Modern Retinal Laser Therapy: Principles and Application

Testimonials
Dedications
Foreword by Igor Kozak
Foreword by Sathy V. Bhavan
Preface
Overview

Section I. Principles of Modern Retinal Laser Therapy
Chapter 1. Modern Retinal Laser Therapy
Chapter 2. Retinal Photocoagulation
Chapter 3. The Foundations of Modern Retinal Laser Therapy

Section II. The Mechanisms of Retinal Laser Action
Chapter 4. Pillar I of Modern Retinal Laser Therapy: Low-Intensity Treatment, with contribution by David Kent
Chapter 5. Pillar II of Modern Retinal Laser Therapy: High-Density Treatment
Chapter 6. Targeted versus Nontargeted Therapy: Fragility versus Antifragility

Section III. General Clinical Considerations of Modern Retinal Laser Therapy
Chapter 7. Neurodegeneration, Neuroprotection, and Neuroregeneration
Chapter 8. Laser Parameters for Modern Retinal Laser Therapy
Chapter 9. Modern Retinal Laser Therapy Treatment Strategies

Section IV. Clinical Applications of Modern Retinal Laser Therapy
Chapter 10. Diabetic Retinopathy
Chapter 11. Modern Retinal Laser Therapy for Age-Related Macular Degeneration
Chapter 12. Open-Angle Glaucoma and Modern Retinal Laser Therapy
Chapter 13. Analog Indications for Modern Retinal Laser Therapy: Extending the Treatment Concepts of the Iconic Chronic Progressive Retinopathies
Chapter 14. Perspectives and Predictions for Modern Retinal Laser Therapy

Acknowledgments
References

Times are bad. Children no longer obey their parents, and everyone is writing a book.
— Marcus Tullius Cicero

I want to thank you for reading this book. You could be doing almost anything else. If nothing else, this represents a triumph of curiosity over skepticism, a good thing. While we love the affirmation we get from agreement, we learn nothing from it. Thus, it is my hope you will find much in this book disturbing. Progress requires replacing old ideas and practices with new ones. For this to happen, we need to question our ideas and opinions. This is often uncomfortable, at best. As said by more than one ancient Greek and many others since, the more deeply held our ideas, the more important it is to examine them. When you find things in this book upsetting, I hope that your notions have been challenged, and not that I have written drivel. Medical books are usually encyclopedic compendia of consensus. Confirmatory by nature, medical books seldom if ever contain information new to readers. Not this one. Most contemporary readers will find the ideas in this book foreign and controversial. If I am right, later readers will wonder what the fuss was about.

Any reservations and criticisms you may have about the author himself are justified and widely held, as a recent email from a prospective patient attests: “I’ve spoken to my retina specialist about (SDM), naturally he knew nothing about you. He looked up Dr Luttrull and commented to me that ‘if this was real Dr Luttrull would have a professorship at a large university and not be in private practice in a small town like Ventura.’” (Email from CB, August 14, 2022) Thus, you are not alone in your apprehensions. The author’s provenance is unimpressive. He has not held or sought any academic position. His experience is mostly unique, and thus his thoughts and conclusions are largely eccentric and mostly unknown to others, let alone tested or shared by them. He belongs to no select clubs. He is in solo private practice in a small town fully engaged in caring for patients. He has no laboratory and no fellows. He has done no randomized clinical trials. The list goes on. However, the author has spent more time thinking about, doing, and exploring clinical retinal laser treatment than anyone in decades, and possibly ever. His bibliography, unique for a solo physician outside academia, documents his journey, and forms the basis for this book.

As noted in the text, you have to do something different to learn anything new. Doing anything different is increasingly rare in our field. The pressure to conform increases daily and the resultant “homogeneity” of practice is hailed as progress rather than the intellectual desertification that it represents, a Faustian assignment of doctors’ individual intellects and consciences to institutions, organizations, companies, and for-hire “thought leaders” (Moynihan 2008, Cimberle 2021). This is bad in itself, and a bad thing if medicine is to advance and progress and this progress is to be made via discovery. Homogeneity of thought and practice meets the classic operational definition of insanity, that of (everyone) doing the same things for the same reasons while hoping for a different result—the different thing in this case being learning something new. While solo practice has certain disadvantages, it does facilitate independent thinking. Isolation attenuates the influence of the typically coercive group-think that tends to dominate small groups (the retina specialty is a small group). The author did not choose an affair with retinal laser treatment simply to be different. He had no unusual interest in laser at all. However, at the age of 44 and well into a typical clinical career, retinal laser treatment chose him. A mystery unexpectedly presented itself that piqued his curiosity and demanded an explanation. Understanding this mystery required the persistence of following one thread to the next to the next, and so on, resulting in a clinical career unlike any other. Different things were done. New things were learned. The purpose of this book is to share those lessons with you.

People tend to dismiss observations that do not fit in with their preconceptions. When this happens in science, as it frequently does, belief upstages data and the objectively open mind and science is replaced by religion. The god of this religion against which science contends is the status quo and the perceived wisdom. The struggle between data and dogmatic disbelief and the power of intellectual inertia has characterized the history of the development of Modern Retinal Laser Therapy. Indeed, inertia can be defined as “the inhibition of progress by a dead weight.” In science, that dead weight is belief based on convention and authority.

What we have learned from the development of Modern Retinal Laser Therapy has been predicated by the conviction that there are good reasons for the way things are, and thus we have hope of making sense of them. If we do not understand something we observe, we do not simply pass it off as being random incomprehensible nonsense, the pointless product of an accidental and meaningless universe; instead, we realize that all things in nature have a purpose that we simply have yet to appreciate, and that this purpose can be apprehended by reason and investigation. Thus, at times the thinking that leads to our current understanding of the “reset” mechanism of retinal laser action came down to simple anthropomorphic projections such as: “If I was the RPE, what would I do?” Or “If you wanted to design a system to do such-and-such, how would it work?” Such thinking, directed to attempting to understand the underlying wisdom of the processes observed, did not disappoint.

Proof belongs to mathematics and theology. Everything else is probability and uncertainty. Modern Retinal Laser Therapy is neither math nor theology. However, dots can be connected, impressions recorded, observations made, data collected, and within reason, at least tentative conclusions drawn. Modern Retinal Laser Therapy is informed by 22 years of immersion and work in retinal laser therapy. Those 22 years (thus far) represent a professional lifetime, which is not nothing. But compared to the time and number of minds it generally takes to understand even the simplest bit of nature, it is uncomfortably close to nothing. It is hoped that the reader will find the observations based on these years of experience, investigation, and accrued data interesting and useful. Modern Retinal Laser Therapy is the report of a journey, not an arrival. The journey is not yet over.

It is important to keep in mind that, fundamental to all that is described in this book, is the fact that SDM, the basis and epitome of MRT is, properly done, harmless—at worst. This is the bedrock for all else, and the main point of separation from everything that went before. Such a level of safety allows consideration and application of MRT wherever existing treatments are nonexistent, poorly effective, or onerous. That is a lot of potential applications. Thus, wherever SDM has been employed it has been safer for the patient than any existing alternative treatment. Where no alternative has existed, failure to act would have allowed the natural history of disease lead to visual loss, while failure of SDM would have resulted in no harm or disadvantage or prohibit any subsequent intervention of any kind. So, why not try? And at every step along the way, Modern Retinal Laser Therapy has exceeded every expectation.

It is my firm belief that Modern Retinal Laser Therapy is the most important development in modern ophthalmology, surpassing even the importance of anti-VEGF medications by virtue of its potential for prevention of all of the most common causes of irreversible visual loss—the chronic progressive retinopathies, as well as the exceptionally wide range of potential treatment indications. Once you stop laughing, consider that nothing described in the Clinical Applications section of this book would have been believed or predicted by anyone not so long ago. So, if you are willing to read on, there is a chance you might conclude my assessment of MRT is not as hyperbolic as it sounds.

Few technologies survive the passage of time. This is good because they are usually displaced by better ones. The anachronism of retinal photocoagulation and current dominance of intravitreal drug injections are presented throughout the following discussion as the main current alternatives to Modern Retinal Laser Therapy. This will change. Eventually, retinal photocoagulation will draw its final breath and be gone. Intravitreal drug injections will also be a thing of the past, sooner than we might think. What does this mean for Modern Retinal Laser Therapy? Almost certainly, a more prominent role. Modern Retinal Laser Therapy will not be defined in relation to its current alternatives. Because Modern Retinal Laser Therapy is harmless, no future treatment will be safer. At the same time, the results of Modern Retinal Laser Therapy are sufficiently robust that the likelihood of another treatment, drug or otherwise, being as effective while also being as safe, are virtually nil. Expect Modern Retinal Laser Therapy to not only survive, but thrive, well into the future.

Jeffrey K. Luttrull, MD
Ventura, CA, USA

Modern Retinal Laser Therapy: Principles and Applications” represents the last of scientific series on the most advanced approach to laser treatment of retinal diseases today. Written by the pioneer in the field, it describes the philosophy of the novel treatment from its conception through clinical testing and trails up to the current scientific knowledge. This memorable and triumphal journey has started with the creation of the idea to use nondamaging laser power to launch reparable processes in the human retina. This was in diametric contrast to philosophy of using predominantly destructive laser photocoagulation techniques, which eliminate diseased tissue only in hope to improve natural history of the disease. The novel concept was followed by establishing physical theory by the author and observing a biochemical evidence of retinal repair mechanisms by other groups. Clinical observations on countless number of patients have solidified the theory attesting to the effects of nondestructive and reparative stimulating therapy. The elegance of this approach is that retinal repair is agnostic to initial retinal process leading to damage and is, therefore, applicable for use in various retinal conditions irrespective of their origin.

All of these are presented to the reader in a breathtaking writing style of an ophthalmologist, pioneer, and a philosopher who paved the way to the modern retinal laser therapy. The book also serves to remind physicians how to fight barriers associated with resistance to novelty in science, medicine, and society posed by established authorities. Prior lack of acceptance was also attributable to imperfect assessment of certain qualities of vision following the treatments. With novel technologies to detect subtle vision changes, we are likely to be able to assess more precisely the effects of this therapy on human retina. As such, the author has seen the potential of this new therapy approach that was invisible to others. He is also showing us how impactful ideas are created and nurtured to grow into new therapies to help people.

Apart from the author, the accolades belong also to all the people who helped to investigate various aspects of modern retinal laser therapy such as physical principles, basic laser tissue interaction, imaging outcomes, and clinical data. Their work has supported and corroborated as proof of concept the visionary idea of the author, which has now converted into recognized treatment for retinal diseases. The author has shown us how much we did not know about retinal lasers. For all these reasons, this book deserves utmost attention by ophthalmologists in all fields of our specialty.

Igor Kozak, MD, PhD, MAS

Consultant Ophthalmologist and Clinical Lead
Moorfields Eye Hospital
Abu Dhabi, United Arab Emirates

The word “laser” often invokes thoughts of advanced innovative futuristic technology regardless of whether it is used in the context of medical treatments or in fighting space aliens above the stars. In the field of ophthalmology, it has been used now for over 60 years. In fact, one of its first medical uses was in photocoagulation of the retina. Yet, over the last decade and with the advent of intravitreal injection, it has seemingly slowly fallen out of favor in the retinal field. The reasons for this are largely two-fold. First, positive therapeutic effects of intravitreal injectable agents are typically quicker than the effect of a laser treatment. Second, retinal laser has historically been and continues to be damaging to the retinal tissue. That is, until now.

After graduating from medical school, I first entered a residency in diagnostic radiology, with a specific interest in interventional radiology. I was attracted to the minimally invasive and minimally damaging aspect of this field when compared with traditional open surgical approaches to many problems. However, ophthalmology had always been in the back of my mind and I had always admired it as being a delicate field treating a very delicate part of the body. My draw to the field ultimately overcame my interest in radiology, and I was able to transfer to a residency program in ophthalmology after completing a year of a radiology residency.

My first decade of practice in ophthalmology was a traditional ascent of any young physician—a careful and conscientious doctor who executed as best as he could everything that was taught to him in all his prior years of training. I was very much a “by the book” conservative type of practitioner. I was excited and rewarded by the ability to help people while minimizing harm and adverse advents. In my second decade of practice, some of that perspective began to change.

Specifically, I began to question our approach to traditional, damaging, thermal laser photocoagulation. I wondered why such an advanced and innovative part of the medical field still considered a treatment that literally irreversibly burned tissue away acceptable. I cringed as I created large burn marks in the retinal periphery of a patient who need panretinal photocoagulation. But I did it. It was what I was taught and what was deemed to be correct. As intravitreal injection began to dominate my practice more and more, I admired the quick results it would generate in a reasonably safe procedure. However, the displeasure of monthly needle sticking weighed on both my patients’ and my own mind. It was when I began to think more about laser. Laser was still less invasive and typically more comfortable to the patient. But why did it always have to be damaging? Why did I have to leave burn marks behind? Surely laser was a more advanced technology than this I thought. Space aliens used it. There had to be a way.

My first introduction to Dr. Jeffrey Luttrull was by way of his article in a 2014 issue of the journal Retina, entitled “Safety of Transfoveal Subthreshold Diode Micropulse Laser for Intra-foveal Diabetic Macular Edema in Eyes With Good Visual Acuity.” Surely this could not be true. Safe transfoveal laser application in a patient with good visual acuity never crossed my mind. It was not what I was taught. I didn’t dare to do it. I was skeptical. But those three words stuck in my mind and stayed with me: safety, transfoveal, and good—three words that should not go together, like oil and water. I continued to read his work over the years. It was ground breaking. It challenged the field. It should change everything. But why was that not happening? Why did none of my colleagues know about it? Surely it was because it was too good to be true, or some sort of gimmick. I continued to be skeptical. But as I read, and as I followed, and as I learned and educated myself on how it really all worked, that was slowly changing.

It was just at this opportune and somewhat disillusioned crossroads of my now mid-career in vitreoretinal disease that I stumbled upon Dr. Jeffrey Luttrull. I had been practicing in the Los Angeles and San Diego area, and I saw an ad to join his practice. I felt lucky to be both in the vicinity and to be fairly well-versed in the work that he had been doing, so I contacted him. I told myself to remain both objective and open minded. I got the opportunity to talk to him at length and see him at work firsthand with his patients in his office. I was impressed with what I saw. Happy smiling patients that were seeing well. Diabetic patients that were astonishingly stable long term with no visible laser scars and minimal continued intervention. Long-term dry macular degeneration patients that had been seeing him for over 20 years with no visible signs of decay. Wet macular degeneration patients that remained stable despite needing needle sticking at a dramatically decreased frequency that I certainly was accustomed to. Central serous retinopathy patients that were actually being healed and doing well.

I had to be a part of this. I just had to.

On top of all of this, I found Dr. Luttrull to be the quintessential package when it comes to my vision of the ideal doctor. A brilliant mind. A questioning scientist. A calm demeanor. Universally loved and trusted by his patients and his family. An innovator who first and foremost does no harm and is still a traditionalist when it comes to what a doctor should be doing for his patient. An old school with just the right mix of new school. An incarnation of the Hippocratic Oath itself. I trusted him. I trusted myself. I trusted what I was seeing. I was going to be a part of this.

It is here that I present to you the book Modern Retinal Laser Therapy. I invite you to read it with an inquisitive and open mind as I have. I invite you to trust yourself in your judgment. I invite you to explore a specialty-changing and ground-breaking approach and technology. I invite you to the future.

Sathy V. Bhavan, MD
Vision Protection Institutes
Ventura, CA

This book is a masterpiece compendium of novel ideas on technology that we have been using so long. In it, the pioneer in the field walks us through his experience in opening new applications for modern retina laser therapy. The book demonstrates what we did wrong and what we can do better in the future. A true guide for every forward-thinking retina specialist.

Igor Kozak, MD, PhD
Moorfields Eye Hospital
Abu Dhabi, UAE

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I was initially very skeptical of the concept of SDM laser (MRT) for chronic macular diseases. Having now implemented these procedures in my practice for 2 years and seen first-hand the clear benefit they offer to patients, I can confidently recommend this monograph to anyone looking for a way to help their patients with retinal pathology. The concepts presented here are an example of innovative thinking with protection of patients as the highest priority. The scientific arguments made are interesting and compelling. The real-world results of implementing these concepts have demonstrated to me that this is the right thing to do for patients.

Thomas Myers, MD
Riverwood Eye Clinic
Provo, UT, USA

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This book represents the masterpiece of the long-standing Jeff’s clinical and research dedication and experience to micropulse laser treatment of different retinal disorders. It’s definitely not “an ordinary” scientific text. I am sure that any reader can find it curious and inspiring, even if not always in agreement. I congratulate Jeff for this extraordinary work!

Stela Vujosevic, MD, PhD, FEBO
University Eye Clinic San Giuseppe Hospital Milan
Milan, Italy

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I have been using SDM laser (MRT) for years and I continue to be positively impressed by it. Currently, I only use continuous wave laser for retinal tears. Diabetic retinopathy used to be managed by photocoagulation and vitrectomy. Now I find that SDM laser and anti-VEGF can control most cases. For age-related macular degeneration, I use SDM to help delay conversion to exudative macular degeneration. Also, it helps to enable longer intervals between anti-VEGF injections for those who convert. This book is a wide-ranging treatise by one of its pioneers. It gives the history, including the author’s first experience with it in 2000. It explains how it works and is safe even for use across the fovea. It gives results from published articles detailing years of experience. I would recommend it for anyone involved with conditions of the retina.

Kenneth R. Diddie, MD
Westlake, CA, USA

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This book may accelerate the sunset of traditional visible-threshold laser photocoagulation, and may disprove many mechanisms of action theorized to rationalize indications and outcomes validated by landmark trials such as the Diabetic Retinopathy Study (DRS), the Early Treatment of Diabetic Retinopathy Study (ETDRS), the Macular Photocoagulation Study (MPS) and many other. Modern laser therapy is the evolution from tissue destroying threshold laser photocoagulation, which is mostly benefitting patients in clinically significant conditions and  should be replaced by nondamaging subthreshold laser photostimulation for the therapy of patients at earlier stages of progressive degenerative retinovascular disorders. With his remarkable pioneering work, Jeffrey Luttrull has been the most valuable prophet to prompt the historical paradigm shift from traditional threshold laser photocoagulation to modern subthreshold laser photostimulation. Conventional threshold laser photocoagulation should not be used any longer in the treatment of retinovascular and progressive degenerative disorders and should be confined to the treatment of structural retinal disorders requiring strong chorioretinal adhesions.

Giorgio Dorin
Cupertino, CA, USA

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Jeffrey K. Luttrull, MD, has given us Modern Retinal Laser Therapy: Principles and Applications. With 108 figures, hundreds of color images, and 13 tables, Modern Retinal Laser Therapy: Principles and Applications is a comprehensive book full of concepts that look at laser photocoagulation in a new more modern way that will appeal to the retina specialists. The development of low-intensity/high-density subthreshold diode micropulse photocoagulation has eliminated laser-induced retinal damage (LIRD). Elimination of LIRD as a necessity for effective therapy has basically eliminated adverse events, and has allowed new, more effective/safer treatment techniques, improved outcomes, and the understanding of the therapeutic mechanisms of retinal laser, and new treatment applications.

J. Fernando Arevalo, MD PhD
Professor of Ophthalmology
Wilmer Institute, Johns Hopkins University
Baltimore, MD, USA

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The methods for the detection, monitoring, and treatment of retinal diseases, now a major cause of vision loss worldwide, have changed dramatically from the severely destructive laser photocoagulation of the retina inaugurated with the DRS through the advent of repetitive intravitreal injection trials, all aimed at the severe, end-stages of neovascularization and edema. More recently the progressive course of neuronal apoptosis and microvascular injury and occlusion, occurring in multiple retinal layers, has demanded the application of new imaging and functional testing along with less invasive treatment methods that can stop the progressive injury and reverse the vision loss within earlier stages of the disease progression. Since 2000, the healing algorithms of contiguous laser, non-damaging, RPE thermal stimulation have been proven to accomplish this, demonstrating significant prevention of the progression and reversal of the functional loss, agnostic of the cause, whether glaucoma, diabetic retinopathy, vascular occlusion, uveitis, or AMD. Dr. Luttrull has been a leader in the demonstration of the benefits of this laser therapy, and this book represents a compilation of the necessary introduction
and application of treatment. It should be read by all ophthalmologists and optometrists as it will become a mainstream of patient ocular care.

Stephen H. Sinclair, MD
Former Chairman of Ophthalmology, Drexel University School of Medicine
CEO Sinclair Technologies,
Salt Lake City, UT, USA

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Jeffrey K. Luttrull has written an excellent book covering modern contemporary approach to laser treatment of the retina. Modern Retinal Laser Therapy not only provides the knowledge on the principles of action and clinical application of non-damaging laser techniques but also gives us an individual view on the subject—the aspect frequently omitted in scientific publications. One might not agree with all the thesis presented by the author, but cannot ignore the consequence, logic, and scientific background in presenting controversial subjects. The book is written with literary passion and as such enormously engaging and engrossing, like traveling in a sports car. Take it in your hand, fasten your seatbelt and enjoy the ride.

Maciej Gaweki, MD, PhD
Head of Department, Specialist Hospital in Chojnice,
Dobry Wzrok Ophthalmological Clinic
Gdansk, Poland

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Dr. Luttrull has succeeded where many others have not by making a complex medical topic both readable and interesting for both practitioner and public alike. If MRT achieves its potential as outlined in this book, it will have most significant impact on the treatment of blinding retinal disease since the advent of anti-VEGF therapy.

Matthew Ward, MD
Riverwoods Eye Clinic
Provo, UT, USA

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Getting to know the author personally in 2011 and following his published papers and congress talks since then, it’s with great pleasure that I agreed to write some words about Modern Retinal Laser Therapy, a book that summarizes 22 years of history with this fascinating retinal treatment. In this book, written in pleasant language and filled with witty quotes and philosophical analogies, Dr. Luttrull provides the reader with evidence-based data (when available) and interesting logical deductions. It should be an insightful read for even the most skeptical minds.Dr. Luttrull achieves in Modern Retinal Laser Therapy an amazing feat. The preface already sets the tone for an unconventional read, one that will challenge the reader’s preconceived concepts and background about current retinal physiopathology and treatment. As the author points out, the subthreshold laser treatment, done properly (and here lies its main barrier for a broader acceptance and popularity among retinologists), really works and is harmless. This is why we needed this book to help spread the word even further.

Renato M. Passos, MD, PhD
Departamento de Oftalmologia, Universidade Federal de São Paulo
São Paulo, Brazil

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Thank you to Dr. Luttrull for this comprehensive overview from one of the most experienced key opinion leaders in retinal laser technology and treatment approaches. This compendium will serve as a great guide for beginners and seasoned retina specialists alike. Most importantly, our patients will benefit from the use of these technologies and techniques in our complex world of pathology.

Veeral S. Sheth, MD, MBA, FASRS, FACS
Clinical Assistant Professor of Ophthalmology, University of Illinois at Chicago
Chicago, IL, USA

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Jeffrey K. Luttrull, MD, is not only a very experienced and excellent ophthalmic surgeon, he is also worldwide recognized as the pioneer in modern restorative retinal laser therapy. In the era of intravitreal anti-vascular endothelial growth factor (VEGF) injections, conventional retinal laser surgery lost ground because of its destructive nature with visible retinal burns inducing permanent scotomas. As a result, new non-damaging laser therapy modalities emerged since 2005 as a safe and tissue-sparing solution for the treatment of retinal diseases and glaucoma. Micropulse laser setting algorithms limitate the transmission of thermal energy, preventing the formation of visible laser burns and scotomas. Its advantages include the ability to apply treatment near the fovea as well as treating the same retinal area multiple times. In many peer-reviewed scientific papers and many presentations during international ophthalmology conferences, Dr. Luttrull demonstrated the
clinical efficacy and safety of the micropulse laser modality in the treatment of various retinal vascular diseases. I strongly recommend ophthalmic surgeons with an interest in restorative retinal laser therapy to read Dr. Luttrull’s monograph Modern Retinal Laser Therapy.

Jan E. E. Keunen, MD, PhD, EBOD
Em. Professor of Ophthalmology
Radboud University Medical Center, Nijmegen, The Netherlands
Member of the Senate of the Dutch Parliament, The Hague, The Netherlands

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As a general ophthalmologist, cornea specialist with an interest in retina, I have been using SDM (MRT) since 2018. I find the procedure effective with an excellent safety profile. A wealth of practical knowledge can be found in
Modern Retinal Laser Therapy. This book should be on every ophthalmologist’s desk for quick reference.

K. Alex Dastgheib, MD
Garden Grove, California

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Ophthalmology adopted laser therapy in the second half of the twentieth century and gradually became more sophisticated in terms of wavelength, setting, and clinical application. But generally speaking, conventional laser treatment has not evolved a great deal so far, except for photodynamic therapy and subthreshold laser applications.This is why the laser approaches described by Dr. Luttrull in Modern Retina Laser Therapy are absolutely revolutionary. Dr. Luttrull shows that he is a true pioneer in the field of retina laser therapy, thoroughly exploring innovative concepts and demonstrating how laser therapy can be applied in many fields previously considered out of reach in common clinical practice. All ophthalmologists who are fans of laser therapy will enjoy reading this exceptional book.

Maurizio Battaglia-Parodi, MD, PhD
Associate Professor Department of Ophthalmology, Vita-Salute San Raffaele University, Ospedale San Raffaele,
Milan, Italy

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The book Modern Retinal Laser Therapy presents many years of fundamental research on the interaction between laser radiation and ocular tissues. The entire history of thermal exposure to the eye evolves from uncontrolled cryotherapy through light coagulation of tissues to gentle subthreshold infrared exposure. This work … calls for sparing our patients and looks to the future for many years to come. I recommend this book to anyone who is planning to practice ophthalmology.

Dr. Andrii Korol, MD, PhD, DMedSc,
Head of Laser Division, The Filatov Institute of Eye Diseases and Tissue Therapy
of the NAMS of Ukraine