Pain relief during panretinal photocoagulation for diabetic retinopathy: A national survey

Aims: Panretinal photocoagulation (PRP) for proliferative retinopathy is known to be painful for some people; however, few studies have explored the effects of pain on the procedure within clinical practice.MethodsThis was a national survey of all Ophthalmic Units within the UK undertaken in late 2006. A questionnaire with 14 questions was developed, piloted, and sent to all NHS units in the UK.ResultsA 77% response rate was achieved. The vast majority of responses (96%) were from doctors. A large proportion (79%) of units see up to 20 cases a week and most patients require up to 5 sessions of PRP. Eighty-eight percent said that the procedure is painful. Once present, pain can affect the number and strength of burns delivered and indirectly increases the number of sessions required to complete the therapy. Sub-tenons anaesthesia was the most commonly used analgesic and there is some tentative evidence to support its effect. Few units have a pre-emptive analgesic protocol. Some respondents were using laser with lower exposure and reported reduced pain.ConclusionsPRP is painful; however, most units do not deliver pain relief pre-emptively. There may be a case to support the routine use of sub-tenons anaesthesia until the full effects of new laser techniques become known. © 2009 Macmillan Publishers Limited All rights reserved.