Traditional panretinal photocoagulation aims at destruction of a significant fraction of photoreceptors in the peripheral retina to reduce the metabolic load on the diabetic retinal vasculature and thereby save the central vision by preventing neovascularization in the macula. However, grid photocoagulation in the macula never had any underlying rationale. We conjecture that the benefits of the laser therapy in the macula may result from thermal stimulation of the retinal cells rather than from their destruction. With this in mind, we established the response range of the retinal cells to hyperthermia below the damage threshold, using bioluminescent marker associated with heat-shock proteins upregulation. We also established a titration protocol to define the proper laser settings for non-damaging laser therapy in every patient.

Using this protocol, we demonstrated that the non-damaging retinal laser therapy (NRT) is effective in treatment of Central Cerous Retinopathy and Macular Telangectasia, and its efficacy for treatment of the diabetic macular edema is being tested. The non-damaging approach may become a new paradigm in the retinal laser therapy, where the lack of tissue damage enables (a) high-density treatment to boost its clinical efficacy, (b) therapy in the fovea, and (c) retreatments to manage chronic diseases.

Subject Matter Level: Intermediate - Assumes basic knowledge of the topic

What You Will Learn:

• Principles and mechanisms of the retinal laser therapy
• Modeling of the retinal hyperthermia
• Applications of non-damaging retinal laser therapy

Who Should Attend:

• Students, scientists and physicians interested in retinal laser therapy and looking to learn about principles, practical aspects and novel capabilities of this method enabled by non-damaging approach which relies on thermal stimulation of retinal tissue below the damage threshold.

About the Presenter: Daniel Palanker, Stanford University

Daniel Palanker is a Professor of Ophthalmology and, by courtesy, of Electrical Engineering at Stanford University. He received MSc in Physics in 1984 from the State University of Armenia in Yerevan, and PhD in Applied Physics in 1994 from the Hebrew University of Jerusalem, Israel. Dr. Palanker studies interactions of electric field with biological cells and tissues, and develops optical and electronic technologies for diagnostic, therapeutic, surgical and prosthetic applications, primarily in ophthalmology. In the optical domain, these studies include laser-tissue interactions with applications to ocular therapy and surgery, and interferometric imaging of neural signals. In the field of electro-neural interfaces, Dr. Palanker is developing retinal prosthesis for restoration of sight to the blind, and implants for electronic control of other organs. Several of his developments are in clinical practice world-wide: electrosurgical scalpel PlasmaBlade (Medtronic), ocular laser PASCAL (Iridex), femtosecond cataract surgical system Catalys (Johnson&Johnson), and neural stimulator for tear secretion TrueTear (Allergan). Several others are in clinical trials, including the retinal prosthesis PRIMA (Pixium Vision).