EURETINA 2026: Retinal laser myths and simulation: a Q&A with Serena Salvatore, MD

Anti-vascular endothelial growth factor (VEGF) therapy has transformed retina care, but it has also left today's fellows performing a fraction of the panretinal photocoagulation (PRP) and macular laser procedures their predecessors did, even though laser remains the right treatment for some patients. At the 26th Congress of the European Society of Retina Specialists (EURETINA), held 1–4 October 2026 in Vienna, Austria, Serena Salvatore, MD, co-chaired the symposium "Mastering Retinal Lasers: Practical Skills, Simulation, and Myth-Busting for Retina Specialists" with Noemi Lois, MD, PhD, a programme designed for residents, fellows and early-career retina specialists.

Salvatore is a consultant ophthalmologist and clinical lead for medical retina and the clinical research unit at Bristol Eye Hospital, Bristol NHS Foundation Trust, in the UK. She closed the symposium with "Myth busters: laser facts vs fiction," in which attendees marked each of 14 claims about retinal laser as fact, fiction or "it depends" before 4 faculty members gave their verdicts.¹

The session was structured in 5 movements covering PRP, lens choice and laser settings, subthreshold micropulse laser, photodynamic therapy (PDT) and retinal vein occlusion. Claims judged to be fiction included the idea that PRP has no place in the anti-VEGF era, that laser settings carry over unchanged between contact lenses and that patients must stay in a dark room after PDT. The claim that subthreshold micropulse laser can work with no visible effect was judged to be fact. A closing tiebreaker asked how many pattern laser burns it takes for severe proliferative diabetic retinopathy to regress. The answer, 6,924, is nearly 6 times the Early Treatment Diabetic Retinopathy Study (ETDRS) minimum of 1,200 burns.¹

In the following Q&A, Salvatore discusses the training gap the symposium was designed to address, how its sessions on laser technique, subthreshold micropulse laser, PDT and simulation fit together, the most persistent myths about retinal laser therapy and practical steps toward safer, more consistent laser treatment.

The following Q&A has been lightly edited for length and clarity.

Ophthalmology Times Europe (OTE): What is the central aim of the Mastering Retinal Lasers symposium at EURETINA, and what gap in current retina training or practice was it designed to address?

Serena Salvatore, MD: Laser has quietly become the procedure we assume everyone can do and nobody is quite sure who taught them. Anti-VEGF changed retina treatment for the better; however, it also changed training. Today's fellows do a fraction of the PRP and macular laser their predecessors did, yet laser has not disappeared from our treatment tools. It is still the right answer for some patients, and sometimes the only realistic one. The Mastering Retinal Lasers symposium was designed for residents, fellows and early-career retina specialists. The aim is simple: to rebuild confidence and competence in laser as a deliberate, evidence-based choice rather than a fading habit or a forgotten skill.

OTE: How do the individual sessions fit together across the symposium, and which key takeaways should attendees leave with?

Salvatore: The course moves from foundation to judgement. Marco Lupidi opens with practical settings, lenses and technique. Noemi Lois takes subthreshold micropulse laser, Andrew Lotery PDT and Peter Scanlon simulation as a way to learn and keep the skill. I close with Myth Busters, where the room votes on 14 claims before the faculty give their verdicts. Each talk answers one question: How do I do this well, when is it the right tool and how do I stay good at it? The takeaways are 3. Laser is a precision instrument, not a blunt one, so your settings and your lens matter more than you think. Laser and anti-VEGF are partners, not rivals. And skill decays without practice, so we need to train on and with purpose.

OTE: Within the "Myth busters: laser facts vs fiction" session, which misconceptions about retinal laser therapy are most persistent, and what does the evidence show about them?

Salvatore: The most stubborn myth is that anti-VEGF has made macular laser, and sometimes PRP, obsolete in proliferative diabetic retinopathy. Protocol S and CLARITY showed that anti-VEGF is a strong alternative. However, eyes lost to follow-up after injections alone do worse than eyes that had PRP. Laser is durable when attendance is not.

The second myth is that settings travel between lenses. They don't. Set 200 µm through a SuperQuad 160 and the retina receives about 400 µm; through a Transequator, about 288 µm. The lens is not a window.

A third is that PRP pain is something patients simply put up with. A 2025 network meta-analysis ranked peribulbar lidocaine first to reduce procedural pain, and a patient who leaves in pain may not come back.

Micropulse has an image problem. No visible burn, no visible change at the slit lamp, so it must be doing nothing. That's fiction. Subthreshold micropulse laser works by stimulating the retinal pigment epithelium without destroying it. The DIAMONDS trial, led by our own faculty member Noemi Lois, found it no worse than standard laser for visual outcomes in centre-involving diabetic macular oedema (DMO) with modest thickening.

Finally, PDT faces a different problem: fewer and fewer of us have been taught how to do it. Many trainees finish their fellowship without ever planning a spot size or setting up an infusion. That is exactly why Andrew Lotery's session matters. He will show how PDT is actually done, from patient selection to the moment the laser fires, with a particular focus on chronic central serous chorioretinopathy. That is where PDT has its strongest modern case.

OTE: What role can simulation play in building and maintaining laser skills, particularly for trainees and early career retina specialists who may perform fewer laser procedures than previous generations?

Salvatore: Surgery accepted long ago that you don't learn on patients first. Laser has been slower to follow, partly because it looks deceptively simple. Simulation lets a trainee learn burn titration, spot spacing and lens handling with no human retina at stake, repeat the same task until it is consistent and get objective feedback rather than "that looks about right." For a generation that may do a few dozen PRP sessions in training rather than a few hundred, that is the difference between competence and confidence. It matters after training too. A skill you use twice a month fades, and simulation offers a way to keep it in tune before the patient who really needs it arrives. Simulation does not replace supervised cases. It means those cases start further up the curve.

OTE: What practical advice would help retina specialists improve the safety and consistency of their laser technique in everyday clinical practice?

Salvatore: Know your lens and check its magnification factor before you set a spot size. For PRP, titrate every session: start low, build up to a light grey burn and adjust for media, pigmentation and the part of the retina you're treating. Remember that pattern lasers use shorter pulses and smaller effective burns, so they need more burns to reach the same area treated. Take analgesia seriously and talk to the patient during the session. Record your settings, lens and burn count every time so the next clinician can build on your work rather than guess. For subthreshold micropulse laser, make sure you are aware of your duty cycle settings, and for PDT, correctly identify the area to treat.

Reference
1. Salvatore S. Myth busters: laser facts vs fiction. Presented at: 26th Congress of the European Society of Retina Specialists (EURETINA); October 1-4, 2026; Vienna, Austria.