Subliminal laser therapy application on macula

A macular treatment

SubLiminal laser therapy is currently most commonly used in cases of retinal vascular diseases with macular edema, such as diabetic macular edema (DME) or central serous chorioretinopathy (CSR).

Other macular pathologies can also be considered like macular edema secondary to branch retinal vein occlusion (BRVO) or polypoidal choroidal vasculopathy (PCV).

Treatment guidelines

SubLiminal laser therapy is a method of delivering laser energy to the retina, producing a bio-stimulation effect, while minimizing permanent thermal damage to the retinal tissue.  The concept involves delivery of a “train” of laser pulses, each pulse separated by sufficient time to allow heat dissipation and reduce permanent damage to the retina. Unlike conventional macular laser treatment, there is no visible scarring on clinical examination, OCT or angiogram.

Refer below to the recommended SubLiminal laser treatment guidelines prepared by Victor Chong, MD (UK).

Retina Treatment: Subliminal Treatment Procedure

25/02/2021
Retina Treatment: Subliminal Treatment Procedure by Victor CHONG, MD (UK), Royal Free London NHS Foundation Trust, Optegra Eye Hospital, Central London

Basic Principles of MicroPulse Lasers

20/11/2015
To understand MicroPulse laser technology, we must first understand conventional photocoagulation. In the latter, the laser beam is constantly “on” and its energy is absorbed by pigmented structures.
Easyret Mozart in its full configuration for subliminal laser therapy

Clinical data

Central Serous Chorioretinopathy (CSC)

Central serous chorioretinopathy (CSC) is one of the most common retinal causes of vision loss. It is characterized by serous detachment of the neurosensory retina secondary to one or more focal lesions of the retinal pigment epithelium (RPE)1. This pathology ranks among the most common vision-threatening retinopathies after AMD, diabetic retinopathy and branch retinal vein occlusion2.

In acute CSC, the detachment is caused by a focal leak in the RPE. It usually resolves spontaneously within a few weeks3. However, chronic CSC can lead to permanent structural damage and often pronounced loss of central vision456.

Different treatment options are available, but there is no “gold standard” treatment for chronic CSC7:

  • Traditional thermal photocoagulation can be used for extrafoveal leakages, but it is destructive and can lead to symptomatic scotomas and choroidal neovascularization.
  • PDT laser therapy can also be used, however, even when using reduced treatment settings; it has also number of side effects such as RPE atrophy, choroidal neovascularization, choriocapillaris ischemia, and transient reduction of macular function.
  • Yellow 577nm SubLiminal® laser therapy seems to be a promising alternative treatment strategy8.
Chronic Central Serous Chorioretinopathy

Images courtesy of Alejandro Filloy Rius, MD. Ph.D
Tarragona, Spain

SubLiminal Laser Therapy for CSC

25/08/2021
Central serous chorioretinopathy (CSC) is a common posterior pole disease with a high recurrence rate and etiology. Its pathogenesis is ambiguous; however, it is characterized by the decompensation of the retinal pigment epithelium (RPE) and usually results in serous detachment of neuroretina, serous pigment epithelium detachment (PED), and RPE atrophy.

Safe and Effective Laser Therapies: Targeting Retinal Diseases Amidst COVID-19

28/09/2020
In this time of uncertainty, one thing is certain (at least in ophthalmology): Retinal pathologies are not going anywhere. In fact, chronic conditions like age-related macular degeneration (AMD) and diabetic retinopathy (DR) are thought to be causing more concerns during this period of worldwide lockdown and social distancing.

The Role of the New Generation of Lasers in Retina

15/03/2020
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.

Efficacy and safety of subthreshold micropulse laser compared with threshold conventional laser in CSC

05/11/2019
To compare the efficacy and safety of subthreshold micropulse laser (SML) with threshold conventional laser (TCL) in central serous chorioretinopathy (CSC).

Lessons Learned: SubLiminal Laser Therapy for Chronic CSC

15/04/2019
The chronic form of central serous chorioretinopathy (CCSC) is a common form of macular disease and can be characterized by vision loss as well as a decrease in contrast sensitivity and reading speed due to prolonged serous detachment of the neurosensory retina.

Micropulse Laser Treatment of Retinal Diseases

13/02/2019
Subthreshold micropulse laser treatment has been intensively used for selected retinal diseases in the last decade; however, the exact mechanism of the action of lasers in the subthreshold micropulse mode is not yet fully understood.

A pilot prospective study of 577-nm yellow subthreshold micropulse laser treatment with two different power settings for acute CSC

14/01/2019
To compare the efficacy of 50%threshold power with 25%threshold power of 577-nm subthreshold micropulse laser (SMPL) for acute central serous chorioretinopathy (CSC). Prospective, interventional, non-randomized, comparative case series. A total of 54 patients (54 eyes) with acute CSC were enrolled.

Yellow (577 nm) micropulse laser versus half-dose verteporfin photodynamic therapy in eyes with CCSC

05/11/2018
To compare the functional and anatomical outcomes of eyes with chronic central serous chorioretinopathy treated with yellow micropulse (MP) laser versus half-dose verteporfin photodynamic therapy (PDT).

SubLiminal Laser Therapy for Central Serous Chorioretinopathy

15/09/2018
Central Serous Chorioretinopathy (CSC) is a challenging disease with causes that are still not fully understood. Occurring most often in young and middle-aged adults, CSC can present itself as an acute, yet temporary, loss of vision, or can become a chronic recurring disease.

Visual outcomes and anatomic changes after sub-threshold micropulse yellow laser treatment for CCSC

05/01/2018
To analyze the long-term efficacy of 577 nm sub-threshold micropulse yellow laser (SMYL) in the treatment of chronic central serous chorioretinopathy (CCSC) and to evaluate the anatomic outcome, visual results and safety profile of the treatment.

Subthreshold micropulse laser treatment-a procedure to resolve subretinal fluid in chronic central serous chorioretinopathy

05/10/2017
Chronic central serous chorioretinopathy is a serious therapeutic problem, as it may lead to significant visual impairment. To date, various invasive and non-invasive treatment methods have been tried with only moderate success.

A Review of Subthreshold Micropulse Laser for Treatment of Macular Disorders

24/05/2017
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.

SubLiminal Subthreshold Laser Versus Photodynamic Therapy

15/05/2017
I was part of the Pan American Collaborative Retina Study (PACORES) that compared yellow SubLiminal laser with photodynamic therapy (PDT) in eyes with chronic central serous chorioretinopathy (CSCR) (unpublished data).

Introduction to MicroPulse for Central Serous Chorioretinopathy

15/01/2017
I would like to introduce you to the principle of MicroPulse laser therapy. To understand MicroPulse laser technology, we must first understand conventional photocoagulation. With conventional photocoagulation, the laser transfers energy to the retina.

Comparison of subthreshold micropulse laser treatment and half-dose photodynamic therapy in patients with chronic CSC

25/08/2016
To compare the short-term treatment outcome of the 577 nm subthreshold micropulse laser (SML) and half-dose photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (cCSC) and persistent subretinal fluid (SRF).

Low-Fluence Photodynamic Therapy versus Subthreshold Micropulse Yellow Wavelength Laser in the Treatment of CCSC

05/08/2016
To compare the efficacy and safety of subthreshold micropulse yellow wavelength laser (SMYL) and low-fluence photodynamic therapy (PDT) in the treatment of chronic central serous chorioretinopathy (CSC).

Comparison of subthreshold micropulse laser (577nm) treatment and half-dose photodynamic therapy in patients with CCSC

08/07/2016
To compare the short-term treatment outcome of the 577 nm subthreshold micropulse laser (SML) and half-dose photodynamic therapy (PDT) in patients with chronic central serous chorioretinopathy (cCSC) and persistent subretinal fluid (SRF).

Subthreshold Micropulse Laser (577 nm) Treatment in Chronic Central Serous Chorioretinopathy

26/09/2015
Central serous chorioretinopathy (CSC) is characterized by vision loss due to a serous detachment of the neurosensory retina. Clinical evidence from multimodal imaging, such as choroidal congestion and thickening and hyperpermeability of the choroid...

Physicians

Talk about Subliminal
Laser Therapy

Lihteh Wu
Dr Lihteh Wu
Physicians' operating place
San Jose, Costa Rica
In the CSCR PACORES study, both the half-dose PDT and the yellow SubLiminal laser were effective in restoring the macular anatomy in eyes with chronic CSCR. It appears, though, that yellow SubLiminal laser had a more beneficial effect in visual acuity than half-dose PDT.
Victor Chong
Dr Victor Chong
Physicians' operating place
London, United Kingdom
What we know today about SubLiminal laser therapy encourages us to move away from using conventional laser for macular treatment. In my experience, SubLiminal laser treatment is best suited for CSR, non-central DME, and as an adjunct for center involved DME.
Lebriz Altay
Dr Lebriz Altay
Physicians' operating place
Köln, Germany
The use of SubLiminal laser therapy is a safe alternative for the treatment of chronic CSC. It that can be repeated as needed to treat the areas of choroidal hyperpermeability, especially in cases where PDT is contraindicated or not available.
Alejandro-Filloy
Dr Alejandro Filloy Rius
Physicians' operating place
Tarragona, Spain
I have been using the Easyret 577nm SubLiminal laser for over 4 years, and it has been an exciting journey. SubLiminal laser therapy is an advanced subthreshold technology and an excellent therapeutic tool to treat DME patients and decrease the burden of monthly visits and costly injections.
Kenneth Fong
Dr Kenneth Fong
Physicians' operating place
Kuala Lumpur, Malaysia
DME is a huge burden to our health care system. In the part of the world where I practice, it is not feasible to do monthly anti-VEGF injections for our patients. The SubLiminal laser therapy is a safe and effective option. It can reduce the treatment burden of injections, and now that we have the latest machines with upgraded software combining Multispot and SubLiminal technologies all in one, we are experiencing a very exciting era in retinal laser therapy.

Bibliography