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      A Review of Subthreshold Micropulse Laser for Treatment of Macular Disorders

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          Abstract

          Micropulse laser treatment is an alternative to the conventional continuous-wave laser for the treatment of retinal or macular diseases. In contrast to the conventional laser, the therapeutic effect of the subthreshold micropulse laser is not accompanied by thermal retinal damage. This fact is of particular importance when a treatment near the fovea is required. Micropulse treatment is applied in indications such as central serous chorioretinopathy (CSC), diabetic macular edema (DME), or macular edema due to retinal vein occlusion (RVO). This review outlines and discusses the published literature of subthreshold micropulse laser treatment for CSC, DME, and macular edema after RVO.

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          Photocoagulation for diabetic macular edema. Early Treatment Diabetic Retinopathy Study report number 1. Early Treatment Diabetic Retinopathy Study research group.

          (1985)
          Data from the Early Treatment Diabetic Retinopathy Study (ETDRS) show that focal photocoagulation of "clinically significant" diabetic macular edema substantially reduces the risk of visual loss. Focal treatment also increases the chance of visual improvement, decreases the frequency of persistent macular edema, and causes only minor visual field losses. In this randomized clinical trial, which was supported by the National Eye Institute, 754 eyes that had macular edema and mild to moderate diabetic retinopathy were randomly assigned to focal argon laser photocoagulation, while 1,490 such eyes were randomly assigned to deferral of photocoagulation. The beneficial effects of treatment demonstrated in this trial suggest that all eyes with clinically significant diabetic macular edema should be considered for focal photocoagulation. Clinically significant macular edema is defined as retinal thickening that involves or threatens the center of the macula (even if visual acuity is not yet reduced) and is assessed by stereo contact lens biomicroscopy or stereo photography. Follow-up of all ETDRS patients continues without other modifications in the study protocol.
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            Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Early Treatment Diabetic Retinopathy Study Research Group.

            (1991)
            The Early Treatment Diabetic Retinopathy Study (ETDRS) enrolled 3711 patients with mild-to-severe nonproliferative or early proliferative diabetic retinopathy in both eyes. One eye of each patient was assigned randomly to early photocoagulation and the other to deferral of photocoagulation. Follow-up examinations were scheduled at least every 4 months and photocoagulation was initiated in eyes assigned to deferral as soon as high-risk proliferative retinopathy was detected. Eyes selected for early photocoagulation received one of four different combinations of scatter (panretinal) and focal treatment. This early treatment, compared with deferral of photocoagulation, was associated with a small reduction in the incidence of severe visual loss (visual acuity less than 5/200 at two consecutive visits), but 5-year rates were low in both the early treatment and deferral groups (2.6% and 3.7%, respectively). Adverse effects of scatter photocoagulation on visual acuity and visual field also were observed. These adverse effects were most evident in the months immediately following treatment and were less in eyes assigned to less extensive scatter photocoagulation. Provided careful follow-up can be maintained, scatter photocoagulation is not recommended for eyes with mild or moderate nonproliferative diabetic retinopathy. When retinopathy is more severe, scatter photocoagulation should be considered and usually should not be delayed if the eye has reached the high-risk proliferative stage. The ETDRS results demonstrate that, for eyes with macular edema, focal photocoagulation is effective in reducing the risk of moderate visual loss but that scatter photocoagulation is not. Focal treatment also increases the chance of visual improvement, decreases the frequency of persistent macular edema, and causes only minor visual field losses. Focal treatment should be considered for eyes with macular edema that involves or threatens the center of the macula.
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              Novel method for analyzing snellen visual acuity measurements.

              Ninel Gregori, William Feuer, Philip J. Rosenfeld (2016)
              Most retrospective reviews convert Snellen visual acuity measurements obtained during routine clinic visits to logarithm of the minimum angle of resolution (logMAR) units so that statistical manipulations can be performed. However, visual acuity measurements expressed as logMAR units are not intuitively interpretable by clinicians. A more intuitive approach is presented here which uses the conversion of Snellen visual acuity fractions to Early Treatment Diabetic Retinopathy Study (ETDRS) letter scores for statistical manipulations. Snellen visual acuity measurements were converted to approximate ETDRS (approxETDRS) letter scores for statistical manipulations and then converted back to Snellen equivalent fractions. The formula to convert Snellen visual acuity measurements to approxETDRS letter scores is 85 + 50 x log (Snellen fraction), which may be rounded to the nearest letter. A linear relationship exists between true ETDRS letter scores, approxETDRS letter scores, and logMAR units. The interconversion between Snellen visual acuity measurements, logMAR units, and approxETDRS letter scores was prepared in a tabular form for easy reference. The same outcomes (in Snellen fractions) were obtained with statistical manipulation of either approxETDRS letter scores or logMAR conversions. Conversion of Snellen visual acuity fractions to approxETDRS letter scores for the purpose of performing statistical manipulations provides more readily interpretable outcomes compared with the current strategy of converting Snellen visual acuity fractions to logMAR units.
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                Author and article information

                Contributors
                Paula Scholz:
                ORCID: http://orcid.org/0000-0002-1730-0566
                paula.scholz@uk-koeln.de
                Journal
                Journal ID (nlm-ta): Adv Ther
                Journal ID (iso-abbrev): Adv Ther
                Title: Advances in Therapy
                Publisher: Springer Healthcare (Cheshire )
                ISSN (Print): 0741-238X
                ISSN (Electronic): 1865-8652
                Publication date (Electronic): 24 May 2017
                Publication date PMC-release: 24 May 2017
                Publication date (Print): 2017
                Volume: 34
                Issue: 7
                Pages: 1528-1555
                Affiliations
                [1 ]ISNI 0000 0000 8852 305X, GRID grid.411097.a, Department of Ophthalmology, , University Hospital of Cologne, ; Cologne, Germany
                [2 ]ISNI 0000 0004 0374 1269, GRID grid.417570.0, , F. Hoffmann-La Roche, ; Basel, Switzerland
                Author information
                http://orcid.org/0000-0002-1730-0566
                Article
                Publisher ID: 559
                DOI: 10.1007/s12325-017-0559-y
                PMC ID: 5504253
                PubMed ID: 28540655
                SO-VID: f4b20f11-201a-4742-ae3f-37b70848f563
                Copyright © © The Author(s) 2017
                History
                Date received : 30 March 2017
                Categories
                Subject: Review
                Custom metadata
                issue-copyright-statement © Springer Healthcare Ltd. 2017

                Keywords: central serous chorioretinopathy,diabetic macular edema,micropulse laser,ophthalmology,retinal vein occlusion,subthreshold laser
                Data availability:
                Keywords: central serous chorioretinopathy, diabetic macular edema, micropulse laser, ophthalmology, retinal vein occlusion, subthreshold laser

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