Public health benefits of the Navilas® 577s laser
Robin D. Ross, MD, MPH, CPH, Global Retina Institute, Arizona, US
Dr. Robin Ross has more than 20 years of experience in practicing ophthalmology. She is running her own private practice, Global Retina Institute, in the Phoenix area in Arizona, USA. Ten years ago, she and her husband founded the non-profit organization, Red Rover Ventures.
Dr. Ross is engaged in multiple projects which seek to improve access to eye care locally and globally. She is also pursuing this work as a Director of Global Outreach at the University of Arizona College of Medicine in Phoenix. Read more about Dr. Ross’ work in this article: http://retinatoday.com/2018/06/many-mountains-to-climb
The Navilas® laser system is like going from a Model T to a self-driving Ferrari with a number of treatment permutations that benefit patients of diverse retinal pathologies.
In one case, I placed over 1,700 spots for PDR treatment and the patient reported no discomfort and promised to return for additional treatment. This was significant because the patient had a history of non-compliance for appointments elsewhere due to the pain from previous laser treatments.
With Navilas®, it was also the first time in my 20+ years career that I had a full PRP in one eye, while the patient graded the pain as a “1” (on a 10-point scale) and asked to have the other eye treated the same day.
The diminished pain experience with Navilas improves the odds of follow-up within our patient population which greatly enhances our chances of saving sight.
We had another patient who had multiple retinal holes in the far periphery. She was treated by LIO previously. This patient had been very uncomfortable with this treatment, ultimately requiring subconjunctival lidocaine. So when her other eye needed treatment, we switched to the navigated laser. After finishing the treatment on Navilas® she asked “is that it?”, and was surprised at how comfortable she was throughout the treatment.
My prior laser was a PASCAL pattern laser and I feel the pain threshold is significantly less with the Navilas® than with the PASCAL. Navilas® permits treatment under infrared, allows for protection of areas where you don’t want treatment, and the pre-planning with eye tracking actually speeds up treatment.
Also, some of our monocular patients who we successfully treated with Navilas® would not have tolerated conventional laser. In these patients, we would have opted for intravitreal injections and deferred conventional focal laser because of the worry we might place inadvertent laser proximal to the fovea. But the “caution zone” of the Navilas combined with the eye tracking protects the fovea and optic nerve. Also focal and microsecond pulsing can be combined in one treatment depending on the edema.
Our team really feels like with Navilas®, we give people a “fighting chance” at saving sight – especially for patients who are already monocular.
We recently were asked to see a group of uninsured patients with advanced diabetic retinopathy age under 55 who were Lost to Follow-up (LTFU).
Recent work by Obeid et al focuses on “real world experience” among LTFU patients with PDR, which maybe as high as 25% [1].
This work also highlights the disparity across race and income.
PRP maybe a real treatment consideration for loss to follow-up – especially among high-risk groups. Unfortunately, the working poor can’t afford to come back for monthly intravitreal injections and this may impact outcomes.[2]
The comfortable PRP experience with Navilas may close the gap the US healthcare system has not effectively bridged yet. We were able to see first-hand the potential public health benefits of the Navilas® OD-OS system.
We always say, “vision is more than eyesight” and Navilas® should be commended for their forward thinking vision.
1. Obeid, A., Gao, X., Ali, F. S., Talcott, K. E., Aderman, C. M., Hyman, L., Ho, A.C., Hsu, J. (2018). Loss to Follow-Up in Patients with Proliferative Diabetic Retinopathy after Panretinal Photocoagulation or Intravitreal Anti-VEGF Injections. Ophthalmology, 125(9), 1386-1392.
2. Obeid, A., Su, D., Patel, S., Uhr, J., Borkar, D., Gao, X., Fineman, M., Regillo, C.D., Maguire J.I., Garg S.J., Hsu, J. (2018). Outcomes of Eyes Lost to Follow-up with Proliferative Diabetic Retinopathy That Received Panretinal Photocoagulation verus Intravitreal Anti-Vascular Endothelial Growth Factor. Ophthalmology, 1-7.
Related publications and webinars
- The treatment strategy and selected parameters presented in content listed here are solely the responsibility of the treating ophthalmologist, who is required to be familiar with the most recent literature/guidelines or recommendations, as well as with the usage of the Navilas Laser System according to the current Operator’s Manual.