A little bit of history...

In the early 1900s, Albert Einstein conceptualized the theory of “light amplification through stimulated emission of radiation”, a concept he named laser theory. For five decades, physicists and scientists continued to develop laser theory and in 1960 the very first laser was built.

In the mid-60’s, laser technology was adopted by medical professionals who believed laser light held the power to induce positive changes at the cellular level.

Thanks to the DRS and ETDRS clinical studies, laser photocoagulation has been the mainstay of diabetic retinopathy treatment since its development. With the advent of anti-VEGF therapy, the role of laser therapy appeared to be diminished, however many advances in laser technology have been developed since. From thermal laser therapy to subthreshold laser therapy.

The very beginning
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Another important time
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The third important time
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What is Subliminal Laser Therapy?

Raison d’être: Eliminate iatrogenic damage from conventional macular photocoagulation

Subliminal laser 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 laser is not accompanied by thermal retinal damage. This fact is of particular importance when a treatment near the fovea is required.

This laser method has been proven to be a safe and effective treatment option for macular pathologies such as central serous chorioretinopathy (CSC), diabetic macular edema (DME).

Which wavelength?

Photocoagulation relies on the absorption of light by various ocular pigments.

The three major ocular pigments are melanin, hemoglobin and xanthophyll, which have varying affinities for different wavelengths and occur in varying proportions throughout the retina.

Theoretically, the 577-nm yellow laser light provides peak absorption of oxyhemoglobin, excellent lesion visibility, low intraocular light scattering and pain, and negligible xanthophyll absorption1,2.

The yellow 577nm wavelength has been describedhttp://introduction-bibliography as the most versatile and safe wavelength3.

Graphics explaining 577nm wavelength absorption

What technology is used for Subliminal Laser Therapy?

SubLiminal laser therapy is a modern subthreshold laser treatment option that employs a custom­izable pattern grid selection and delivers treatment through a succession of short, microsecond-long pulses of laser.

This allows for cooling of the retinal pigment epithelium (RPE) between pulses, preventing a critical amount of heat from accumulating in the tissue and the consequential RPE and retinal scar­ring which we know to be unnecessary to attain a therapeutic response4 and to limit the possibilities for future retreatments.

What is subliminal laser therapy?

Clinical data

The Role of the New Generation of Lasers in Retina

Through the years, laser has evolved dramatically. Although intravitreal injections have become the first line of treatment of macular pathologies such as diabetic macular edema (DME), laser application within clinical settings continues to prove efficacious in macular conditions.

Vascular endothelial growth factor inhibition and proliferative diabetic retinopathy, a changing treatment paradigm?

Prior to the development of panretinal photocoagulation (PRP) in the 1970s, proliferative diabetic retinopathy (PDR) was the most common cause of blindness in diabetic patients. The diabetic retinopathy study demonstrated that PRP could decrease severe visual loss from PDR by 50%.

How new generation lasers are different from each other

Laser has changed a lot over the years, the newer laser can deliver energy in different ways, by reducing the duration to 10-20 ms, in a train of pulses of 0.1 ms as in the micropulse / subliminal laser, and extremely short duration of 0.0017 ms as in the nanosecond laser. Clinical studies have shown that micro­pulse laser is efficacious in multiple macular conditions.

Comparison of 577-nm Multispot and Standard Single-Spot Photocoagulation for Diabetic Retinopathy

To compare two different laser strategies of panretinal photocoagulation for diabetic retinopathy.

Laser Versus Anti-VEGF Injections

This case involves a 28-year-old man who has type 1 diabetes and severe nonproliferative diabetic retinopathy. I asked the patient to return for follow-up in 3 months. Two years later, the patient returned with early neovascularization of the disc (NVD) with 20/20 visual acuity (Figure 1). What are you going to do?

Why Consider the Yellow 577 nm Wavelength?

There are numerous reasons to use a laser when we are treating retinal disorders, and there are numerous lasers from which to choose. Most of us have experience with the green 532 nm lasers.

Clinical experience with Multispot yellow 577nm laser

Retinal laser photocoagulation has been the mainstay of treatment for various retinal and macular diseases for many years. In addition, the quest for better visual outcomes and the minimization of side effects has resulted in the development of new, improved photocoagulation systems.

A histological comparison of micropulse and standard laser treatment in threshold and sub-threshold modes

Laser photocoagulation is a common treatment for diabetic macular edema but not without side effects and can damage the neurosensory retina. Sub-threshold micropulse laser produces therapeutic effects without inducing detectable clinical visible changes.