DME is one of the most common causes of sight-threatening retinopathy for people with diabetes, which currently affects more than 30 million people worldwide. As the prevalence of diabetes and vision diseases related to diabetes continues to rise, so does the burden it creates on health care systems.
Treatment options for DME vary as we continue to learn more about its pathogenesis and molecular pathways. These new insights have led to innovative clinical trials where we’ve learned a significant amount about different treatment protocols.
According to the results from the Early Treatment Diabetic Retinopathy Study (ETDRS), the research group led to laser photocoagulation becoming the initial mainstay treatment for DME. In order to treat DME, corticosteroids, anti-VEGF therapy injections, laser therapies, and several combinations had been introduced to the industry until this date.
As far as developing an appropriate treatment response is concerned, SubLiminal laser therapy is becoming increasingly relevant.
The subthreshold laser that employs a customizable pattern grid selection and delivers treatment through a succession of short, microsecond-long pulses of a laser instead of the usual “continuous” beam of a conventional laser.
Then this enables for cooling of the retinal pigment epithelium (RPE) between pulses, preventing a critical amount of heat from accumulating in the tissue and the consequential RPE and retinal scarring which we know to be unnecessary to attain a therapeutic response and to limit the possibilities for future retreatments.
Repeatability and safety are the two leading advantages of treating DME with subthreshold SubLiminal laser therapy versus conventional laser. SubLiminal laser therapy also enables to be physicians less dependent on intravitreal therapy.
In every sense of the word, SubLiminal laser therapy is a strong option for patients with mild to moderate exudative/inflammatory edema, saving injections and associated risks and costs, as well as decreasing the number of visits.
Concerning the application technique, the learning curve is relatively flat compared to conventional macular laser. Particular considerations involve the treatment of large areas to stimulate a significant response from the targeted RPE cells. To treat these areas densely and avoid leaving “blank spaces,” the goal is to recruit every cell in the treatment area to “work for you.”
It is important to note that insufficient spots have been identified as the number one cause for treatment failure. When treating DME with SubLiminal laser therapy the OCT thickness map should guide your treatment area. The power to use in each patient should be individually titrated for efficacy and safety purposes.
Through the local treatment of DME, Steroids are the most powerful tool available but they also cost the most both in terms of raw costs and intraocular complications. AntiVEGF is less powerful than steroids and at a lesser cost comes with fewer intraocular complications including a very mild risk of endophthalmitis.
Continuous-wave (conventional) laser photocoagulation while way more affordable than the aforementioned alternatives comes with potentially dangerous side effects including epiretinal fibrosis, choroidal neovascularization, and enlargement of laser scars which as mentioned will limit your chances of retreatment. Subthreshold lasers offer a safer, more efficient treatment profile than continuous-wave laser photocoagulation while remaining in the lower-cost scale.
DME manifests itself in many different degrees, and a significant number of patients present with mild to moderate edema with the potential for deterioration. SubLiminal laser therapy might be all you need to treat DME safely, effectively, and efficiently in these cases, both to achieve improvement and to prevent them from advancing to more severe phases. In light of considering SubLiminal laser therapy, good patient selection is key.