Laser Treatment

What to Expect

Modern retinal surgery has benefited enormously from the introduction of laser treatments. The vast majority of applications to retinal surgery involve the use of lasers, which produce visible light. The wavelength, power, and duration of light used depends upon the nature of the tissue to be treated.

1. The Welding Mode: Retinal tears and small retinal detachments are treated by welding the retina to the underlying tissue to prevent retinal detachment. Thermal spot welding is used to completely surround a lesion to prevent leakage of fluid under the retina.

2. The Destructive or Coagulation Tissue Mode: Using the thermal energy of the laser to scar tissue such as aneurysms, leaking blood vessels, or tumors. Laser treatment is placed over and around these lesions to stop them from bleeding, leaking, or growing.

3. The Activation Mode: A non-burning or "cold laser" can be used to activate a special chemical dye that will shut down scar tissue development. This is done in treatments such as photodynamic therapy for macular degeneration or central serous chorioretinopathy.

In treating the eye, two laser light delivery systems are available. In one, a small lens is placed directly on the eye after the eye has been anesthetized with a drop. The patient sits up with their head in the chin rest of the microscope. The doctor can then treat the eye, delivering the laser through the lens with magnification. An aiming beam is used for precise control of the treatment. In the other system, the laser light is directed into the eye from the doctor's head light apparatus while the patient is lying down. Again, an aiming beam is used for precise placement of the laser spot. During the treatment, the patient is aware of a very short flash of light. Often this is the only sensation the patient feels. Occasionally, treatment has to be close to one of the very few sensory nerves hidden behind the retina, and the result is the sensation of an ache or a twinge. For larger laser treatments such as those given to patients with proliferative diabetic retinopathy, patients may rarely develop a low-grade headache following the treatment. This is usually best treated with a couple of Tylenol and rest. The need to anesthetize the eye, other than with a drop of a topical numbing agent, is extremely rare. However, very sensitive patients may be given medication for the relaxation of tension or discomfort.

Following treatment, the eye may have mild irritation and pinkness for 24 hours. Younger patients, or those who require a fair amount of laser treatment, may have a heavy sensation or an unusual awareness of their eye over the next 3 to 10 days. When new floaters appear in the eye prior to the treatment, they may be expected to remain following it. They will gradually evolve and resolve over weeks and months, as is their nature. Lasers do not cure floaters. Patients should report unusual pain, redness, swelling, or discharge in the days after treatment. New floaters or newly appearing flashes of light (usually with eye movements) should also be reported.