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For many years, ophthalmologists treated diabetic macular edema (DME) primarily with focal and grid laser thermal photocoagulation. With the advent of anti-VEGF therapy, the approach shifted dramatically, and laser therapy lost its place as a first-line treatment. Yet, as laser technology evolved—especially with the introduction of the subthreshold laser (STL)—we began to rediscover its potential.

Dr Wu explains the efficacy of the subthreshold laser for treating DME based on clinical studies and share 2 clinical cases for sharing his experience.

The question of whether to titrate in subthreshold laser treatments has sparked considerable debate among ophthalmologists and researchers. Titration—adjusting the laser’s power settings to gauge the treatment’s effectiveness—has been a common practice to prevent retinal damage.

When to use laser therapy, treatment guidelines, and why it matters.

A new front-line treatment

Laser photocoagulation can improve vision by promoting resorption of the drusen.

Many countries are unable to afford continuous unending intravitreal injections for macular diseases,” said Dr. Kenneth Fong. Building the case for the use of subthreshold laser (STL) treatment and its application for retinal diseases, Dr. Fong and two other vitreoretinal doctors presented at a symposium on behalf of The Subthreshold Ophthalmic Laser Society (SOLS) at the recently held CAKE & PIE Expo 2.0 in Da Nang, Vietnam.

Subthreshold laser therapy has been utilised in clinical practice for more than three decades, and numerous randomised and real-life studies has proven its efficacy and safety in various retinal diseases. However, despite decades of usage, we still do not have a standard protocol for subthreshold laser applications and settings.

Given the difficulty of obtaining verteporfin for chronic CSCR, it is worth considering subthreshold laser therapy as an alternative given its comparable efficacy and practical advantages. We know that the prognosis for this disease depends on the level of disease progression, so a therapeutic option that allows for an undelayed treatment is extremely interesting.

Diabetic macular edema (DME) is the leading cause of irreversible visual loss in the diabetic population. Laser plays a very important role in the treatment of DME despite the use of anti-VEGF agents, said Dr. Victor Chong, consultant ophthalmic surgeon at London Medical, United Kingdom, during a symposium at the recently held APAO 2021 Virtual.