Insight Ophthalmology · Retina Companion Note

Panretinal
Photocoagulation in Diabetic Retinopathy

Panretinal photocoagulation, or PRP, is extensive peripheral retinal laser treatment used to reduce the angiogenic drive responsible for neovascularisation in proliferative diabetic retinopathy. This companion note explains why PRP works, when it is considered, how treatment is delivered and what visual trade-offs it may produce.

Diabetic Retinopathy · Laser Treatment Foundation to Postgraduate

Watch the Lecture

Watch the lecture first, or use the companion note below to revise the mechanism, indications, settings, treatment field and current clinical role of panretinal photocoagulation.

Companion-note approach: the lecture sets the teaching sequence, while the note below updates terminology, evidence and present-day clinical decision-making.

Not All Diabetic Retinal Laser Is the Same

LASER stands for Light Amplification by Stimulated Emission of Radiation. In diabetic retinopathy, peripheral scatter laser and macular laser have different treatment targets and clinical purposes.

Panretinal Photocoagulation

Also called scatter photocoagulation or scatter laser

Area
Extensive treatment of the mid-peripheral and peripheral retina
Target
The ischaemia-driven angiogenic stimulus
Main role
Control of neovascularisation in proliferative diabetic retinopathy

Macular Laser

Focal or grid laser applied close to the macula

Area
Selected leaking lesions or areas of retinal thickening near the macula
Target
Selected components of diabetic macular oedema
Main role
Macular treatment—not control of peripheral proliferative disease
This note focuses on panretinal photocoagulation. Macular-laser technique is covered separately in Laser Treatment of Diabetic Macular Oedema .
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The Principle of Retinal Photocoagulation

Photocoagulation is controlled thermal injury produced when laser energy is absorbed by ocular pigment and converted into heat.

1

Laser Light

Selected wavelength reaches the retinal pigment epithelium.

2

Pigment Absorption

Energy is absorbed mainly by melanin in the RPE and choroid.

3

Heat Generation

Absorbed optical energy is converted into local thermal energy.

4

Coagulative Injury

Protein denaturation produces a controlled chorioretinal lesion.

What Determines the Tissue Reaction?

  • Laser wavelength
  • Retinal and choroidal pigmentation
  • Media clarity
  • Spot diameter and contact-lens magnification
  • Power and exposure duration
  • Retinal location and tissue thickness
Clinical implication: laser settings should be adjusted according to the visible retinal response. The same machine setting can produce different effects in different eyes—or even in different areas of the same retina.

Why Does PRP Cause Neovascularisation to Regress?

PRP does not normally work by applying laser directly to the new vessels. It reduces the ischaemia-driven angiogenic stimulus responsible for their growth.

Before PRP
Retinal capillary closure
Retinal hypoxia
Increased VEGF and angiogenic signalling
NVD, NVE, NVI or NVA
Peripheral Photocoagulation
After PRP
Reduced outer-retinal metabolic demand
Improved oxygen availability to the inner retina
Reduced hypoxic and angiogenic drive
Regression or stabilisation of neovascularisation

The photoreceptor layer has a high metabolic requirement. Controlled treatment of the peripheral outer retina reduces its oxygen consumption.

Retinal thinning after photocoagulation may also facilitate oxygen diffusion from the choroid toward the remaining inner retina.

Review how capillary non-perfusion produces retinal ischaemia and neovascularisation in Diabetic Retinopathy: Pathogenesis .
References: [4,7]

The Evidence That Established PRP

The landmark Diabetic Retinopathy Study—DRS established that retinal photocoagulation could substantially reduce profound visual loss in proliferative diabetic retinopathy.

Landmark Trial

Diabetic Retinopathy Study

The DRS evaluated eyes with severe non-proliferative or proliferative diabetic retinopathy and compared photocoagulation with observation.

The greatest benefit was seen in eyes with high-risk proliferative diabetic retinopathy, where the risk of severe visual loss was greatest.

Earlier Method

Xenon Arc

Effective, but associated with greater collateral retinal damage and more severe treatment-related effects.

Historical Standard

Argon Laser

Produced fewer harmful treatment effects than xenon-arc photocoagulation in the DRS.

Modern Delivery

532-nm Green Laser

Frequently generated using frequency-doubled Nd:YAG technology, with single-spot or pattern-scanning delivery.

Clinical meaning: PRP has permanent functional problems. Its protective benefit is greatest when the risk of severe visual loss from untreated proliferative disease outweighs the expected harm from treatment.
References: [2,3]
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When Should PRP Be Considered?

The historical DRS criteria remain important for examinations, but present-day treatment also considers disease activity, progression risk, associated DME, traction and follow-up reliability.

Diabetic retinopathy study (DRS) Framework

High-Risk Proliferative Diabetic Retinopathy

Prompt photocoagulation provided a clear net benefit when any of the following high-risk characteristics were present.

Criterion 1

Extensive NVD

NVD approximately ¼–⅓ disc area or more, even without preretinal or vitreous haemorrhage.

Criterion 2

NVD with Haemorrhage

Less extensive NVD accompanied by preretinal or vitreous haemorrhage.

Criterion 3

NVE with Haemorrhage

NVE approximately ½ disc area or more with preretinal or vitreous haemorrhage.

Current Clinical Framework

Clinical Situation Role of PRP
High-risk PDR Prompt treatment is generally indicated.
Active PDR without historical high-risk features PRP, anti-VEGF or combined treatment may be chosen according to disease activity and the clinical situation.
NVI, NVA or neovascular glaucoma Urgent control of the retinal ischaemic drive is required. PRP is often combined with anti-VEGF and IOP management.
Selected severe or very severe NPDR PRP may be considered when progression risk is high or delayed treatment would be difficult or unsafe.
Dense vitreous haemorrhage or significant traction Outpatient PRP may not be possible. Anti-VEGF, vitrectomy and intraoperative endolaser may be required.

When Might Earlier PRP Be Considered?

  • Rapid progression has been documented.
  • The fellow eye already has advanced PDR or severe visual loss.
  • Reliable follow-up is doubtful.
  • Pregnancy or systemic circumstances increase concern.
  • An upcoming procedure may make later treatment more difficult.
Review severe NPDR, very severe NPDR and the 4–2–1 rule in Classification of Diabetic Retinopathy .
References: [1–3,10]

Before Laser: Assess the Whole Eye

Do not plan PRP by looking only at the new vessels. The macula, media, haemorrhage, traction and ability to complete follow-up may all change the treatment strategy.

Assess Why It Matters
Visual acuity and macular status Centre-involving diabetic macular oedema may alter the timing or combination of PRP and anti-VEGF treatment.
NVD and NVE Their extent, activity and associated haemorrhage help determine treatment urgency.
Preretinal or vitreous haemorrhage Haemorrhage may indicate high-risk disease and may also obscure areas that require laser.
Fibrovascular proliferation and traction Significant traction or tractional retinal detachment may shift management toward vitreoretinal surgery.
Media clarity Cataract or vitreous haemorrhage may prevent adequate outpatient retinal visualisation and PRP completion.
Previous laser coverage Look for untreated peripheral retina, widely spaced burns or persistent neovascularisation after earlier treatment.
NVI, NVA and intraocular pressure These findings may indicate anterior-segment neovascularisation or neovascular glaucoma requiring urgent additional management.
Follow-up reliability The ability to return for repeated injections and surveillance influences the choice between PRP and anti-VEGF treatment.

Visual Acuity and Macular Status

Centre-involving DME may alter the timing or combination of PRP and anti-VEGF treatment.

NVD and NVE

Assess their extent, activity and association with retinal or vitreous haemorrhage.

Haemorrhage

Preretinal or vitreous haemorrhage may indicate high-risk disease and can limit the retinal view.

Traction

Significant fibrovascular traction may change management toward vitreoretinal surgery.

Media Clarity

Cataract or vitreous haemorrhage may prevent adequate outpatient PRP.

Previous PRP

Identify untreated retina, insufficient coverage or persistent proliferative activity.

NVI, NVA and IOP

These may indicate anterior-segment neovascularisation or neovascular glaucoma.

Follow-Up Reliability

Long-term attendance affects the choice between durable PRP and injection-dependent treatment.

The Treatment Decision

After assessing the whole eye, decide whether the patient is best managed with PRP, anti-VEGF, combined treatment or vitreoretinal surgery.

References: [1,10]

How Is PRP Delivered?

Retinal laser may be delivered through a slit lamp, laser indirect ophthalmoscope or intraocular endolaser probe. The choice depends on the retinal view, required peripheral access and whether treatment is being performed during surgery.

1

Slit-Lamp Laser

Routine Outpatient PRP

Laser is delivered through a retinal contact lens while the patient is positioned at the slit lamp.

It provides a stable, magnified view and allows controlled placement of individual or patterned burns.

2

Laser Indirect Ophthalmoscopy

Wider Peripheral Access

Laser is incorporated into an indirect ophthalmoscope and delivered through a handheld condensing lens.

It is useful for far peripheral treatment, difficult patient positioning or treatment around selected media opacities.

3

Endolaser

Intraoperative Treatment

Laser is delivered directly inside the eye through an intraocular probe during vitreoretinal surgery.

It may be used when vitreous haemorrhage, traction or another surgical indication prevents adequate outpatient PRP.

Clear view and cooperative patient
Slit-lamp delivery is usually the most controlled and convenient outpatient approach.
Far peripheral retina or difficult positioning
Laser indirect ophthalmoscopy may provide better access and can be combined with scleral indentation when required.
Surgery already required
Endolaser allows PRP to be completed during vitrectomy under direct intraoperative visualisation.
Clinical Pearl: the biological purpose of PRP remains the same regardless of the delivery system. What changes is the method of visualising and reaching the retina.
Reference: [7]
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Which Contact Lens Is Used for PRP?

Wide-field contact lenses make it easier to reach the peripheral retina. The lens also changes the actual laser spot produced on the retina.

the lens changes the actual retinal spot
Machine-Selected Spot (µm)
Lens Spot-Magnification Factor
Retinal Spot Diameter (µm)

Example: 200 µm × 1.50 = 300 µm retinal spot

Lens Field: Centred / With Manipulation Spot Factor Retinal Spot From 200 µm Clinical Reach and Use
Ocular Three-Mirror Universal Laser Central optic with three peripheral mirrors 1.08× 216 µm Posterior pole and selected peripheral sectors Rotate the lens to view and treat each peripheral sector.
Mainster Focal/Grid 90° / 121° 1.05× 210 µm Posterior pole to midperiphery Mainly used for detailed focal or grid laser.
Mainster Wide Field 118° / 127° 1.50× 300 µm Broad midperipheral and peripheral access Suitable for routine PRP.
ProRetina 120 PB 120° / 136° 2.00× 400 µm Broad peripheral access Designed for PRP and peripheral retinal treatment.
Volk SuperQuad 160 160° / 165° 2.00× 400 µm Mid- to far-peripheral retinal access Designed for wide-field PRP and peripheral treatment.
Volk HR Wide Field 160° / 165° 2.00× 400 µm Mid- to far-peripheral retinal access Manufacturer describes access from the posterior pole toward the ora serrata.
Mainster PRP 165 165° / 180° 1.96× 392 µm Extensive far-peripheral access Designed for broad-coverage PRP.

Ocular Three-Mirror Universal Laser

Field

Central optic with three peripheral mirrors

Spot Factor

1.08×

200 µm Becomes

216 µm

Posterior pole and selected peripheral sectors. Rotate the lens to treat each sector.

Mainster Focal/Grid

Field

90° / 121°

Spot Factor

1.05×

200 µm Becomes

210 µm

Posterior pole to midperiphery. Mainly used for focal or grid laser.

Mainster Wide Field

Field

118° / 127°

Spot Factor

1.50×

200 µm Becomes

300 µm

Broad midperipheral and peripheral access. Suitable for routine PRP.

ProRetina 120 PB

Field

120° / 136°

Spot Factor

2.00×

200 µm Becomes

400 µm

Broad peripheral access. Designed for PRP and peripheral treatment.

Volk SuperQuad 160

Field

160° / 165°

Spot Factor

2.00×

200 µm Becomes

400 µm

Mid- to far-peripheral retinal access. Designed for wide-field PRP and peripheral treatment.

Volk HR Wide Field

Field

160° / 165°

Spot Factor

2.00×

200 µm Becomes

400 µm

Mid- to far-peripheral retinal access. Manufacturer describes access toward the ora serrata.

Mainster PRP 165

Field

165° / 180°

Spot Factor

1.96×

200 µm Becomes

392 µm

Extensive far-peripheral access. Designed for broad-coverage PRP.
Centred field is visible with the lens in its usual position. Field with manipulation is the additional retina reached by tilting or decentring the lens and redirecting the patient’s gaze. The wider field is not seen simultaneously.

Retinal Regions and Field Terminology

Posterior pole Retina within the vascular arcades and slightly beyond them.
Midperiphery Retina beyond the posterior pole, extending approximately to the posterior border of the vortex vein ampullae.
Far periphery Retina anterior to the vortex vein ampullae, extending toward the ora serrata.
Ora serrata The anterior termination of the neurosensory retina.

Widefield and ultra-widefield are primarily imaging terms—not additional anatomical retinal zones.

Widefield: extends beyond the posterior pole but remains posterior to, or includes, the vortex vein ampullae in all four quadrants.

Ultra-widefield: extends anterior to the vortex vein ampullae into the far periphery in all four quadrants.

These terms should not be assigned to a contact lens solely from its stated angular field.

Choose the Lens for the Treatment Goal

PRP usually benefits from a wide field and good peripheral access. Narrower lenses provide greater posterior-pole detail but are less efficient for completing peripheral treatment.

References: [9,14]

Understanding the PRP Settings

PRP is defined by more than one machine setting. The final retinal effect depends on the spot diameter, power, exposure duration, spacing and total treatment coverage.

Parameter Unit What It Controls
Spot diameter µm The retinal area treated by each application. Interpret it with the contact-lens magnification factor.
Power mW The rate at which laser energy is delivered to the tissue.
Exposure duration ms How long each laser application remains active.
Burn spacing Burn widths The density of treatment and the amount of untreated retina between adjacent lesions.
Number of applications Spots Contributes to total treatment coverage, but does not alone prove that PRP is complete or adequate.

Spot Diameter

µm

Area treated by each application. Account for contact-lens magnification.

Power

mW

The rate at which laser energy is delivered.

Exposure Duration

ms

Length of each laser exposure.

Burn Spacing

Burn widths

Determines treatment density and the intervening untreated retina.

Number of Applications

Spots

Contributes to coverage, but is not a complete treatment endpoint by itself.

Traditional Memory Aid

The 200–200–200 Reference

200 µm Machine-selected spot
200 mW Starting power
200 ms Exposure duration

This is a traditional teaching reference—not a universal prescription. The power must be adjusted to produce the intended retinal reaction.

Why Must the Power Be Titrated?

The same power can produce different burns in different eyes or different areas of the same retina.

  • Retinal pigmentation
  • Media clarity
  • Laser wavelength
  • Selected duration
  • Contact-lens magnification
  • Retinal location
References: [5,7]

Conventional and Short-Pulse Pattern-Scanning PRP

Both techniques aim to reduce the same ischaemia-driven angiogenic stimulus. They differ mainly in how each burn is delivered, its pulse duration and the number or density of spots needed to cover an equivalent retinal area.

Feature Conventional Single-Spot PRP Short-Pulse Pattern-Scanning PRP
Delivery One manually aimed spot at a time Multiple spots delivered rapidly in a preset square, arc or other spatial pattern
Typical pulse duration Approximately 50–200 ms Approximately 10–30 ms
Thermal spread Greater lateral diffusion of heat Less lateral diffusion because each exposure is shorter
Immediate lesion Relatively larger for the same beam diameter Smaller and often lighter for the same beam diameter
Power setting Titrated to the required visible retinal reaction Often higher because the energy is delivered over a shorter time
Number and density Fewer, larger conventional lesions More spots or denser patterns are usually needed for equivalent retinal coverage
Example Manually delivered single-spot PRP PASCAL or another pattern-scanning laser platform
Conventional Single-Spot PRP
Delivery

One manually aimed application at a time.

Typical Duration

Approximately 50–200 ms.

Lesion

Relatively larger, with greater lateral thermal spread.

Coverage

Fewer, larger conventional lesions.

Short-Pulse Pattern-Scanning PRP
Delivery

Multiple spots delivered rapidly in a preset spatial pattern.

Typical Duration

Approximately 10–30 ms.

Lesion

Smaller, with less lateral thermal spread.

Coverage

More spots or denser treatment is usually required.

Pattern Selection

The operator selects a preset arrangement such as a square or arc.

Rapid Sequential Delivery

The system delivers each spot rapidly within that pattern while the clinician controls its retinal position.

Why are more spots needed? Shorter pulses generally produce smaller retinal lesions. Using the same spot count and spacing as conventional PRP may therefore leave a smaller total retinal area treated. Pattern density and total applications must be adjusted accordingly.
References: [5–7]
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Grading the PRP Burn

Burn grade is judged by the immediate retinal colour change. The classical endpoint for conventional PRP is a moderate white-grey lesion.

Grade Appearance Interpretation
Grade 0 Subvisible No definite retinal blanching; not the intended endpoint for conventional visible-burn PRP.
Grade 1 Barely visible or light grey Lighter than the classical conventional PRP endpoint.
Grade 2 Moderate white-grey Classical target Traditional visible endpoint for scatter PRP.
Grade 3 Dense white Excessive burn. May be accompanied by surrounding retinal oedema and should be avoided.
Clinical point: burn appearance is subjective and may vary with retinal pigmentation, media clarity and retinal location. Titrate the power to the desired endpoint—a whiter burn is not a better burn.
References: [2,5]

Where Is PRP Applied?

PRP is applied to the midperipheral and peripheral retina while protecting the optic disc, macula and major retinal vessels.

Nasal

Begin approximately 500 µm from the optic-disc margin.

Temporal

Maintain approximately 2 disc diameters from the fovea.

Superior and inferior

Keep the posterior treatment boundary at or outside the major vascular arcades.

Peripheral extent

Extend treatment through the peripheral retina, traditionally to at least the equator.

References: [2,3,7]
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What Constitutes Complete or Adequate PRP?

A fixed number of burns does not, by itself, prove that PRP is adequate.

Requirement Meaning
Geographic completion Broad treatment of the midperipheral and peripheral retina, extending from the protected posterior boundary toward the equator.
Appropriate density Intervening untreated spaces are controlled; current complete-treatment frameworks commonly describe approximately one burn-width spacing.
Appropriate endpoint Controlled visible lesions without excessive dense-white burns.
Protected posterior pole The fovea, optic disc and major retinal vessels remain untreated.
Clinical response Neovascularisation regresses or becomes inactive.
Supplementation when required Persistent activity prompts fill-in PRP, anti-VEGF treatment or surgery according to the cause.

The National Institute for Health and Care Excellence (NICE) guideline NG242 [8] defines complete PRP geographically as treatment of the midperipheral and peripheral retina from approximately 2 disc diameters from the fovea to the equator, with approximately one burn-size spacing. Persistent active PDR after complete treatment requires reassessment and additional management.

Clinical Pearl: Complete PRP describes treatment coverage. Adequate PRP also requires an appropriate clinical response.
Reference: [8] National Institute for Health and Care Excellence. Diabetic retinopathy: management and monitoring. NICE NG242.

One Session or Several?

PRP may be completed:

  • in one session;
  • over two or more staged sessions;
  • with later supplemental treatment.

The approach depends on:

  • disease urgency;
  • patient tolerance;
  • laser platform and pulse duration;
  • area requiring treatment;
  • media clarity;
  • macular-oedema risk;
  • ability to return.

When treatment is staged, completing the inferior retina early may be useful. If vitreous haemorrhage occurs between sessions, blood may settle inferiorly and obscure that retina.

This is a practical strategy rather than a mandatory sequence.
References: [1,6,8]

Follow-Up After PRP

At follow-up, assess:

  • regression or persistence of NVD and NVE;
  • new preretinal or vitreous haemorrhage;
  • untreated or lightly treated retina;
  • macular oedema;
  • fibrovascular traction;
  • NVI or NVA;
  • intraocular pressure;
  • need for supplemental PRP, anti-VEGF or surgery.

Follow-up timing is individualised. A formal assessment of regression is generally performed after treatment has had time to act. The NICE recommends assessing regression approximately 2–3 months after treatment is completed [8], with earlier review when disease activity or complications require it.

Analgesic, topical anti-inflammatory, cycloplegic or IOP-lowering treatment may be used when clinically indicated. None should be presented as mandatory after every uncomplicated session.

References: [1, 8, 13]
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Complications and Visual Trade-Offs

PRP reduces the risk of severe visual loss from proliferative disease, but it produces permanent peripheral chorioretinal scars and has recognised functional costs.

Category Important Effects
During or shortly after treatment Pain, transient blurred vision, inflammation and temporary intraocular-pressure elevation.
Macular or exudative effects New or worsening diabetic macular oedema, choroidal effusion and, rarely, exudative retinal detachment.
Functional trade-offs Peripheral-field constriction, reduced night vision, reduced dark adaptation and possible colour or contrast disturbance.
Treatment errors Accidental injury to the macula, optic disc, retinal vessels or anterior segment.
Later concerns Persistent neovascularisation, recurrent vitreous haemorrhage, progressive traction and the need for additional treatment.
PRP produces permanent chorioretinal scars. It reduces the risk from proliferative disease but does not cure diabetic retinopathy or remove the need for continued follow-up.
References: [1,2,7,13]

PRP or Anti-VEGF?

PRP is no longer the only evidence-supported treatment for proliferative diabetic retinopathy. Protocol S showed that ranibizumab was a viable alternative to PRP, with broadly similar mean visual-acuity outcomes through five years among eyes completing follow-up. Anti-VEGF treatment produced less visual-field loss and less vision-impairing diabetic macular oedema, but required repeated surveillance and treatment.

PRP Anti-VEGF
Durable peripheral retinal treatment Avoids permanent scatter-laser scars
Less dependent on repeated injections Produces rapid neovascular regression
Useful when future follow-up is uncertain Particularly useful when vision-impairing DME coexists
May reduce peripheral and night vision Requires repeated monitoring and retreatment
May worsen macular oedema Disease may reactivate if treatment is interrupted
Can be combined with anti-VEGF May later be supplemented with PRP
Clinical Bottom Line: PRP and anti-VEGF are both effective treatments for proliferative diabetic retinopathy, but they are not interchangeable in every patient.
References: [11,12]
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Remember PRP in Five Steps

Use these five steps to connect the indication, treatment and follow-up.

  1. Identify the Angiogenic Drive

    Look for active PDR, NVI or NVA.

  2. Assess the Whole Eye

    Check the macula, haemorrhage, traction, media clarity and follow-up reliability.

  3. Treat the Peripheral Retina Adequately

    Protect the posterior pole, optic disc and major retinal vessels.

  4. Titrate the Retinal Reaction

    Do not rely blindly on one memorised machine setting.

  5. Reassess for Regression

    PRP may require supplementation and never removes the need for continued follow-up.

Related Videos

Continue with the related diabetic retinal-laser lectures.

References

Key clinical guidelines, landmark trials and technical sources supporting this companion note.

  1. Lim JI, Kim SJ, Bailey ST, et al. American Academy of Ophthalmology Preferred Practice Pattern Retina/Vitreous Committee. Diabetic Retinopathy Preferred Practice Pattern®. Ophthalmology. 2025;132(4):P75–P162. DOI: 10.1016/j.ophtha.2024.12.020
  2. Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy: clinical application of Diabetic Retinopathy Study findings. DRS Report Number 8. Ophthalmology. 1981;88(7):583–600. DOI: 10.1016/S0161-6420(81)34978-1
  3. Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy. ETDRS Report Number 9. Ophthalmology. 1991;98(5 Suppl):766–785. DOI: 10.1016/S0161-6420(13)38011-7
  4. Stefánsson E. Ocular oxygenation and the treatment of diabetic retinopathy. Survey of Ophthalmology. 2006;51(4):364–380. DOI: 10.1016/j.survophthal.2006.04.005
  5. Palanker D, Lavinsky D, Blumenkranz MS, Marcellino G. The impact of pulse duration and burn grade on size of retinal photocoagulation lesion: implications for pattern density. Retina. 2011;31(8):1664–1669. DOI: 10.1097/IAE.0b013e3182115679
  6. Muqit MMK, Marcellino GR, Henson DB, et al. Single-session versus multiple-session pattern-scanning laser panretinal photocoagulation in proliferative diabetic retinopathy: the Manchester PASCAL Study. Archives of Ophthalmology . 2010;128(5):525–533. DOI: 10.1001/archophthalmol.2010.60
  7. Everett LA, Paulus YM. Laser therapy in the treatment of diabetic retinopathy and diabetic macular edema. Current Diabetes Reports . 2021;21(9):35. DOI: 10.1007/s11892-021-01403-6
  8. National Institute for Health and Care Excellence. Diabetic retinopathy: management and monitoring. NICE Guideline NG242. Published August 13, 2024. View NICE Guideline NG242
  9. Ocular Instruments and Volk Optical. Official manufacturer specifications for retinal laser contact lenses, including the Ocular Three-Mirror Universal Laser, Mainster Wide Field, Mainster PRP 165, ProRetina 120 PB, Mainster Focal/Grid, Volk SuperQuad 160 and Volk HR Wide Field. Field-of-view and laser-spot factors are model-specific and should be checked against the current specification for the lens being used.
  10. Yonekawa Y, Modi YS, Kim LA, et al. American Society of Retina Specialists clinical practice guidelines: management of nonproliferative and proliferative diabetic retinopathy without diabetic macular edema. Journal of VitreoRetinal Diseases . 2020;4(2):125–135. DOI: 10.1177/2474126419893829
  11. Gross JG, Glassman AR, Liu D, et al. DRCR Retina Network. Five-year outcomes of panretinal photocoagulation versus intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial. JAMA Ophthalmology. 2018;136(10):1138–1148. DOI: 10.1001/jamaophthalmol.2018.3255
  12. Maguire MG, Liu D, Glassman AR, et al. DRCR Retina Network. Visual field changes over 5 years in patients treated with panretinal photocoagulation or ranibizumab for proliferative diabetic retinopathy. JAMA Ophthalmology. 2020;138(3):285–293. DOI: 10.1001/jamaophthalmol.2019.5939
  13. Reddy SV, Husain D. Panretinal photocoagulation: a review of complications. Seminars in Ophthalmology . 2018;33(1):83–88. DOI: 10.1080/08820538.2017.1353820
  14. Choudhry N, Duker JS, Freund KB, et al. Classification and guidelines for widefield imaging: recommendations from the International Widefield Imaging Study Group. Ophthalmology Retina . 2019;3(10):843–849. DOI: 10.1016/j.oret.2019.05.007
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