So I had a theory about a new subtheshold laser therapy they are using for DME as a potential for prevention at a severe NPDR stage: Yeah I know... translation please?... laser that does not cause collateral damage because it works on faster and lower wavelengths which does not cause the underlying Photoreceptors to be destroyed to save central vision by creating oxygen need balance. So I sent this question out to a few key people in the field. Got this response... though not the one I was hoping for: The funny thing was I got all three Drs to be ccing each other discussing the potential for this. It seems it really comes down to funding and the thought that traditional PRP would still work better. Was nice to be taken seriously enough with the question I had for them all to respond and take it into consideration. So for now DME is the only thing Micropulse can treat. Sorry kids.
You have raised a relevant and fascinating question, but I don't know the answer to it. If the mechanism by which conventional laser photocoagulation induces regression of DME is the same as the mechanism by which it induces PDR regression, then perhaps the same would be true for subthreshold micropulse laser. However, I am not sure that hypothesis is correct. There is some evidence (from the Pascal laser) that the intensity of conventional laser treatment might be important in inducing regression of PDR. If that were true, I would not be optimistic about using subthreshold to treat or prophylax PDR development. That question is probably best answered by a clinical study. I'm copying Drs. Chong and Midena on this reply to see if they have a comment.
-Dr Zarbin PHD