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New technologies deliver laser treatment for DME
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WAILEA, Hawaii — Laser still plays a critical role in treatment of diabetic macular edema, and there is a “proliferation of new devices out there to deliver subthreshold laser,” Elias Reichel, MD, told colleagues at Retina 2018.
“Laser still has an effect in treating diabetic macular edema,” Reichel said.
In the DRCR.net Protocol I trial, vision continued to improve to about a line of vision over 2 years in patients who received laser alone, and in patients who received ranibizumab with deferred laser, visual acuity increased relative to those who received ranibizumab with prompt laser or triamcinolone. In Protocol T, there was significant use of conventional laser when it was thought that the effect of anti-VEGF treatment was not sufficient.
“I have to caution you that alternative laser technologies, meaning subthreshold laser technologies ... were not evaluated in any of these clinical trials,” he said. Subthreshold laser is a different type of laser and includes all types of laser therapy that show no signs of damage to the examiner.
The new subthreshold technologies include micropulse, continuous wave endpoint management and microbubble disruption therapy.
“Micropulse is the only therapy that supports treatment through the fovea [for diabetic macular edema],” Reichel said. “Endpoint management avoids the fovea and microbubble therapy avoids the fovea as well.”
For all, the wavelength is typically in the green to yellow range and the pulse duration depends on the technology, ranging from the nanosecond level to the millisecond level, Reichel said. Many of the technologies have patterns, but the microbubble technology does not yet have an FDA-approved pattern, he said.
Iridex, Quantel and Lumenis all have micropulse products, Topcon has an endpoint management product, and Ellex and Lutronic have microbubble platforms.
“There are no clinical trials that show noninferiority or superiority to conventional laser with any of these technologies,” he said. – by Patricia Nale, ELS
Reference:
Reichel E. Subthreshold laser therapies for DME. Presented at: Retina 2018; Jan. 14-19, 2018; Wailea, Hawaii.
Disclosure: Reichel reports he is a consultant for and has equity interest in Lutronic and is a consultant for Iridex, Lumenis, Regeneron and Genentech.