“Dr. Paul Lagonigro and staff gave me confidence and kept me informed. Forever grateful to Dr. Joseph Schwartz who performed my surgery and the entire Atlantic Retina Center team for excellent care.”
Retinal Laser Photocoagulation
Types of Retinal Laser Treatment
Not all retinal laser procedures are the same. Our Retina Specialists choose from several approaches based on the condition, its location on the retina, and the extent of disease. Each type is designed to achieve a specific goal with the least disruption to healthy tissue.
Focal laser targets small, specific areas of the retina. A Retina Specialist uses this approach to seal individual leaking blood vessels or treat discrete clusters of abnormal vessels. It is commonly applied for diabetic macular edema, where particular vessels are leaking fluid into the macula and causing swelling that blurs central vision.
Because focal treatment involves a limited number of carefully placed laser spots, it typically causes fewer side effects than broader approaches. The aim is to stop leakage at its source while preserving as much surrounding healthy retinal tissue as possible.
Pan-retinal photocoagulation, commonly called PRP or scatter laser treatment, covers a much wider area of the retina. During PRP, a Retina Specialist applies hundreds of laser burns across the peripheral retina while carefully avoiding the macula. This is the standard treatment for proliferative diabetic retinopathy (PDR), the advanced stage of diabetic eye disease in which abnormal new blood vessels grow on the retina.
PRP works by reducing the oxygen demand of the peripheral retina. When areas of the retina are not receiving adequate blood supply due to diabetes, they release chemical signals that trigger fragile new vessel growth. Treating these oxygen-starved areas with laser reduces those signals and significantly lowers the risk of severe vision loss from PDR.
When a retinal tear is detected, a Retina Specialist can use laser photocoagulation to build a ring of scar tissue around the tear. This barrier acts like a spot-weld, bonding the retina firmly to the underlying tissue so that fluid cannot pass through the tear and lift the retina away. Treating a tear early, before a retinal detachment begins, is far simpler and far more likely to preserve vision than treating a full detachment after the fact.
Newer laser systems have improved comfort and precision. Pattern scanning laser photocoagulation, known by the abbreviation PASCAL, delivers shorter pulse durations that require less total energy per burn. This produces smaller, more uniform treatment spots with less heat spread into surrounding tissue, resulting in less discomfort and less unintended injury to nearby retinal layers compared to conventional techniques.
Targeted retinal photocoagulation is an emerging approach that uses retinal imaging to identify specific areas of poor blood flow. Laser energy is applied only to those ischemic (oxygen-deprived) zones rather than the entire peripheral retina, which may reduce the total number of burns needed and lower the risk of side effects associated with traditional PRP.
Who May Benefit from Laser Treatment
Laser photocoagulation is appropriate for a range of patients, from those managing a chronic systemic disease like diabetes to those who discover a retinal tear unexpectedly during a routine exam. Your Retina Specialist will evaluate your retina thoroughly before recommending this or any treatment.
Diabetes is one of the most common reasons patients need retinal laser treatment. High blood sugar damages the small blood vessels of the retina over time, leading to diabetic retinopathy. Patients with proliferative diabetic retinopathy or diabetic macular edema that has not responded fully to injection therapy may be recommended for laser treatment, sometimes in combination with anti-VEGF injections such as Eylea (aflibercept), Lucentis (ranibizumab), Avastin (bevacizumab), or Vabysmo (faricimab).
Retinal tears can affect anyone but are more common in people who are significantly nearsighted, have a family history of retinal detachment, have had previous eye surgery, or have experienced eye trauma. As we age, the vitreous gel inside the eye naturally shrinks and can tug on the retina, sometimes causing a tear. Not every tear requires immediate treatment, but those that cause new floaters or flashes of light carry a higher risk of progressing to detachment, and laser is often recommended in these cases.
Retinal vein occlusion occurs when a vein draining blood away from the retina becomes blocked, leading to swelling, bleeding, and sometimes abnormal new blood vessel growth. When these complications develop, laser photocoagulation may be used to reduce swelling or prevent further vessel growth. Treatment decisions depend on the type and severity of the occlusion and are often made alongside anti-VEGF therapy.
What to Expect During the Procedure
Laser photocoagulation is performed in our office, not in a hospital operating room. Knowing what happens at each stage helps patients feel comfortable and prepared on the day of treatment.
Before the procedure, numbing drops are placed in the eye to minimize discomfort. Dilating drops are also applied so that the Retina Specialist has a clear, wide view of the retina. Once the pupil is fully dilated, a special contact lens is placed gently on the surface of the eye to help focus the laser beam precisely and keep the eye steady during treatment. Preparation typically takes about 15 to 30 minutes, most of which is waiting for the dilating drops to take full effect.
The patient sits at a slit lamp, a standard piece of equipment used in eye care. The Retina Specialist looks through the slit lamp and directs the laser through the contact lens onto the targeted areas of the retina. Each laser pulse lasts only a fraction of a second. Most patients feel a mild stinging or pricking sensation with each pulse. Some spots during PRP may cause a brief, sharper sensation due to the larger number of burns being applied. The laser application itself typically takes between 10 and 30 minutes. For extensive PRP, the treatment may be divided into two or more sessions spaced a few weeks apart to reduce discomfort and manage side effects.
Vision is often blurry for several hours after treatment, partly because of the dilating drops and partly due to the procedure itself. Most patients can return to normal activities within a day or two. Driving on the day of treatment is not recommended. Over-the-counter pain relievers are usually sufficient for any mild discomfort, and the eye may feel slightly sensitive to light for several hours.
Possible Side Effects and Risks
Like all medical procedures, laser photocoagulation carries some risk of side effects. Most are mild and temporary, but patients should understand the full picture before treatment. Our Retina Specialists take careful precautions to minimize risk at every step.
Some side effects are a normal part of the healing process and are expected after treatment.
- Blurred vision for one to two days after the procedure
- Mild discomfort or a dull ache in or around the eye
- Light sensitivity for several hours after treatment
- Small blind spots in treated areas, which are often not noticeable in everyday vision
Because PRP treats a large area of the peripheral retina, it can cause more noticeable changes in vision than focal treatment. Some patients experience a mild decrease in night vision, reduced peripheral (side) vision, or subtle changes in color perception or contrast sensitivity. These changes occur because the laser intentionally creates areas of scar tissue across the periphery. While these side effects can feel concerning, they are generally mild when compared to the severe central vision loss that untreated proliferative diabetic retinopathy can cause. The goal of PRP is to protect the most important central vision.
Serious complications from laser photocoagulation are uncommon but possible. These include bleeding inside the eye (vitreous hemorrhage), traction on the retina caused by contracting scar tissue, and in rare cases an accidental burn to the fovea, the tiny central point of the macula responsible for the sharpest vision. Other rare risks include fluid accumulation beneath the retina and sudden elevated eye pressure. Our Retina Specialists use precise targeting and carefully calibrated energy settings to minimize these risks, and for most patients the benefit of preventing disease progression far outweighs the risk of treatment.
Recovery and Ongoing Care
Most patients recover quickly from laser photocoagulation, but the conditions that require laser treatment are typically chronic and need long-term monitoring. Following your Retina Specialist's guidance after treatment is just as important as the procedure itself.
Most patients can resume normal daily activities within a day or two. Vision may be blurry for several hours to a couple of days. Significant pain is uncommon. Patients are typically advised to avoid strenuous activity and heavy lifting for a short period after treatment, as directed by their Retina Specialist.
A follow-up visit is usually scheduled within two to six weeks after treatment, though timing varies depending on the condition. For retinal tears, the Retina Specialist will confirm that a secure barrier of scar tissue has formed. For diabetic retinopathy or vein occlusion, additional imaging will determine whether abnormal vessels have regressed or whether further treatment is needed. Some patients require more than one laser session, particularly those undergoing PRP for proliferative diabetic retinopathy.
At Atlantic Retina Center, we perform serial retinal photo comparisons at every visit, giving us and our patients a documented, year-over-year record of how the retina is responding over time.
Laser photocoagulation is often used alongside other therapies for the best possible outcome. For diabetic eye disease and retinal vein occlusion, our Retina Specialists may combine laser with anti-VEGF injections such as Eylea (aflibercept), Lucentis (ranibizumab), Vabysmo (faricimab), or Avastin (bevacizumab). Research supports that combining these approaches can produce better structural and functional results for many patients than either treatment alone. For retinal tears, laser may be the only treatment needed when the tear is caught early. If a detachment has already begun, surgery such as pars plana vitrectomy or scleral buckling may be required in addition to or instead of laser.
When to See a Retina Specialist
Knowing when to seek care urgently, versus when to schedule a routine visit, can make a significant difference in protecting your vision. Some retinal events require immediate attention, while other conditions benefit from consistent long-term monitoring.
The following symptoms may signal a retinal tear or detachment and require same-day evaluation. Do not wait for a scheduled appointment if you experience any of these.
- A sudden increase in floaters, especially a shower of dark spots
- New flashes of light, particularly at the edges of your vision
- A shadow or dark curtain moving across your field of vision
- A sudden loss or significant blurring of vision in one eye
Retinal detachment can lead to permanent vision loss within hours to days and should be treated as a medical emergency. Early treatment of a retinal tear with laser photocoagulation can often prevent a detachment from occurring altogether.
Patients with diabetes, retinal vein occlusion, or other systemic conditions that affect retinal blood vessels should maintain regular visits with a Retina Specialist even when their vision feels stable. Many retinal conditions progress silently in the early stages without any noticeable symptoms. Routine dilated examinations allow early detection and timely treatment before significant vision loss occurs. Patients who have already had laser treatment should continue all recommended follow-up appointments, as the underlying disease may require additional monitoring or further treatment over time.
Frequently Asked Questions
These answers address practical questions patients often have about laser photocoagulation that go beyond the basics of how the procedure works.
Most patients describe it as a mild sting or prick with each pulse. The level of discomfort depends largely on the type of treatment: focal laser for macular edema tends to be well tolerated, while PRP with its larger number of spots can feel more intense, especially over the peripheral retina. Numbing drops are used before every session, and newer pattern scanning laser systems use shorter pulses and less energy per spot, which has reduced discomfort compared to older techniques. If you are concerned about pain, speak with your Retina Specialist before the session, as there are ways to help manage your comfort during treatment.
Laser photocoagulation is primarily a preventive treatment, not a restorative one. Its purpose is to stabilize disease and protect the vision you still have. It does not reverse retinal scarring or damage that has already occurred. In some cases, treating macular edema with laser can lead to modest improvement in vision as swelling decreases, but this is not guaranteed, and outcomes vary between patients. If significant vision has already been lost, your Retina Specialist will discuss realistic expectations as part of your treatment plan.
The scar tissue created by laser is permanent, and a properly sealed retinal tear generally remains sealed. However, new tears can form elsewhere on the retina at any time, which is why ongoing monitoring matters even after a successful procedure. For diabetic retinopathy, the underlying disease process continues as long as diabetes is present, and new abnormal vessels can develop over time. Managing blood sugar, blood pressure, and cholesterol levels is important for reducing that risk alongside any retinal treatment you receive.
For several conditions, yes. Anti-VEGF injections have become a primary treatment for diabetic macular edema and are increasingly used for proliferative diabetic retinopathy and retinal vein occlusion. In many cases, laser and injections are used together for better results. For retinal tears, cryopexy, a brief freezing treatment applied to the outside of the eye, can create a seal similar to laser. Your Retina Specialist will recommend the approach best suited to your specific diagnosis, the stage of disease, and your overall health picture.
The number of sessions depends entirely on the condition being treated and how the retina responds. A single retinal tear may be fully treated in one brief session. Proliferative diabetic retinopathy often requires two or more PRP sessions spaced a few weeks apart to complete the full treatment while managing discomfort and side effects. After any laser procedure, your Retina Specialist will review imaging and examination findings at follow-up visits to determine whether additional treatment is needed. There is no universal answer, and your plan will be tailored to your specific situation.
A retinal tear that is identified and monitored closely may sometimes be observed without immediate laser if it is small, symptom-free, and does not have features associated with higher detachment risk. However, a tear that causes sudden floaters or flashes carries a meaningful risk of progressing to a retinal detachment, which is a surgical emergency. Laser barrier treatment applied around the tear early is far less invasive and has a much higher success rate than repairing a full detachment. If you have been told you have a retinal tear, do not ignore new or worsening symptoms, and attend all scheduled follow-up appointments.
Schedule Your Retinal Evaluation
Our team at Atlantic Retina Center is exclusively dedicated to the health of the retina, vitreous, and macula, bringing subspecialty expertise that general eye care practices cannot replicate. We proudly serve patients across the Eastern Shore of Maryland and central and southern Delaware with the full range of retinal laser treatments and the ongoing monitoring your vision deserves. If you have been referred for laser photocoagulation, are experiencing retinal symptoms, or have a condition that puts your retina at risk, we encourage you to contact us and take the next step toward protecting your sight.