BLOG: Long-term durability of MicroPulse laser treatment
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The topic of durability is more relevant now than it ever has been. There is more and more interest in durable therapies, whether it’s pharmacotherapy or adjuncts like laser.
There’s no question that the COVID-19 pandemic has radically changed how we interact with and treat our patients. We’ve had to totally rethink patient flow through our practices to reduce and prevent personal contact, while trying to offer the best possible treatment. But what happens when we can’t see our patients?
Missed appointments are unfortunately a growing concern. There is still a lot of uncertainty, anxiety and fear of exposure, especially among our patients with diabetes. Many of these patients have comorbidities that put them at a greater risk coming into the office. They’re missing one, two or even more appointments, and while their vision is deteriorating, they might not notice the change because they’re still functional. The progression is slow and insidious. Then they come back with worsening edema and capillary nonperfusion. So, while anti-VEGF injections have drastically improved our ability to treat our patients with diabetes, the missed follow-ups necessitate a reevaluation of available treatment options, their efficacy and now, even more importantly, their durability.
Conventional continuous-wave (CW) laser is effective for panretinal photocoagulation, and focal laser for diabetic macular edema is still a consideration. However, I don’t feel that traditional CW laser is an appropriate treatment for the majority of my patients with DME due to the inability to treat over the fovea. MicroPulse laser therapy (Iridex) offers a treatment solution that can be as durable as CW laser but without causing irreversible thermal damage to the cells and secondary vision loss. In my experience, combining MicroPulse laser and anti-VEGF injections is a therapy that can be more durable than anti-VEGF alone.
A young professional patient of mine with branch retinal vein occlusion and macular edema had been receiving monthly anti-VEGF injections over 2 years with great success. She was 20/20 with the treatments and happy with her vision, but making it to the monthly appointments was a burden due to the drive as well as taking time off work. We discussed MicroPulse laser therapy as a treatment option. After one MicroPulse session, utilizing a 532 nm green laser in a confluent pattern over the fovea, I didn’t need to treat her again for more than a year — either with pharmacotherapy or laser. She was able to extend her follow-up visits to once every 3 to 4 months, significantly reducing the treatment burden and improving her quality of life.
We know that not all treatment interventions — whether it be anti-VEGF or MicroPulse laser — work for every eye. However, in this current environment, we need to consider the use of all treatment options and adjunct therapies to achieve long-term durability to reduce our patients’ office visits. Even if a patient is doing well with injections, we don’t need to wait until those injections fail before we consider laser as an option. In my experience, MicroPulse can reduce the burden of intravitreal injections and therefore fewer office visits, which these days could be both life-changing and lifesaving for the patient.
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