Retina laser

What is a retina laser?

In principle, a laser is a very strongly concentrated source of light that, depending on physical properties, triggers a certain effect when it hits tissue. In the case of the retina laser, the laser penetrates the anterior sections of the eye without having an effect. When it reaches the retina, it has a primarily thermal reaction. This leads to a(n) (intentional) burning effect. In the case of microsecond pulsing laser therapy, in which the laser beam is pulsed very briefly onto the retina, the tissue is "heated", but not burned.

How do retina lasers differ?

Broadly speaking, there are two types of retina lasers – the conventional, slit lamp based laser, and the modern, navigated Navilas® laser system. Both types of laser systems primarily differ in terms of the type of application – i.e. how precisely the laser is positioned on the retina.

Conventional slit lamp laser

Patientin an der Spaltlampe - shutterstock

The conventional slit lamp laser has been used on the retina since around 1965. After initial experiments with sunlight, lasers have been used as a source of light for treatment. Because ophthalmologists already own slit lamps – they are used as a diagnostic tool – it’s easy for them to use it for this new application. Despite numerous further developments on the effectiveness of the laser itself, the application concept with the slit lamp has always remained the same.

Treatments with the conventional slit lamp laser

Advantages of the conventional laser:

Very long tradition of use
Cost-effective system
Popular

Disadvantages:

Limited field of view through slit lamp
Manual control without advanced planning
No digital documentation

Navigated Navilas® Laser System

These days, we could scarcely do without the navigation and assistance systems in cars which bring us reliably and safely to our destination. This technology has also found a place in ophthalmology, for example to correct defective vision. To date, the Navilas® Laser System is the only laser system to facilitate more precise and secure application than conventional systems, thanks to modern eye-tracking technology.

Treatment with the navigated Navilas® laser

Advantages of the Navilas® Laser System:

Excellent precision and safety¹
More comfortable and less painful than conventional lasers^{2. 6}
Fewer subsequent treatments^{3 ,4, 5}

Disadvantages:

Higher costs for advanced technology

What effect does the laser have on the retina?

A retina laser system concentrates the light on the retina – at a point that normally only measures a tenth of a millimeter. This heats the tissue at this spot, and leads to coagulation of the protein components. The tissue “burns.” This burning, known as coagulation can positively affect the course of a retinal disease. For one, this re-seals leaking vessels. In addition, it inactivates diseased areas that no longer receive circulation. Both of these things lead to an improvement in the supply to still-functioning areas of the retina, and therefore to its preservation. In addition, it is assumed that this “burning” triggers the production of messenger substances, which has a positive impact on the healing of the disease itself.

Forms of laser therapy

Different forms of retinal laser treatment are used depending on the retinal disease in question. The treating doctor makes the decision based on the stage and cause of the disease.

Focal laser therapy

Focal laser therapy is generally used for swelling of the macula, known as macular edema. Leaking vessels near the location of sharpest vision are sealed up in a very targeted way. At the same time, the targeted sealing of vision cells increases the activity of the pigment layer, which leads to a reduction in macular swelling.

With this treatment, the eye-tracking and navigation only available with the Navilas® laser system leads to:

Great safety by protecting sensitive areas¹
Fewer subsequent laser treatments through more thorough planning^3 ,4, 5
Less painful use due to no need of using treatment contact lenses²

Panretinal laser treatment

Panretinal laser coagulation is carried out on the fringes of the field of view. The number of photoreceptor cells is reduced in an even manner. For one thing, this leads to a decrease in the need for oxygen. In addition, the resulting scarring of the retina activates messenger substances, which reduces the growth of diseased vessels

The Navilas® Laser System has a pre-planning mode and an adhoc pattern mode, in which short laser pulses are applied to the retina in very rapid succession, thus minimizing the sensation of pain as well as the time required.

In this form of treatment, the eye-tracking and navigation technology only available with the Navilas® Laser System leads to:

Less pain⁶
Shorter treatment time⁶

Tissue-sparing therapy

In a new procedure, which is called microsecond pulsing therapy, the laser beam is applied in repeated, short pulses of less than one thousandth of a second. This warms the tissue, but it cools again in the pause between the laser pulses. In certain diseases, this can start the healing process without demonstrably damaging the tissue. This procedure therefore exploits the positive effect of the laser without destroying photoreceptors (vision cells). Your doctor can explain to you whether navigated microsecond pulsing therapy could be a potential, gentle option for you.

The eye-tracking and navigation technology – only available with the Navilas® Laser System – results in:

Transparent treatment documentation
Complete treatment planning
No need to use treatment contact lenses

What are the risks of laser treatment?

In conventional laser treatment, the effect is always achieved through the destruction of a small area and therefore always leads to the impairment of small areas of the retina. In general, this is not consciously perceived by the patient, as the damaged parts of the retina usually only have a small diameter of approx. 0.1 mm. In certain cases, vision may deteriorate, however.

Many patients find it uncomfortable to put on a special contact lens for laser treatment. Sometimes, this treatment contact lens can cause pain after the treatment. However, this generally subsides relatively quickly. Nevertheless, the treatment duration and the glare of the laser can lead to unpleasant sensations for the patient. Very rarely, bleeding and an increase in intraocular pressure may occur.

Find out how the Navilas® Laser System reduces these risks.

Reference studies

Clinical Evaluation and Treatment Accuracy in Diabetic Macular Edema Using Navigated Laser Photocoagulator NAVILAS. Kozak I, Oster SF, Cortes MA, Dowell D, Hartmann K, Kim JS, Freeman WR. Ophthalmology. 2011 Jan 24
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Pain and accuracy of focal laser treatment for diabetic macular edema using a retinal navigated laser (Navilas). Kernt M, CheuteuRE, Cserhati S, Seidensticker F, Liegl RG, Lang J, Haritoglou C, Kampik A, Ulbig MW, Neubauer AS. Clin Ophthalmol. 2012;06:289-96
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Navigated macular laser decreases retreatment rate for diabetic macular edema: a comparision with conventional macular laser. Neubauer AS, Langer J, Wolf J, Kozak I, Seidensticker F, Ulbig M, Freeman WR, Kampik A, Kernt M. Clin Ophthalmol. 2013:121-128
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From Art to Science in DME Treatment A comparison of anatomical outcomes following navigated OCT-based laser and conventional focal laser treatments.ANG LI, BA • RUMNEEK BEDI, BA • RISHI P. SINGH, MD.
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Comparative evaluation of combined navigated laser photocoagulation and intravitreal ranibizumab in the treatment of diabetic macular edema. Liegl R, Langer J, Seidensticker F, Reznicek L, Haritoglou C, Ulbig MW, Neubauer AS, Kampik A, Kernt M. PLoS One. 2014 Dec 26;9(12)
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Comparison of pain scores between patients undergoing panretinal photocoagulation usingnavigated or pattern scan laser systems. Inan UU, Polat O, Inan S, Yigit S, Baysal Z. Arq Bras Oftalmol. 2016 Feb;79(1):15-8. doi: 10.5935/0004-2749.20160006.
Read more

"The Navilas laser achieves an excellent precision. Facing the increase importance of microsecond pulse laser, the strength of a detailed documentation of every single laser spot is a huge advantage. My patients highly appreciate the comfort of a contact-free laser treatment."

Prof. Dr. Focke Ziemssen, University Eye Hospital Tübingen