Experiences from a Retina Practice in Hawaii: Managing a Special Patient Population
Dr. Marc Tafoya runs a retina specialty practice in Waipahu, Hawaii. In this interview, he explains why his treatment regimen needs to be very efficient and durable, and how navigated laser therapy helps improve the care he offers.
Dr. Tafoya, your practice in Waipahu, Hawaii, is a bit different due to its patient population. Can you please describe why your patients are special and how you manage this population in your daily routine?
In my retina specialty practice I have several patients from remote islands, which include Samoa, Tonga, Marshall islands and Micronesia in the South Pacific with no dedicated retina care. These patients usually present with very severe forms of diabetic retinopathies.
Due to their lack of retina care they come to Hawaii for a relatively small amount of time to visit their families and get their treatment. Afterwards, I may not see them for a longer time, maybe three months, sometimes up to two years. I do laser, injections and surgeries but in the end, my treatment regimen needs to be very efficient and I need to offer a durable solution.
How does navigated laser therapy help you improve the care you offer your patients? How do you manage injections vs. laser treatments?
Especially for the patients from the islands, I try to do as much laser as I can: Pan-retinal treatments to prevent retinal detachments, but also focal laser to help maintain the benefit of injections received.
So first, I do as much PRP as possible. Next visit, they get an injection. Sometimes – in case of a longer stay of the patient – I can apply a second or third injection, before they get a focal laser treatment to stabilize their vision.
With the Navilas® 577s navigated retina laser which I am using, it is easier to have more laser treatments in a short amount of time. Patients feel more comfortable than with my old 532nm laser. And pre-planning lets me perform work faster. So I can do as much laser spots as possible in one session.
For focal applications, I appreciate the accuracy of the navigated system, because it helps me manage aneurysms that are actually very close to the fovea. Often, closing just one leaking microaneurysm stabilizes the edema which might otherwise increase during the long interval before the next injection.
Do you incorporate subthreshold treatment with microsecond pulsing in the management of your patients?
Yes, I do. The microsecond pulsing (MSP) options were another reason why I decided to work with navigated laser. MSP helps me manage diffuse edema by importing the Fluorescein angiography and then treating the affected areas in MSP subthreshold mode.
With the all-digital Navilas® laser, I can document those MSP treatments to better understand the long-term effect. I do a combination of traditional focal burns for microaneurysms and MSP for diffuse areas or areas too close to the fovea. The closer I get to the fovea, the more I tend to use subthreshold treatment parameters.
Based on my short term experience, I would estimate a positive reaction to MSP treatment in roughly 50%-60% of the chronic, recurring DME patients, while I am still refining the ideal settings for even better response.
You have mentioned benefits for you and your team.
Do your patients consciously take notice of the advantages of the navigated laser system?
Yes, definitely. They really appreciate the comfort, and they were curious to see this modern laser. For some I had done one eye with the old laser, the other with the new laser and they said “I wish I would have had the new treatment for the other eye as well”.
Many patients found that treatment with the old laser was unbearable. They were afraid of the old laser. Now with the computer-guided laser, I just did 3 PRPs this afternoon before talking to you. In one PRP, I did 3200 spots and the patient said she had no pain, “it rather felt like a massage”.
You can contact Dr. Tafoya at: