APAO 2023: Use of subthreshold laser for DME

Jay Chhablani, MD, provides an overview of the Subthreshold Ophthalmic Laser Society treatment guidelines for patients with diabetic macular edema with Sheryl Stevenson, group editorial director, during the 2023 meeting of the Asia-Pacific Academy of Ophthalmology. Chhablani is a vitreoretinal specialist at the University of Pittsburgh Eye Center in Pittsburgh, Pennsylvania.

Video transcript

Editor’s note: This transcript has been edited for clarity.

Sheryl Stevenson: We're joined today by Dr. Jay Chhablani, who is presenting at this year's Asia-Pacific Academy of Ophthalmology. Welcome to you. I wonder if you could take a few minutes and tell us a little bit about your talk.

Jay Chhablani, MD: I'll be talking about subthreshold laser in diabetic macular edema. Before I really jump onto the talk [of] what I'm going to give is that we created a society called Subthreshold Ophthalmic Laser Society (SOLS). The idea behind this society was to promote the understanding about subthreshold laser, which started way back almost 3 to 4 decades ago, but still we don't have set protocols for it. We still don't have guidelines of the use of this. In the current era of anti-VEGF therapy, the subthreshold laser is taking a backstep...particularly for diabetic macular edema. As the first step of the society, what we did was we established guidelines of use of subthreshold laser for 2 diseases. One is central serous chorioretinopathy, as well as diabetic macular edema.

Coming to the diabetic macular edema...and this is what I'm primarily going to talk [about] in my presentation. I'm going to talk primarily about the SOLS society guidelines for diabetic macular edema, which we are primarily going to use certain parameters which is still haphazard across the world and with the help of these guidelines, we will be setting up standard protocols for the laser parameters. We are definitely going to clarify to the audience that these guidelines don't advise on the treatment of diabetic macular edema because we do understand that the anti-VEGF therapy or intraocular steroid therapy plays a very important role for [the] management of diabetic macular edema. Our guidelines are primarily to establish the parameters for subthreshold laser.

In addition to that, I will also be showing a couple of examples where the use of subthreshold laser has shown [a] beneficial effect in cases with diabetic macular edema, particularly for the cases which are unable to come for regular visits for injections where we can always offer this treatment which can actually help them in the long run. One of the cases where I'll be showing how the repeat subthreshold laser helped us to manage the diabetic macular edema without any injections. The main focus is going to be how the repeat laser did not cause any structural damage in these cases. Overall, the use of subthreshold laser as well as the treatment guidelines for diabetic macular edema.

Stevenson: What are the key takeaways of these guidelines, and where might retina specialists learn more about them?

Chhablani: We did publish these guidelines last year in the journal Eye¹ and it is freely available. I would recommend that interested people go through those guidelines. The overall key message with these guidelines is that you do start your diabetic macular edema patients with anti-VEGF therapy but at some point, where you feel that there is a supplement required or your patients cannot come for the frequent follow-up for injections, you can always use these lasers for recalcitrant cases as well. I don't want to go into the details of the exact laser parameters because I'm sure that people will definitely get to read about it. The main crux is that there is definitely a role of subthreshold laser in today's world for diabetic macular edema patients.

Reference

1. Chhablani J; SOLS (Subthreshold Laser Ophthalmic Society) writing committee. Subthreshold laser therapy guidelines for retinal diseases. Eye (Lond). 2022;36(12):2234-2235. doi:10.1038/s41433-022-02136-w