This 57YO man presented on 5/26/22 with asymptomatic diabetic macular edema (DME) in his left eye. Vision was 20/20.
Extensive lipid exudates with associated macular thickening were noted in the temporal macula. A gentle thermal laser was applied to the leaking vessels.
One year later, vision remains at 20/20, with total resolution of all lipid and DME.
Learning Points:
Beginning in the 1970s, macular laser was the gold standard for treating DME. In the early to mid-2000s, a perfect storm brewed with the advent of OCT technology and intravitreal injections. Unlike lasers, which take many months to work and rarely significantly improve vision, intravitreal injections cause a rapid and dramatic improvement in vision, making them the mainstay for treating DME ever since.
Clinically significant macular edema (CSME) is now an outdated term, as we are more concerned with whether the edema is central (central involved, CI-DME) or non-central (NCI-DME). Eyes with CI-DME are usually best treated with injections for superior visual outcomes.
However, our patient exemplifies why macular laser still has a place in any retinal surgeon’s toolbox, and should be considered a viable option for treating NCI-DME and even CI-DME when the leaking microaneurysms are outside the foveal avascular zone (FAZ).
In our practice, macular laser remains the initial treatment for eyes with NCI-DME. When applied gently with small, low-power, and short-duration applications well outside the FAZ, patients rarely, if ever, experience scotoma. Both the treatment burden and the financial costs to society are dramatically less. And there is no risk for endophthalmitis.
Although the role of thermal laser for treating DME is currently a source of debate (see Eye 2022;36:485-486 and Eye 2022;36:483-484 for great pro-laser and anti- laser editorials) we are not sure what all the fuss is about. Old-fashioned lasers work and, in our opinion, are incredibly under-utilized.
