Retinal Laser Treatment: Key Questions and Insights

Q: Retinal Laser Treatment: Key Questions and Insights

Hello Andre： 1. There should only be one type. 2. Scarring will persist and typically will not be repeated on the same area. 3. 4. 5. Injecting around the entire circumference is ineffective and does not provide protection to the center; it should be d

Retinal laser treatment

Dear Dr.
Gao,
I recently discovered a retinal tear due to high myopia and underwent laser treatment.
I am determined to protect my eyes to avoid the path to blindness in the coming years or even decades.
This has led to many questions and decisions regarding my care.
I appreciate the opportunity to consult with you, and I apologize for the complexity of my inquiries.
1.
I would like to ask if there are two types of lasers used for retinal tears.
Are their functions identical, or is one more suitable for certain conditions (e.g., is one better for more severe cases or larger areas)?

2.
Will the laser marks be permanent after the procedure? If I have a check-up with a different doctor years later, will the original laser marks be clearly visible? Additionally, could reapplying the laser on the same area have adverse side effects?
3.
If there is one tear, would you recommend treating the entire circumference of the eye with laser treatment? If so, how many layers would you suggest for safety?
4.
If treating the entire circumference, when viewed in a side cross-section (with the left side being the cornea and iris, and the right side being the macula), where would the laser treatment ideally project on the vertical line of this cross-section? For example, if the left is 0 units and the right (macula) is 100 units, where would be the optimal position along this axis?
5.
How many sessions would be reasonable for a full circumferential treatment of one eye? Additionally, I have some questions regarding the laser procedure.
6.
What is the most serious danger if the treated eye cannot control its movement and looks away during the laser procedure? During the treatment, I noticed two types of light: a purplish guiding light and the green light emitted during the laser.
7.
To prevent the treated eye from moving, should I keep the other eye open and focus on a fixed point, or should I close it and just keep the treated eye open as the doctor holds it? I find it difficult to determine the position of the treated eye, but opening the other eye increases overall light stimulation and mental distraction.
8.
Does the purplish guiding light pose a risk of distracting the treated eye? I felt that the frequency of the laser application was about 0.5 to 1 second per shot, but this frequency seemed to rapidly increase discomfort (soreness and overall pain).
However, when the doctor took longer (over 2 seconds) to find the position, it significantly alleviated discomfort.
9.
Is there any basis for this experience? Have others reported similar situations? Would it be appropriate to request the doctor to extend the firing interval to 1-2 seconds or more?
10.
Regarding post-treatment care to prevent deterioration, I would like to ask about the impact of the following activities: (1) excessive eye use, (2) exposure to blue light, (3) exposure to ultraviolet light, (4) riding roller coasters with centripetal acceleration, (5) free-fall rides, (6) head shaking, (7) inversion or straining that causes blood to rush to the head, and (8) high-intensity aerobic exercise that rapidly increases heart rate and blood circulation.
Are these directly or indirectly related to potential retinal damage? To what extent? (I currently believe that 6 has a direct correlation, while 1 may indirectly worsen myopia.)
11.
Would it be beneficial to avoid looking at my phone and frequently gaze at distant landscapes? (After all, it seems that my myopia has stabilized after age 20, so this may not prevent further deterioration.) Is there still a reason to encourage this practice to prevent diseases other than retinal detachment?
12.
Is bright light better for the eyes (e.g., outdoors on sunny days or indoors with high-wattage bulbs), or is it better to avoid overly bright light (e.g., outdoors at dusk or indoors with lower-wattage yellow bulbs)?
13.
Should the brightness of 3C screens be slightly brighter or dimmer, as long as I can clearly see the images and text?
I apologize for the complexity of these questions, and I sincerely thank you for taking the time to address them.

Andre, 30~39 year old female. Ask Date: 2022/06/03

Dr. Gao Pilin reply Ophthalmology

Hello Andre: 1.
There should only be one type.
2.
Scarring will persist and typically will not be repeated on the same area.
3.
4.
5.
Injecting around the entire circumference is ineffective and does not provide protection to the center; it should be done around the perimeter of the hole.
6.
7.
8.
Usually, the eyes cannot move erratically because they are covered by a full retinal contact lens or a three-mirror lens that encompasses the cornea.
There is no need to worry.
9.
Due to the high number of injections, there is a certain speed at which they are administered.
It cannot be prolonged for too long.
If discomfort arises, discussing it with the physician should not be a problem.
10.
There will be direct effects.
The extent varies from person to person.
11.
It is helpful.
12.
13.
Moderation is key; both overly bright and overly dark conditions are not ideal.
Comfort should be the priority.

Reply Date: 2022/06/03

More Info

Understanding retinal laser treatment is crucial for patients, especially those with high myopia and retinal issues. Your questions reflect a deep concern for your eye health, and I appreciate the opportunity to address them comprehensively.

1. Types of Laser Treatment for Retinal Holes: There are generally two types of laser treatments for retinal holes: argon laser photocoagulation and diode laser treatment. Both aim to create a scar around the hole to seal it and prevent fluid from entering, but they may be used in different situations. Argon lasers are often used for more extensive areas or when the hole is larger, while diode lasers might be preferred for smaller, more localized issues. The choice depends on the severity and specific characteristics of the retinal hole.

2. Permanent Laser Marks: The laser treatment will leave a mark on the retina, which can be seen during future examinations. These marks are generally permanent, but they do not indicate ongoing issues unless accompanied by new symptoms. Repeating laser treatment on the same area can carry risks, including potential damage to surrounding tissue, so it should be approached cautiously.

3. Full Circumferential Laser Treatment: If there is a significant concern about multiple holes or a high risk of retinal detachment, some doctors may recommend a circumferential laser treatment. This involves treating the entire perimeter of the retina. However, the decision should be based on a thorough evaluation of your specific condition and the potential risks versus benefits.

4. Laser Treatment Positioning: When considering the positioning of the laser treatment, it is essential to focus on the area of concern. The treatment should ideally target the affected area while ensuring that the surrounding healthy retina is preserved. Your ophthalmologist will determine the best approach based on your eye's anatomy.

5. Number of Sessions for Circumferential Treatment: The number of sessions required for a full circumferential treatment can vary. It may be done in one session or divided into multiple sessions, depending on the extent of the treatment needed and your comfort level.

6. Eye Movement During Laser Treatment: It is crucial to keep the eye steady during laser treatment. If the eye moves, it can lead to misalignment of the laser and potentially cause damage. Patients are often instructed to focus on a specific point to help maintain stability.

7. Managing Eye Movement: Keeping the non-treated eye open and focused on a fixed point can help stabilize the treated eye. However, if the light from the laser is distracting, closing the other eye might be beneficial. Discussing this with your doctor can help find the best approach for you.

8. Impact of Guide Light: The guide light used during the procedure can indeed be distracting. If it causes discomfort or makes it difficult to focus, communicate this with your doctor, as they may adjust the lighting or technique.

9. Pain Management During Treatment: If you experience discomfort during the laser treatment, it is reasonable to discuss this with your doctor. They may adjust the frequency of the laser pulses or provide additional numbing agents to enhance your comfort.

10. Post-Treatment Care: After laser treatment, it is essential to avoid activities that could strain your eyes or increase intraocular pressure. This includes excessive screen time, exposure to bright lights, and high-impact activities. Each of these factors can contribute to eye strain and potentially worsen your condition.

11. Eye Health Practices: Regularly looking at distant objects can help reduce eye strain and may be beneficial for overall eye health. While myopia may stabilize after a certain age, maintaining good eye habits can help prevent further deterioration.

12. Lighting Conditions: Adequate lighting is essential for eye health. Bright, natural light is generally better than dim lighting, as it reduces strain. However, avoid excessive brightness that can cause glare.

13. Screen Brightness: When using screens, it is advisable to keep the brightness at a comfortable level that allows you to see clearly without straining your eyes. Adjusting the brightness to match your environment can help reduce discomfort.

In conclusion, your proactive approach to understanding retinal laser treatment and eye health is commendable. It is essential to maintain open communication with your ophthalmologist, who can provide personalized advice based on your specific condition and needs. Regular follow-ups and adhering to post-treatment care guidelines will be crucial in safeguarding your vision. Thank you for your thoughtful questions, and I wish you the best in your eye health journey.

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