Pain and accuracy of focal laser treatment for diabetic macular edema using a retinal navigated laser (Navilas®)

Abstract

AimTo investigate treatment-related pain and the accuracy of navigated laser photocoagulation in the treatment of clinically significant macular edema.MethodsFocal laser treatment of diabetic macular edema in 54 consecutive patients was digitally planned on fundus images and performed using the navigated laser photocoagulation system Navilas® (OD-OS GmbH, Teltow, Germany). Treatment-related pain was quantified on a visual analog scale directly after treatment and compared with a matched control group who received conventional laser treatment (n = 46). In addition, for Navilas-treated patients, the accuracy of spot placement on color images was analyzed 1 month after treatment.ResultsIn total, 5423 laser spots (mean 100 per eye) were analyzed. With navigated treatment, 90% of laser spots were visible on color images, of which 96% were within 100 μm from the target. Eighty percent of the laser spots were placed and visible within the 100 μm target on an intention-to-treat basis for color imaging. Optical coherence topography confirmed that laser effects were limited to the outer retina. Treatment-related pain following navigated laser photocoagulation was significantly lower than that of conventional laser treatment (1.6 vs 4.4 on a visual analog scale, P < 0.001).ConclusionNavigated laser effects could be visualized to a high percentage on post-treatment color images, and their location showed a high concordance to targeted areas. Patients reported that treatment-related pain following Navilas laser photocoagulation was significantly lower than pain following conventional laser treatment.

Combination of Navigated Macular Laser Photocoagulation and Anti-VEGF Therapy: Precise Treatment for Macular Edema under Dry Retinal Conditions

“…The uncertainty regarding the resulting size of the laser burn may lead to unfavorable visual acuity or visual field outcome and decreases controllability of the MLP performed in the presence of a retinal edema. Our results go well along with previous studies that demonstrated a higher laser spot application accuracy focal MLP for DME [14] and a higher rate of accuracy in focal MLP treatment of DME than standard manual-technique laser treatment [15]. However, the concordance between the size of actual laser burns and that of planned laser burns has not been investigated until now, and this aspect of MLP controllability and accuracy is more important in grid MLP than in focal MLP due to a higher number of laser burns applied to the retina.…”

Comparison of pain scores between patients undergoing panretinal photocoagulation using navigated or pattern scan laser systems

“…Consequently, patients usually report less pain, most probably because retinal sensitivity is better preserved as compared with pain in conservative approaches (9,17) . Recent studies have consistently shown that patients treated with either the PASCAL or NAVILAS laser system modalities experienced less pain as compared with those treated with conventional laser treatment modalities (9,10,17,22) . The reason why patients treated with the NAVILAS system experience less pain than those treated with the PASCAL system may in part be attributed to the fact that the former uses infrared light instead of the bright slit-lamp light used in the latter.…”

“…The pattern scan laser (PASCAL; Opti-Medica Corp., Santa Clara, California, USA) is a new generation semi-automatic and multi-shot photocoagulator, which uses either a single or predetermined pattern array with pulse durations as short as 10-30 ms (8,9) . Navigated laser pho tocoagulation (NAVILAS; OD-OS GmbH, Teltow, Germany) is another novel computer-based double-frequency ND:YAG laser photocoagulation system (532 nm), which, apart from offering retina navigation, has similar technical specifications as PASCAL (single or prede- termined pattern array, 10-30-ms pulse duration) (10,11) . Compared with conventional lasers, both modalities use shorter laser pulses, cause relatively less thermal damage to adjacent retinal tissues and are therefore possible to produce relatively less painful photocoagulation.…”

NAVILAS Laser System Focal Laser Treatment for Diabetic Macular Edema - One Year Results of a Case Series

“…The NAVILAS system has been shown to have both a high degree of safety and combines the advantages of computerized precision and accuracy to efficiently perform focal retinal laser therapy [4-7,10,11]. Traditional focal laser therapy requires a contact lens, topical anesthesia, and the patient’s cooperation to fixate for the treatment period.…”