Nanosecond laser technology features a speckled beam profile which exclusively targets selected, individual cells within the retinal pigment epithelium (RPE). The application of nanosecond laser to the RPE results in the formation of microbubbles around the melonasomes. These microbubbles expand and then coalesce, causing intracellular damage. A process of extracellular signaling occurs in response to the selected death of the targeted RPE cells, which causes the neighboring RPE cells to migrate and proliferate into the cell space vacated by these dead RPE cells.
Several years ago, in the mid-nineties, whilst I was working with Professor John Marshall in London, we discussed the effects of lasers on the retinal pigment epithelium and how retinal laser treatments both worked and damaged the retina. In fact, it was the first stage in the research I did with him leading up to my MD thesis. In the last decade, a laser has become available that may well have achieved many of the benefits with few or none of the complications.
Having brought together nanosecond laser technology and Professor Robyn Guymer at the Centre for Eye Research Australia (CERA) I was the first person to use nanosecond laser on patients with macular degeneration in the pilot study. A few years on, a larger study is under way and it’s good to see that the results so far are promising. It’s going to take a long time to find out for sure whether it’s worthwhile, but it may be a huge step in prevention of a disease that remains the commonest cause of visual loss in older Australians.