BLOG: Following up after MicroPulse laser treatment
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With MicroPulse laser therapy, I aim to maximize treatment intervals and reduce office visits. I also want to keep a close eye on my patients. My follow-up protocol is a balance of these goals.
After treating patients for macular edema, I generally bring them back after a month. I think a lesser interval is too short because with MicroPulse (Iridex) you’re altering retinal pigment epithelium metabolism, so you have to change the underlying outflow pattern, and that just takes time.
I have had some “wow” moments when patients come in at that 1-month interval and they’re dry. They’re just bone dry, and they stay that way. That’s a win. But I don’t counsel my patients that this is the expectation.
Typically, what I see with my MicroPulse success patients is they have an interval improvement after a month. This is what I tell them to expect.
At that first follow-up visit, I monitor the patients for their overall functional outcomes. I check their vision. I want to know how their vision is functioning as they carry out daily activities. I also check how the patient has done historically because if there is a slight increase in their central foveal thickness or in their macular volume, but it’s blunted compared with previous pharmacologic treatment recurrences, that’s still a win.
If the patient is improving, I space out their visit and see them again in 2 months. I then use the same diagnostic paradigm. If they’re stable or improved, I schedule their next visit 3 months out.
I sometimes see continued improvement in MicroPulse patients even after 3 months. There are some eyes that just have more fluid. Those eyes may take longer to resorb. Some eyes will improve to a point and then just stay stable. Reduction of retinal thickness variability, as we are starting to see across disease spectrums, might actually be an even more important biomarker than just the presence of fluid.
Occasionally, I will repeat MicroPulse laser therapy in a patient who has shown some signs of benefit from their initial MicroPulse, but it’s incomplete at month 3. I do not repeat MicroPulse treatment for patients who look significantly worse.
At the 6-month visit, I usually repeat fluorescein angiography to make sure the patient’s macular leakage has improved. After that, I will continue to monitor them every 3 months to ensure stability in visual function and clinical biomarkers.
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