Retinal Laser

What is a laser?

Lasers are machines that amplify light rays to the point where they can be useful for many different applications. In eye surgery, laser can be used for many different reasons, including treating:

Why might laser be used for retinal diseases?

An argon laser can be focused on the retina in order to spot-weld layers of the retina together, or to destroy diseased retina to prevent it from causing any further problems.

Why is laser used in retinal tears?

Unfortunately, there is a high risk of developing a retinal detachment if you have a retinal tear. By lasering around the retinal tear, we can reduce the risk of the tear progressing to a full retinal detachment. Essentially the laser 'spot-welds' the retina to the deeper layers in the eye, preventing it in most cases from detaching.

Why is laser used in diabetic retinopathy?

Diabetic retinopathy is a relatively common eye disease and is the most common cause of blindess in working-age Australians.

In proliferative diabetic retinopathy, abnormal and fragile blood vessels grow on the retina. These have the propensity to bleed easily and cause scar tissue in the retina. The risk of going blind is considerable in such cases. Laser is effective in halving the risk of blindness in some patients with proliferative diabetic retinopathy. Almost always, you will need several sessions of laser in each affected eye.

In diabetic maculopathy, abnormal blood vessels that leak fluid can reduce the vision. Laser can be used in these instances to reduce the leakage. This form of laser is becoming less common due to newer intravitreal therapy being shown to be more effective at improving vision, and less likely to cause long-term retinal scarring.

Why is laser used in retinal vein occlusions?

Up until several years ago, the only effective treatment for retinal vein occlusions was laser. Intravitreal injections now have a larger role in the treatment of vein occlusions, but there are still instances when laser is useful.

In central retinal vein occlusions it is still beneficial in patients with significant retinal ischaemia. It these cases it reduces the risk of developing a severe form of secondary glaucoma called rubeotic glaucoma.

In branch retinal vein occlusions, laser may still be used when there is significant retinal ischaemia, to prevent the growth of abnormal blood vessels on the retina. It can also be used for macular oedema, if intravitreal injections are not adequately managing the disease.

Why is laser used in central serous retinopathy (CSR)?

Whilst, on most occasions, CSR resolves itself, sometimes there may be a small, focal area of leakage underneath the retina. This can be sealed with laser in some cases.

Are there any risks to retinal laser?

Generally speaking, retinal laser is safe. It is rare to have any adverse damage from a retinal laser, but as with any medical procedure there are small risks involved.

Does retinal laser hurt?

Retinal laser usually doesn't hurt. Unfortunately, diabetic patients, who often need the most treatment, may experience the most discomfort as a result of retinal laser. Usually this isn't severe enough to require any significant anaesthetic. If you have significant pain, then a numbing injection may be given to reduce the discomfort. 

Are there any side effects after the retinal laser?

If your eye required a lot of laser, it may be sore for up to 24 hours. Usually this resolves with some paracetamol.

Most of the time, you won't notice any great difference to your vision. If you have needed a lot of laser, you may notice some transient blurring, or some spots in the vision, but this usually returns to normal after a couple of months.

Occasionally, you may notice a spot in the vision which remains there permanently.

Clinical Case: Coats' Disease

This is a retinal photograph of a rare disease named Coats' Disease. In this disease, retinal blood vessels become abnormally leaky, resulting in blindness in the worst cases. You can see the abnormal blood vessels on the far left hand side of the photograph. The small white spots are lipids (cholesterol) leaking from those abnormal blood vessels.

The treatment of Coats' Disease is retinal laser to prevent ongoing leakage. The pale white dots on the retinal photograph below are laser spots that have been applied a minute or two before.

It takes a surprisingly long time for retinal laser to work, usually months. In the photograph below, you can see that the amount of leakage from the blood vessels is considerably less and the abnormal blood vessels have reduced.

If you would like to make an appointment for retinal laser surgery, please click here.

Dr Joshua Yuen

Dr Joshua is an experienced consultant ophthalmic surgeon, who specialises in retinal diseases and cataract surgery... read more

Dr Brad Johnson

Dr Johnson is an experienced consultant ophthalmic surgeon, who specialises in retinal diseases and cataract surgery... read more