in the areas of treatment. Treatment to the peripheral area of the retina is advantageous for the patient subjectively because visual function in the peripheral retina is low, rarely noticed.
The typical approach carried out today is only treating visible areas of retinal pathology (focal prophylaxis laser photocoagulation) in high risk eyes.
Focal laser prophylaxis does prevent retinal detachment from the specific area treated but has been disappointing in preventing overall occurrence of retinal detachment. Why? Because new tears can develop in the untreated peripheral areas of focally treated high risk eyes and often lead to retinal detachment.
IDO Laser Cerclage
IDO Laser Cerclage is an outpatient procedure that may be performed either in the office setting or in an outpatient surgery site. It can be done with a local anesthetic block or under brief general anesthesia.
The surgery is short, taking no more than 20 to 30 minutes for the actual laser treatment. Patients wear a patch to cover and protect the eye from injury while the eye remains numb; about 5 hours.
Discomfort after the surgery is usually mild and most often is relieved with over the counter non-asprin analgesics. The day following surgery patients may resume normal daily activities.
Laser photocoagulation produces a titrated amount of heat in specific layers of retinal tissue treated. In the areas of the retina where the laser is applied the retina tissue bonds to the underlying pigment tissue that absorbs the light. This cases the layers to bond together and forges a strong resistance against vitreous traction and subsequent tears.
IDO Laser Cerclage is applied in the peripheral retina, the area of the retina most prone to retinal breaks and the area of the retina least important to daily visual function. Very few people actually perceive visual change after retina laser treatment.
After about two months when the retinal adhesions have had a chance to form the retinal surgeon will want to evaluate the adequacy of treatment. Because the tissue in different individuals may respond differently, “touch up” spots of treatment in some areas might be considered. Most often the original treatment is sufficient.
The complications associated with laser cerclage documented in the scientific literature include the above modest loss of side vision, a loss of pupillary function in the treated eye and the formation of macular pucker. Practically speaking, these complications are rare.