Grey Spots After Laser Photocoagulation
The grey spots you see when blinking after laser photocoagulation are normal visual phenomena (scotomas) that occur in 60-70% of patients following treatment and typically fade with time. 1 These temporary visual disturbances are an expected outcome of the treatment and generally do not indicate a complication.
Understanding Laser Photocoagulation and Visual Disturbances
Laser photocoagulation involves creating discrete burns in the retina, resulting in permanent structural changes that can manifest as visual disturbances:
- The treatment creates intentional retinal burns that appear as scotomas (blind spots) in your visual field
- These scotomas are more noticeable during blinking or eye movement
- Most patients adapt to these visual changes over time 1
- The benefits of preventing severe vision loss (reduced from 15.9% to 6.4% in diabetic retinopathy) outweigh the risk of these visual disturbances 2, 1
Why These Visual Disturbances Occur
The grey spots you experience are a direct result of the laser treatment mechanism:
- Laser photocoagulation creates thermal burns in the retina
- These burns cause tissue coagulation that improves retinal oxygenation 3
- The thermal energy disperses within the retina and choroid
- This dispersion creates the scotomas you perceive as grey spots 3
When to Be Concerned
While grey spots that fade after blinking are typically normal, you should monitor for concerning symptoms:
- Report to your ophthalmologist if you experience:
- Significant worsening of symptoms
- Spots that don't fade or become permanent
- Increasing number or size of spots
- Central vision changes
- Pain or discomfort
Follow-up Recommendations
The American Academy of Ophthalmology recommends:
- Monitoring for changes in the pattern or size of perceived scotomas
- Annual comprehensive eye examinations after laser photocoagulation
- Diagnostic assessment including visual acuity testing, dilated fundus examination, and OCT imaging of the macula 1
Factors That Influence Visual Disturbances
The extent and duration of visual disturbances can vary based on:
- Type of laser procedure performed
- Underlying condition being treated
- Laser parameters used (power, duration, spot size)
- Location of treatment (macular vs. peripheral)
Minimizing Visual Disturbances
Modern approaches to reduce visual disturbances include:
- Using shorter exposure times (0.02s vs. 0.1s), which has been shown to be equally effective but significantly less painful 4
- Lower intensity settings
- Avoiding treatment within 500 μm of the center of the macula
- Using pattern scan laser systems 1
Remember that these visual disturbances are generally a normal part of the healing process following laser photocoagulation, and most patients adapt to them over time. The treatment's benefits in preventing severe vision loss significantly outweigh these temporary visual effects.