Improving results with greater precision

Article

Experiences with PASCAL sub-threshold laser treatments for DME

Fortunately, advances in laser therapy have yielded refinements in pulse duration, lesion intensity and several other parameters, improving overall quality of treatment. A recent application furthering physician control over these factors is the Endpoint Management software available for the PASCAL Photocoagulator (Topcon Medical Laser Systems, Santa Clara, California, USA).

Development of treatment protocols

The goal of focal laser treatment for DME should be to combine safety with efficacy. In this case, that means a resolution of - or, at least, a significant reduction of - macular oedema. Hopefully, this will facilitate improved or preserved vision. The idea that visible lesions are not necessary for effective treatment has been reinforced by the recent success of micropulse lasers.3 However, one distinct disadvantage of micropulse is its difficulty and complexity in setting laser dosimetry. A key advantage of Endpoint Management is its Landmark feature, which delivers laser application at the visible, titrated dose.

The goal of sub-threshold laser treatment is to achieve the best results with reduced energy, thereby reducing unintended effects from thermal reaction. Endpoint Management first titrates to a comfortable visible endpoint and then uses algorithms to modulate power and duration, enabling control over treatment endpoints.

New options

I then apply my laser treatment pattern, typically using 2x2 and arc grid patterns. I can add a grid with uniform intensity or vary the grid so that landmarks use a higher amount of energy than central points. In this instance, endpoints would deliver a reduced amount of energy as set by the endpoint percentage. These points would use just enough energy to stimulate the retina into pumping out accumulated fluid, but not enough to cause visible whitening of the RPE and actual thermal burn. Here, greater physician control yields a more precise - and potentially efficacious - treatment.

Newsletter

Join ophthalmologists across Europe—sign up for exclusive updates and innovations in surgical techniques and clinical care.

Recent Videos
A photo of Seville, Spain, with the Congress on Controversies in Ophthalmology logo superimposed on it. Image credit: ©francovolpato – stock.adobe.com; logo courtesy COPHy
Anat Loewenstein, MD, Professor and Director, Department of Ophthalmology, Tel Aviv Medical Center, discusses the Congress on Controversies in Ophthalmology (COPHy)
(Image credit: Ophthalmology Times Europe) AGS 2025: Clemens Strohmaier, PhD, on improving aqueous humour outflow following excimer laser trabeculostomy
3 experts are featured in this series.
Anat Loewenstein, MD, speaks about the 22nd Annual Angiogenesis, Exudation, and Degeneration Meeting in February 2025 and shares her global forecast for AI-driven home OCT
3 experts are featured in this series.
3 experts are featured in this series.
Sarah M. Thomasy, DVM, PhD, DACVO, a veterinary ophthalmologist at UC Davis, talks about how her research at the Glaucoma 360 symposium
I. Paul Singh, MD, an anterior segment and glaucoma specialist, discusses the Glaucoma 360 conference, where he participated in a panel discussion on the use of artificial intelligence (AI) in glaucoma care.
Sunita Radhakrishnan, MD, an associate at the Glaucoma Center of San Francisco, speaks at the annual Glaucoma 360 meeting about electrical neurostimulation.
© 2025 MJH Life Sciences

All rights reserved.