BLOG: Maximizing the benefits of technology by improving the user
We are practicing medicine at a time when technology is constantly evolving and improving the way we treat our patients.
As physicians, it is our responsibility to stay abreast of the developments and incorporate these technologies into our practices for the benefit of our patients, and this may require us to do some unlearning. It is important to recognize that there is a difference between treatment failure and treater failure. The technology is there, and it is consistent. When it works well in some people’s hands but not in others, we have to look at our technique and experience level rather than the actual modality.
MicroPulse (Iridex) therapy changed my entire perception about the technique of administering laser. Initially, it was difficult to change my mindset from using a continuous-wave focal laser that coagulates vessels to using a tool to “tickle” the underlying retinal pigment epithelium to induce a metabolic change. It seemed that every single cell in my body was yelling at me to play it safe. I left wide spaces, used minimal power and stayed away from the fovea completely, consequently leaving maximum benefit unrealized. Over time, I became more comfortable with the technology and honed my technique. My results improved, and ancillary testing provided the proof that there was no evidence of clinical or angiographic burns, or any other permanent ocular damage.
As my comfort level increased, I started delivering more confluent spacing and treating over the fovea. In a retrospective analysis of my first 100 eyes with diabetic macular edema receiving MicroPulse therapy, a sub-analysis compared the results of my first 50 eyes with the second 50. There was a statistically significant anatomical improvement in the second half of eyes as compared with the first. This was likely due to an improvement in my technique and comfort level, not because the technology changed. The more adept I became with the technique, the better my results.
If you have tried MicroPulse therapy for DME or other retinal diseases and did not get the desired outcomes, I encourage you to take a step back and consider your role as the treater in the success or failure of the treatment. This worked for me, and I believe it can work for you as well. Be willing to learn and gain experience using a new technique. In skilled hands, MicroPulse can produce results that benefit a key subset of our patients. Providing our patients with an essentially pain-free, durable treatment option benefits our practices and, most importantly, our patients.