Do you know what the best thing is about joining a new club or society? Sure, there’s discussion and debate to look forward to, and maybe even some cool activities to take part in (like the CAKE and PIE Expo). Above everything else though, is belonging to something and feeling like part of a family…
“Consider yourself at home. Consider yourself one of the family. It’s clear we’re going to get along.”
Now, we’re not suggesting that they should adopt the Oliver Twist musical number as their society anthem (or maybe we are), but congratulations to the Subthreshold Ophthalmic Laser Society (SOLS) on their launch! The organization’s debut event, a symposium on Do We Still Need Subthreshold Laser for Macular Diseases? was one of the standout events of the Expo’s first day. If you’re fascinated by all things laser, as well as ophthalmology, then this is the society for you.
Moderated by Drs. Kenneth Fong (Oasis Eye Specialists, Kuala Lumpur, Malaysia) and Victor Chong (Royal Free Hospital, London, England), the symposium began with Dr. Chong outlining his hopes for the society’s work. He said he hopes it will help change perceptions about how laser technology works and clear up misunderstandings. He added this is particularly important to improve awareness about best practices.
What is SOLS?
The first presenter, Dr. Lihteh Wu of the Asociados de Mácula Vitreo y Retina de Costa Rica in San Jose, gave an introduction to subthreshold lasers. He described their raison d’etre as eliminating iatrogenic damage from conventional macular photocoagulation. He also described the perfect subthreshold laser as being strong in three aspects: yellow wavelength, multispot technology and low duty cycle.
Moving on to treatment guidelines Dr. Wu said that large 160 µm spot sizes are used to increase the treatment area and ensure dense delivery of laser impact. He said that during subliminal laser treatment, no visible reduction should be observed and that there is no need to change power with different degrees of edema. The laser settings should be set at 160 µm spot size with a duty cycle of 5% and an exposure time of 0.2 seconds.
What conditions are best suited for laser?
Dr. Jay Chhablani at UPMC Pittsburgh (Pennsylvania) presented on central serous chorioretinopathy (CSR) and subthreshold lasers. He described the condition as a major vision threat to middle-aged men, with symptoms including blurred vision, positive scotoma and micropsia. Dr. Chhablani recommends using subthreshold lasers in early cases without previous treatment or where subfoveal leaks are present.
He discussed a case study of a 49-year-old man who was diagnosed with CSR with a central black spot in the left eye. After subthreshold laser was applied to the patient, he returned for a check-up after two months. His best corrected visual acuity (BCVA) in the left eye had improved from 20/25 to 20/20, and intraocular pressure (IOP) decreased from 19 to 15 mmHg, along with the alleviation of acute symptoms.
The last presenter was Dr. Alejandro Filloy Rius of the Rovira i Virgili University (Tarragona, Spain). He focused on using subliminal laser for diabetic macular edema (DME), stating that in most cases a “weak laser treatment’ is all that’s required.” The key to deciding between a weak or strong treatment process is guided by balancing the degree of the edema with cost.
Dr. Filloy Rius also elaborated on his treatment guidelines for DME, which should be optical coherence tomography (OCT) guided with a 5% duty cycle, 300-400 mw power titration, and 160 µm spots. He argued that patient selection is key and that “surface area and density are the cornerstones to a successful treatment.” He added that one should audit results as with any surgical procedure.
Editor’s Note: A version of this article was first published in Issue 2 of CAKE & PIE POST, C&PE 2021 Edition. The CAKE & PIE Expo 2021 was LIVE on June 18-19. All sessions are available on demand until July 19 at expo.mediamice.com upon login.
