IRIDEX outlines MicroPulse best practices

Glaucoma treatment usually starts with drops or surgery, but MicroPulse transscleral laser therapy sits in between: it lowers eye pressure without cutting into the eye. (eyeworld.org) (dovepress.com) IRIDEX and a 10-surgeon international Delphi panel turned that approach into a formal playbook, publishing one paper on dosimetry and patient selection in *Clinical Ophthalmology* in June 2022 and a second on technique, postoperative care and retreatment in January 2023. (dovepress.com 1) (dovepress.com 2) The group reviewed 61 published studies and used three Delphi rounds to settle questions where evidence was thin. Response rates ran 90%, 90% and 80% in the first paper, then 70%, 70% and 80% in the second. (dovepress.com) (uio​wa.edu) MicroPulse works by delivering laser energy in short bursts instead of one continuous burn, with rest periods meant to limit collateral tissue damage. That is why doctors describe it as a gentler cousin of older cyclophotocoagulation used for hard-to-treat glaucoma. (pmc.ncbi.nlm.nih.gov) (eyeworld.org) The first consensus paper said treatment should cover both hemispheres while avoiding the 3 and 9 o’clock positions, a safeguard to reduce risk to nearby ciliary nerves and vessels. It concluded the therapy is safe and effective for many glaucoma types and stages when surgeons stay within defined energy ranges. (dovepress.com) The second paper expanded from settings to execution: how to sweep the probe, what anti-inflammatory drops to use after treatment, what pressure reductions to expect, and when to repeat or enhance treatment. It also stressed that fluence depends not just on power and duration, but on how fast the surgeon moves the probe. (dovepress.com) (eyeworld.org) That last point matters because early users often learned by trial and error. Jella An of the Wilmer Eye Institute told *EyeWorld* that moving too fast can leave a surgeon thinking the device failed when the real problem was under-delivery of energy. (eyeworld.org) The backdrop is a broader shift in glaucoma care. MicroPulse was once associated mainly with refractory eyes, but the panel said it can fit earlier in the treatment pathway for selected patients, including some who are poor candidates for incisional surgery. (ophthalmologytimes.com) (dovepress.com) The evidence base is still developing. A 2023 meta-analysis found micropulse transscleral laser lowered intraocular pressure with a better safety profile than continuous-wave transscleral cyclophotocoagulation, but it also called for more high-quality comparative studies. (pmc.ncbi.nlm.nih.gov) So the story here is less a brand-new device than an attempt to standardize how a fast-adopted laser is used. After years of scattered practice patterns, glaucoma surgeons now have a published map for who to treat, how to treat them and when to treat again. (iridex.com) (dovepress.com)