New Laser Technologies for Diabetic Retinopathy

Diabetic retinopathy is a leading cause of severe visual impairment for adults worldwide. Vision loss from systemic diabetes usually occurs secondary to macular edema or from de novo proliferation from the retinal vasculature. The Diabetic Retinopathy Study (DRS) established that panretinal photocoagulation (PRP) reduces the risk of severe vision loss from proliferative disease by >50 % and, thus, PRP has become the gold standard in the treatment of proliferative disease. The Early Treatment of DRS expanded the use of laser photocoagulation to clinically significant macular edema. Advances in laser technology have led to the development of semi-automated lasers, including pattern scanning laser (PASCAL ® , Topcon) and fully automated lasers, such as the navigating lasers (NAVILAS ® , OD/OS), that aim to deliver faster, safer, more accurate, and less painful treatment of diabetic eye disease and other retinal conditions. Sublethal phototherapy with subthreshold diode micropulsed laser treatment for macular edema has led to a paradigm shift in our understanding of retinal photocoagulation by demonstrating similar efficacy with less collateral damage. Here, we review the current data on laser treatment of diabetic retinopathy with an emphasis on understanding the new laser photocoagulation technologies for treatment of proliferative diabetic retinopathy and clinically significant diabetic macular edema.