title: Laser photocoagulation spot-size errors stemming from the refractive state of the surgeon's eye.
abstract: OBJECTIVE
  Meaningful errors in photocoagulation spot size may result from several factors. In this article we discuss one major factor, namely, fluctuations in the surgeon's accommodative state, coupled with an inaccurate setting of the slit-lamp oculars.
  
  
  METHODS
  Experimental study.
  
  
  METHODS
  We analyzed and tested the optics of slit-lamp mounted lasers. Varying the ocular setting is correlated with measurements of the actual spot size obtained with each system.
  
  
  METHODS
  The spot size obtained.
  
  
  RESULTS
  Three distinct, but related, phenomena that may lead to spot size errors are defined: (1) focusing the laser spot as opposed to focusing the retinal image; (2) instrument misalignment; (3) inadvertent accommodation.
  
  
  CONCLUSIONS
  The ocular setting must be meticulously calibrated to produce a true spot-sized burn. At the 50 microm setting, each diopter of induced accommodation, or erroneous ocular setting, almost doubles the actual spot size obtained. With large (500 microm) spot size settings, the defocused delivery system is more prone to spot-size errors in contrast with parfocal lasers.
authors.affiliation: Department of Ophthalmology, Hadassah University Hospital, and Hebrew University-Hadassah Medical School, Jerusalem, Israel.
authors.forename: E Z
authors.initials: EZ
authors.lastname: Blumenthal
authors.forename: C N
authors.initials: CN
authors.lastname: Serpetopoulos
mesh_terms: D000065:Accommodation, Ocular; D002138:Calibration; D006801:Humans; D017075:Laser Coagulation / Q000009:adverse effects* / Q000592:standards; D019300:Medical Errors / Q000009:adverse effects*; D009885:Ophthalmology; D010815:Physician Impairment; D012029:Refraction, Ocular; D012030:Refractive Errors / Q000150:complications*; D012160:Retina / Q000601:surgery*