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    Cyclophotocoagulation device can help lower IOP

    Consider glaucoma severity, eye pigmentation, medication use


    Pearls to maximize use

    Dr. Radcliffe follows several pearls to maximize use of the laser for effective results:

    ·      Titrate according to glaucoma severity. For example, if Dr. Radcliffe sees a glaucoma patient with 20/20 vision who is on one or two glaucoma drops, he’ll treat with 2,000 mW delivered for 100 seconds—50 seconds to the top half of the eye and 50 seconds to the bottom half (sparing the neurovascular bundles at 3:00 and 9:00). “You get a 30% pressure reduction and a very good safety profile,” he says.

    However, if it’s a patient using four or five eye drops and who has had failed surgeries and 20/200 visual acuity, he’ll likely increase the MicroPulse’s power setting. The strongest setting Dr. Radcliffe uses is 2,500 mW, so he may select that power setting in such a patient and deliver the energy for the same amount of time.

    ·      Consider eye pigmentation. As the laser is better absorbed in eyes with a lot of pigment, Dr. Radcliffe will use a lower setting, at least for starters, in eyes that are dark brown. In a patient with very blue eyes, he may use 2,200 mW for the initial treatment depending on other patient factors. Assess the patient’s willingness to undergo a repeat procedure and treat conservatively until you understand the laser–pigment interaction.

    ·      Go aggressive to reduce medication use. If a patient uses three or four medications, including oral Diamox, Dr. Radcliffe is more likely to start them at 2250 or 2500 mW. “There’s more room to go down in terms of IOP,” he said. “If a patient is on four medications, the likelihood of overtreating and inducing hypotony is low. We can be more aggressive with laser power in eyes that have worse visual acuity,” he said. In contrast, if a patient does not use any medications and has MicroPulse treatment, we would be more cautious with laser settings, typically starting with a power of 2,000 mW. For patients with an IOP of 55 mm Hg or 60 mm Hg, Dr. Radcliffe may treat in the 2,300 or 2,500 mW range and be able to lower their IOP to the mid-teens.




    1. Aquino MC, Barton K, Tan AM, et al. Micropulse versus continuous wave trans-scleral diode cyclophotocoagulation in refractory glaucoma: A randomised exploratory study. Clin Exp Ophthalmol. 2015;43:40-46. 



    Nathan Radcliffe, MD

    E: [email protected]

    This article was adapted from Dr. Radcliffe’s presentation at the 2016 meeting of the American Academy of Ophthalmology meeting. Dr. Radcliffe is a consultant for Iridex and other ophthalmic companies.





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