ANAESTHESIA BEHIND THE EYE; TO MUCH LASER OR NOT; ONE EYE OR TWO TO LASER???

1. In giving an injection of anaesthesia to numb the area behind the eye to reduce discomfort during laser surgery,  does the ophthalmologist or an anaesthesiologist do the injection?

2. Can to much laser cause the eye to bleed and/or lead to macular edema, if so, what is to much?

3. It is said that Retinopathy is symmetrical and that when carrying out PRP laser under certain conditions it is very important to treat the fellow eye. Under what “certain conditions” should the other eye get treated with the PRP laser?
                        THREE QUESTIONS - THREE ANSWERS PLEASE AND THANKS SO SO SO MUCH!!!

[Houman Vosoghi, MD]

1. Either one can do it but all ophthalmologists are trained to do this whereas anesthesiologists need special training.

2.  Too much laser in the older days with the really strong lasers did lead to worsening of macular edema.  With todays lasers, this is not the case.  In fact, there is plenty of evidence out there that the more laser we perform when there are abnormal blood vessels, the better the macular edema gets.  Bleeding and worsening edema after laser are likely a side effect of diabetic retinopathy with poor control +/- high blood pressure.

3.  The two eyes are not alway symmetric when it comes to needing laser.  One eye usually passes the threshold prior to the second.  But if one eye needs laser the other eye needs to be watched very carefully as it is likely to follow suit.  If the other eye has high risk features and seems to be on the brink of developing proliferative retinopathy, it would be wise to preemptively treat the second eye as well.

HV