Altering the pattern of panretinal photocoagulation: could the visual field for driving be preserved?

To identify the area of retina required to provide the visual field for driving and to investigate whether the pattern of panretinal photocoagulation (PRP) for proliferative diabetic retinopathy could be altered to avoid treatment in this area whilst leaving the total number of burns constant.

A mathematical model of the emmetropic eye is used to calculate retinal dimensions corresponding to different angles of visual field. These are used to define retinal regions that correspond to the UK DVLC visual field criteria and regions that lie outside this area. Further calculation estimates the number of laser burns applied within these regions for both 500 microns and 200 microns diameter spot sizes and various burn spacings.

Modelling of the number of burns applied in the normal pattern of PRP agrees with the number required to control proliferative retinopathy. Reducing burn spacing or extending treatment up to the ora serrata allows application of sufficient burns to control the disease without encroaching on areas of the retina that provide the driving field.

It is theoretically possible to alter the pattern of PRP to avoid treatment in retinal areas concerned with the driving visual field whilst leaving the total number of burns constant. This suggests that a clinical trial of such a pattern PRP could be performed to assess adequate control of proliferative retinopathy along with preservation of the visual field required for driving.