title: Does laser still have a role in the management of retinal vascular and neovascular diseases?
abstract: OBJECTIVE
  To discuss the current role of laser therapies in the management of retinal vascular and neovascular diseases.
  
  
  METHODS
  Perspective.
  
  
  METHODS
  Laser's role in the management of diabetic retinopathy, age-related macular degeneration, and venous occlusive disease is discussed, with emphasis on comparing laser with anti-vascular endothelial growth factor (VEGF) therapy and discussion of situations where these treatment methods can be complementary.
  
  
  RESULTS
  Thermal panretinal photocoagulation remains the usual practice for treatment of neovascularization in proliferative diabetic retinopathy and after venous occlusive events. Focal/grid laser still has a role for patients with macular edema resulting from diabetes or venous occlusion that is poorly responsive to anti-VEGF agents and in patients who are unable or unwilling to return for frequent injections. Focal/grid laser also is used as combination therapy with anti-VEGF agents for these indications. Focal laser can be used for extrafoveal choroidal neovascularization to avoid the treatment burden and risks of multiple injections. Photodynamic therapy may be beneficial in the treatment of central serous chorioretinopathy and idiopathic polypoidal choroidal vasculopathy and as combination therapy with anti-VEGF agents in age-related macular degeneration.
  
  
  CONCLUSIONS
  Anti-VEGF agents are effective in preventing vision loss and improving vision in multiple diseases, including diabetic retinopathy, neovascular age-related macular degeneration, and retinal vein occlusions. Despite a substantial decrease in its use for these conditions in recent years, laser therapies continue to serve important roles in our ability to combat retinal pathologic features and will remain a pivotal component of our practices for at least the next several years.
authors: Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
authors: Ankur M
authors: AM
authors: Shah
authors: The Wilmer Institute, Johns Hopkins University, Baltimore, Maryland.
authors: Neil M
authors: NM
authors: Bressler
authors: Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: l-jampol@northwestern.edu.
authors: Lee M
authors: LM
authors: Jampol
mesh_terms: D020533:Angiogenesis Inhibitors / Q000627:therapeutic use; D003131:Combined Modality Therapy; D003930:Diabetic Retinopathy / Q000188:drug therapy / Q000601:surgery*; D006801:Humans; D017075:Laser Coagulation; D015861:Retinal Neovascularization / Q000188:drug therapy / Q000601:surgery*; D012170:Retinal Vein Occlusion / Q000188:drug therapy / Q000601:surgery*; D042461:Vascular Endothelial Growth Factor A / Q000037:antagonists & inhibitors; D014786:Vision Disorders / Q000517:prevention & control; D057135:Wet Macular Degeneration / Q000188:drug therapy / Q000601:surgery*
chemical_list: D020533:Angiogenesis Inhibitors; C467484:VEGFA protein, human; D042461:Vascular Endothelial Growth Factor A