Photocoagulation in diabetic retinopathy: II. Methodology.

There is now evidence from clinical trials that patients with diabetic retinopathy have their visual lives prolonged by photocoagulation. However, the exact indications for treatment have not yet been established and are undergoing continuous reevaluation. For many years, the presence of fibrous tissue either on the optic disc or the retina was considered to be a contraindication to treatment. However, recently treatment has been possible using gentle photocoagulation. It is hoped that over the next few years the exact indications for treatment will be established. It may be found in the future that the treatment of patients with maculopathy by panretinal photocoagulation and focal treatment and similarly patients with a few peripheral new vessels, by panretinal photocoagulation may prevent further progression and remove the necessity for treatment. It is important to limit as much as possible the number of visits to the opththalmologist that the patient must make. It is therefore important to establish a technique that requires as few treatment sessions as possible. Ultimately, follow up should be done by the well trained physician. The difficulty with the development of this type of technique is that diabetic retinopathy is a progressive disease and therefore new abnormal areas may well develop in patients who have had seemingly adequate treatment. Also, relatively mild background retinopathy or maculopathy may progress ultimately to proliferative retinopathy. However, with improvements in technique and establishment of safe treatment regimens, the goal of single treatment may be achieved.