Pattern-scan laser photocoagulation quicker, less painful way to do PRP

The Pascal photocoagulator (OptiMedica) offers patients a quicker, less painful way to undergo panretinal photocoagulation (PRP). In addition, the system provides physicians with a less tedious experience while delivering a clinical response that is comparable with conventional photocoagulation, according to several speakers at an OptiMedica-sponsored meeting Saturday evening.

The pattern-scan photocoagulator is a 532-nm green laser that allows multiple laser bursts to be applied in rapid succession. Various pattern arrays are possible, and the pulse durations are shorter than with conventional photocoagulation. Fewer treatment sessions are needed, therefore, and the need for retrobulbar block or other pre-procedure medication is reduced or eliminated.

"Speed is an absolute benefit here," said Kirk Packo, MD, chairman, department of ophthalmology, Rush Presbyterian Hospital, Chicago. "You can get your PRPs done anywhere from seven to 10+ times as quick. There's no question that there's less discomfort for the patient and less tedium for the doctor."

Dr. Packo cautioned, however, that the learning curve for the system is steeper when working in the far periphery of the lens.

The other speakers echoed Dr. Packo's comments; they included Ray Gariano, MD, PhD, Stanford University, Palo Alto, CA, and Santa Clara Valley Medical Center, San Jose, CA; John Lehr, MD, Magruder Eye Institute, Orlando; and J. Edward Ysasaga, MD, Southwest Retina Specialists, Amarillo, TX.

"As a rule, patients are much more comfortable," Dr. Gariano said, and that makes follow-up more reliable.

Dr. Lehr said that 120 procedures (PRPs and others) have been performed using the Pascal system in his group practice in the past 3 months. He said he can deliver 1,200 spots in 7 or fewer minutes now, as opposed to the multiple sessions that were required using his previous laser. The ability to deliver multiple bursts quickly, as well as the elimination of the need for retrobulbar blocks, freed time in his practice such that 15 more appointment times could be added to the weekly schedule.

Dr. Ysasaga said that he and his practice partner have performed more than 300 procedures since June. At first, most of the procedures were PRP, he said, but increasingly they use it for focal therapies as well.

"Once you get it in your office, you won't go back," he told session attendees.

Dr. Ysasaga said his patients' chief complaint has related to the brightness of the light during the pattern scan. Some patients instinctively move in reaction to the light, so "we just hold their head," he said.

Dr. Ysasaga suggested that smaller spots and patterns are better for sensitive patients.