Treatment Guidelines for

SP-Mode® Microsecond Laser Technology

The following treatment guidelines relate to using SP-Mode® Microsecond

Laser Technology with the LIGHTLas 532, LIGHTLas 577, LIGHTLas 810,
LIGHTLas TruScan and LIGHTLas TruScan Pro laser systems.
All information contained herein has been compiled in good faith from results of various generic clinical studies and
investigations, and intended to serve as general guidance only. While SP-Mode® Microsecond Laser Technology
provides a highly effective and minimally invasive treatment, LIGHTMED strongly recommends that all physicians
new to this technique seek professional peer training, and gain proficiency of current peer recommended treatment
methods prior to commencing treatment.

Introduction:
Advances in laser technology are constantly evolving, offering physicians groundbreaking and novel treatment
approaches to achieving optimum clinical outcomes for patients. In the past, retina tissue would be sacrificed during
surgery. Yet now, physicians are able to treat the central macula, and stimulate recovery and rejuvenation without
even leaving a footprint. Patients with chronic visual deficits, who are resistant to cutting-edge therapies, have
experienced their vision dramatically improve rapidly over weeks, even days. Diseases previously thought to be
inescapable may respond to this therapy without toxicity or even treatment discomfort.

Technological advances in laser using semiconductors have also enabled treatment customization with a diversity of
wavelengths, streamlined in a single multi-modality platform. The ability to treat at a threshold below detection gives
physicians optimism as never before.

LIGHTMED’s LIGHTLas 532, LIGHTLas 577, LIGHTLas 810, LIGHTLas TruScan and LIGHTLas TruScan Pro models
come standard with Conventional Continuous Wavelength (CW) and SP-Mode® Microsecond Laser Technology
treatment options.

Q: What is SP-Mode® Microsecond Laser Technology?

SP-Mode® Microsecond Laser Technology is an advanced laser technology where the treatment occurs below the
level that causes visible thermal damage. It targets the underlying pathology of vision loss by stimulating the very
cells that can nurture the damaged tissue. Unlike traditional lasers, this effect is achieved with short microsecond
bursts of laser energy that cycle on and off so that each exposure to the tissue does not generate enough heat to
cause thermal damage.

Studies have shown that physicians are now able to:

• Eliminate laser-induced thermal tissue damage and treatment side effects
• Deliver a broader range of treatment modalities
• Treat disorders at a much earlier stage
• Provide repeat treatment in retinal and glaucoma applications

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MKT-01-014
 Treatment Guidelines for SP-Mode® Microsecond Laser Technology

SP-Mode® stimulates the nurturing cells to support retinal healing, known as RPE or Retinal Pigment Epithelium,
without leaving any visible damage. During SP-Mode® treatment, the temperature elevation is confined in the RPE
and the neurosensory retina is spared; therefore, the laser leaves no visible mark and is safe for the retina. With
SP-Mode®, it may be possible to achieve the desired therapeutic effect and resolve various retinal disorders without
induction of pain and iatrogenic burns caused by visible photocoagulation.

Q: How does it work?

SP-Mode® exploits two key principles to achieve clinically effective, yet non-traumatic photocoagulation:
• Selectivity: SP-Mode® targets the RPE and isolates the heat to the tissue.
• Cold Photocoagulation: Low‐duty cycle (5% to 15% “ON” and 95% to 85% “OFF”) allows for relaxation time
between pulses; thus, thermal damage is minimized, creating a significant safety margin over traditional
Continuous Wave (CW) laser.

The type of photocoagulation may be determined by the thermal change induced in time and space. The types of
treatment may be characterized as:
• Supra-Threshold – visible mark in the exposure of the laser.
• Threshold – with mark slightly visible at the end or immediately after the laser exposure.
• Sub-Threshold (SP-Mode® Microsecond Laser Technology) ‐ no visible mark.

SP-Mode® Microsecond Laser Technology avoids cell necrosis, apoptosis, formation of bubble with micro-explosions
and hyperthermia of the retina.
Target Area:
CW Laser Temperature rise
POWER

Conventional Continuous Wave (CW) Treatment 20-30°C (above

normal body
Target Area: temperature of 36°C)
CW Laser TIME Temperature rise Target Area:
POWER

CW Laser Temperature rise

20-30°C (above
POWER

Laser Adjacent
20-30°C Area:
(above
ON Time normal body
Target Area: of 36°C)
temperature Temperature
normal body rise
TEMPERATURE

CW Laser Temperature rise 10-20°Cof(above

temperature 36°C)
TIME
POWER

Laser TIME 20-30°C (above normal body

Adjacent Area:
ON Time Laser normal body rise temperature of 36°C)
Adjacent Area:
Temperature
ON Time temperature of 36°C)
10-20°C (above Temperature rise
TIME TIME
normal body 10-20°C (above
Laser Adjacent Area:
temperature of 36°C) normal body
ON Time Temperature rise temperature of 36°C)
10-20°C (above
normal body
temperature of 36°C)
SP-Mode Pulse ON
Next-Generation Sub-Threshold
SP-Mode® Microsecond (SP-Mode) Technology
Laser Technology Target Area:
POWER

Pulse OFF
Pulse PERIOD
Temperature rise 10-15°C
SP-Mode® ON Pulse ON (above normal body
SP-Mode Time Target
Pulse ONArea: temperature of 36°C)
POWER

Pulse OFF
TIME Target Area:
Temperature riseOFF
10-15°C
POWER

Pulse
ON Pulse PERIOD
Time OFFPulse (above normal body No visible burn
Temperature rise 10-15°C
SP-Mode Pulse PERIOD
temperature of 36°C) mark seen in
(above normal body
TimeON Pulse
TEMPERATURE

ON Target Area:
TIME
POWER

OFF Time
OFF temperature ofSP-Mode
36°C) treatment
Pulse PERIOD TIME Temperature rise 10-15°C
Time (aboveNonormal
visiblebody
burn
ON OFF mark seen in No visible burn
Time temperature of 36°C)
TIME Time SP-Mode treatment
TIME mark seen in
SP-Mode® treatment
OFF No visible burn
Time mark seen in
SP-Mode treatment

In SP-Mode®, there are two important time

ON
intervals:
• The time “ON” is the duration of irradiation time, in which the laser is turned on.
• The time “OFF” is the interval between successive “ON” periods, which enables the retina the relaxation time and
allows for cooling. This regulates the additive effect of each pulse of laser power.

PULSE ON?

PULSE OFF

PULSE ON?

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PULSE PERIOD

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PULSE OFF

PULSE ON?
PULSE PERIOD
 Treatment Guidelines for SP-Mode® Microsecond Laser Technology

The ratio of irradiation time during one cycle is known as the duty cycle. One cycle is 1/500th of a second or 2
milliseconds, which equals 2000 microseconds. When the duty cycle is set to 10%, irradiation is ON for 200
microseconds and OFF for 1800 microseconds with irradiation repeated during this process. Duty cycle and power
are adjusted to provide the required level of energy to be applied to the target cells. The repetition rate is how
quickly each pulse is delivered. Duty cycle and repetition rate determine the additive effect of elevated temperature
produced by each SP-Mode® pulse.

Types of Treatments:
Ongoing clinical studies and publications demonstrate the SP-Mode® as a very safe and effective treatment
indicated for MOST cases and conditions of retinal photocoagulation. SP-Mode® has also been shown to be highly
effective in clinical cases of:
• Diabetic Macular Edema
• Macular Edema from Retinal Vein Occlusions (CRVO, BRVO)
• Central Serous Retinopathy

Pre-Treatment:
SP-Mode® with the LIGHTMED laser can be performed with the patient sitting at a slit lamp or treated with an LIO
(Laser Indirect Ophthalmoscope).

Ocular Mainster (Standard) Focal / Grid Laser Lens

Product Code Static Field of View Laser Spot Mag. Image Mag.
OMRA–S 90° 1.05x .96x
OMRA–S–2 90° 1.05x .96x

Volk (Standard) Area Centrallis Laser Lens

Product Code Static Field of View Laser Spot Mag. Image Mag.
Area Centrallis 70° / 84° 1.06x .94x

Treatment:
SP-Mode® treatment power must first be clinically evaluated by physicians. The example below uses the titration
method for treating macular edema. Power may differ for individual patients. In order to determine this power
experimentally:
• Activate the laser in SP-Mode®.
• Set laser power to 600mW, duty cycle to 5% (100 microseconds ON, 2900 microseconds OFF), duration of
irradiation to 2000 microseconds, and interval to 2000 microseconds.
• Position the laser lens on the patient’s eye and make a visible test burn applied outside the posterior pole,
nasal to the optic disc, avoiding any areas of edema or hemorrhage.
• When firing the laser, increase power incrementally, and carefully observe the lesion until a light grey
discoloration (burn mark) is produced, indicating the optimum treatment power threshold range. Record that
SP-Mode® power setting then divide in half.

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Treatment Guidelines for SP-Mode® Microsecond Laser Technology

• For example, if the SP-Mode® power needed to make a light grey burn mark using 5% duty cycle is 640mW,
then reduce the power to 320mW.
• After reducing the power in half, apply laser several times on non-edematous area to make sure the laser does
not induce any tissue reaction.
• After confirming that the laser does not cause a tissue reaction, apply high-density sub-threshold laser to the
entire treatment area and repeat the sub-threshold laser applications as necessary.

Clinical research indicates that higher density or confluent laser spots may enhance the clinical effectiveness of
SP-Mode®, which enriches the area of activation of the RPE.

In other words, the greater the number of pulses, the lower the energy required per pulse to achieve the same level
of effectiveness, which in turn can also overcome the limitations in use of laser power. It is not recommended to
increase the spot size beyond the recommended treatment protocols because this can affect the safety and desired
clinical outcome of the laser treatment.

Post‐Treatment:
• Post-operative topical medication is not routinely necessary.
• Patients are usually seen post-operative follow up within 4-6 weeks, monitored at monthly intervals in the short
term. Improvement in patient vision may continue for several months after treatment.
• Ongoing care is determined at the frequency determined by the patient’s underlying conditions under the
discretion of the physician.
• SP-Mode® treatment may be performed repeatedly over the previously treated lesions as indicated and
recommended by the physician.

Conclusion:
Information derived from various ongoing clinical studies indicate when used by qualified physicians following
recommended parameters, SP-Mode® treatments are very safe with no known adverse side-effects.

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USA TAIWAN JAPAN

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