Small Grey Spots After Laser Photocoagulation
The small grey spots you see after laser photocoagulation are laser scars (photocoagulation burns) that develop as a normal and expected outcome of the treatment. 1 These spots represent areas where the laser energy has created controlled thermal damage to the retina, resulting in permanent structural changes that appear as grey or white lesions.
Characteristics of Laser Scars
- Immediate appearance: Immediately after treatment, laser burns appear as well-defined grey or white spots in the retina
- Evolution over time: These spots typically:
- Start as small discrete lesions
- May gradually enlarge over time (89.5% of laser scars show gradual expansion) 2
- Can develop pigmentation changes as they heal
Normal Progression of Laser Scars
The appearance and progression of these spots vary based on several factors:
- Location: Scars in the posterior pole expand faster (12.7% annual expansion rate) compared to those in the mid-periphery (7.0% annual expansion rate) 2
- Time since treatment:
- Early period (within 4 years): 8.8% annual expansion rate
- Late period (beyond 4 years): 16.5% annual expansion rate 2
- Laser wavelength used:
- Argon laser: minimal expansion (1.2%)
- 590-nm wavelength: moderate expansion (11.7%)
- 610-nm wavelength: highest expansion (15.8%) 2
Potential Complications Related to Laser Scars
While most laser scars remain stable with minimal impact on vision, some complications can occur:
- Scotoma development: 60-70% of patients develop multiple scotomas (blind spots) corresponding to the laser treatment areas 1
- Progressive enlargement: In some cases (approximately 9% of treated eyes), laser scars can progressively enlarge and potentially affect central vision if they expand into the fovea 3
- Retinal revascularization: In about 7% of cases, new blood vessels can develop within the treatment scar, which could be mistaken for recurrent disease 4
When to Seek Medical Attention
You should contact your ophthalmologist if you notice:
- Changes in the pattern or size of the grey spots
- New visual symptoms (particularly worsening vision or new blind spots)
- Distortion in your central vision
- Flashes of light or new floaters (which could indicate complications)
Follow-up Recommendations
The American Academy of Ophthalmology recommends:
- Annual comprehensive eye examinations after laser photocoagulation 1
- Diagnostic assessment including:
- Visual acuity testing
- Dilated fundus examination
- OCT imaging of the macula if there are concerns about the spots affecting central vision 1
Prevention of Complications
To minimize complications from laser scars:
- Early treatment of small lesions when appropriate (for conditions like retinal hemangioblastomas, success rates are 100% for lesions ≤1.5mm) 5
- Avoiding treatment near the fovea when possible (at least 500 μm from the center of the macula) 1
- Consideration of alternative treatments like anti-VEGF therapy or photodynamic therapy in appropriate cases 1
Remember that these grey spots are an expected outcome of the laser treatment and generally represent successful treatment of the underlying condition. However, regular follow-up with your ophthalmologist is essential to monitor for any concerning changes.