Retinal Rejuvenation Therapy
The 2RT laser is a specially designed Q-switched, frequency doubled Nd:YAG (green) with a wavelength of 532 nm. It offers a breakthrough laser therapy which has the potential to positively influence the lives of millions of people suffering from retinal disease, including Age Related Macular Degeneration (AMD).
Please tell me more about 2RT
A non-thermal, laser-based therapy
2RT applies nanosecond pulses of laser energy through a proprietary beam profile to stimulate a natural, biological healing response in the eye to preserve and/or improve macular appearance and function, thereby reducing disease progression. This breakthrough treatment approach retains the therapeutic benefit of laser-based therapy while eliminating the thermal tissue damage inherent in conventional retinal photocoagulation treatment.
Allowing restoration & rejuvenation
2RT stimulates the natural immune response of the retina, resulting in drusen clearance and restoration of natural metabolite flow to the retinal environment, through a limited apoptosis effect. This response has a diffuse positive remote effect on the surrounding tissue without tissue necrosis or inflammation.
As a result, the RPE is rejuvenated without damage to the overlying neurosensory retina (specifically, no damage is caused to the photoreceptors and choroid.)
Selectively target individual cells
The three-nanosecond pulse of 2RT is designed to exclusively target selected, individual cells within the Retinal Pigment Epithelium (RPE). This unique approach of lethally injuring a small, targeted monolayer of RPE cells triggers the adjacent cells to subsequently recreate a normally functioning pigment epithelial layer. The new cells undergo a process of adaptation that releases growth factors and extracellular matrix proteins, resulting in improved permeability of Bruch’s Membrane, thereby restoring the transport of fluid.
Mononuclear Cell Response of 2RT
2RT induces a mononuclear cell response, including the release of microglia. Microglia, the resident immune cell of the central nervous system, is known to remove cellular debris and facilitate healing.
In this image, the retinal microglia are shown extending their processes through the outer nuclear layer toward the laser treatment site.
Extremely fast pulse duration
The 2RT boasts a pulse duration is 3 nanoseconds with energy of approximately 200 μJ per pulse. The underlying difference between 2RT and conventional retinal laser treatments is the use of extremely fast nanosecond pulses instead of millisecond or microsecond treatment times.
The 2RT also features a large 400 μm spot size, with patented beam profile, instead of the traditional top-hat or gaussian-shaped laser beam and 50-μm spot size commonly used in retinal photocoagulation.
AMD is a chronic eye disease that can result in blurred vision and/or a loss of central vision. When it occurs it is typically categorised into early or advanced AMD. 2RT is recommended in patients with early AMD, where it can produce bilateral improvements in macular appearance and function.
The pathogenesis of AMD has several contributing factors, including drusen, RPE changes and photoreceptor atrophy.
2RT offers the potential to intervene much earlier in the disease process and thereby eliminate or delay the risk of vision-threatening complications associated with AMD. This is a breakthrough approach to the management of AMD patients.
Clinical studies have shown 2RT to provide improvements in biological pathways that develop pathological changes implicated in the development of AMD. Specifically, improved permeability of Bruch’s membrane, drusen clearance and improved metabolite flow.
Not only has 2RT been shown to avoid significant collateral damage to the photoreceptors, it can also induce the expression of potentially protective factors, namely protein factors which have autocrine and paracrine effects.
Natural healing process
Targeted at the RPE, 2RT stimulates a natural biological healing process that results in migration and proliferation of RPE cells into the lasered area. The new cells undergo a process of adaptation that releases growth factors and extracellular matrix proteins, resulting in improved permeability of Bruch’s Membrane.
2RT also stimulates a natural immune response of the retina, resulting in drusen clearance and restoration of natural metabolite flow to the retinal environment. It has also demonstrated a fellow eye effect with respect to the clearance of drusen and up-regulation of extracellular matrix genes and microglial activity.
What is CSME?
CSME is a form of Diabetic Macular Edema (DME) characterised by the occurrence of retinal thickening and exudates within 500 microns of the fovea. As per the Early Treatment Diabetic Retinopathy Study (ETDRS), CSME can be classified based on the following;
Retinal thickening within 500 µm of the centre of the fovea, hard, yellow exudates within 500 µm of the centre of the fovea with adjacent retinal thickening and at least one disc area of retinal thickening, any part of which is within one disc diameter of the centre of the fovea.
Benefits of 2RT for CSME
Clinical studies have shown 2RT to be as effective as retinal photocoagulation in reducing cystoid macular edema. This is secondary to diabetic retinopathy, but with the added benefit of sparing the photoreceptors and therefore retinal function, of thermal damage.
Using 500 times less energy than retinal photocoagulation, 2RT eliminates the incidence of heat damage to the retina and surrounding cells.
CSME: How does 2RT work?
The application of 2RT in the treatment of CSME patients results in targeted RPE lesions that are specific to the RPE cells. This selective approach leaves the basement membrane intact. As demonstrated in animal models and human histology evidence, this ‘wound healing’ effect occurs within 7 days for animal models and 1 month for human eyes.
In summary, selective RPE ablation and the resultant stimulation of factors within the RPE cells, both within the ablated area or the area adjacent to the lasered area, underlies the therapeutic beneficial wound-healing response of 2RT in the treatment of CSME.
Tables configured to meet your needs
The 2RT laser can be combined with the ‘Total Solution’ table range in order to meet the needs of ophthalmic offices, ambulatory surgery centres and hospital outpatient clinics.
These tables are designed to meet the needs of any environment, with the added benefit of comfort, flexibility and an optimised patient-surgeon interface. They are portable and wheelchair accessible.