Proliferative Diabetic Retinopathy: Understanding Your Treatment Choices

A patient information and decision-making sheet

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This sheet is to help you understand the two main treatments for proliferative diabetic retinopathy (PDR) and to support a conversation with your eye specialist. It is general information, not personal medical advice. The right choice depends on your eyes, your circumstances and your wishes. There is more than one reasonable choice, and the decision is yours to make with your doctor. Please read it, write down your questions, and ask your eye specialist anything that is unclear.

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⚠ DANGER — the greatest risk to your sight is dropping out of care, whatever treatment you choose

The single biggest danger is not which treatment you pick — it is missing appointments and dropping out of care. This applies equally to BOTH injections AND laser.

When follow-up is interrupted, proliferative diabetic retinopathy can progress silently to bleeding, retinal detachment and irreversible blindness — even in an eye that was doing well. In a study of patients treated with injections alone whose treatment then lapsed, most lost three or more lines of vision and nearly half ended with vision of “hand movements” or worse.

When things go wrong, it is almost always the FOLLOW-UP that has failed — not the treatment, and not the “protocol.” Both injections and laser work when you keep attending. Please commit to lifelong appointments, and tell us early if illness, cost, transport or anything else is getting in the way, so we can help you stay in care.

 

1. What is proliferative diabetic retinopathy?

Diabetes can damage the small blood vessels at the back of the eye (the retina). Over years, some of these vessels close off, so parts of the retina stop getting enough oxygen. We call these areas ischaemic — areas of retina with reduced blood flow.

In response, the ischaemic retina releases a chemical signal called VEGF. VEGF tells the eye to grow new blood vessels. Unfortunately these new vessels are abnormal and fragile. This stage is called proliferative diabetic retinopathy. The fragile vessels can:

• bleed into the eye (vitreous haemorrhage), causing sudden floaters or loss of vision;

• form scar tissue that pulls on the retina and can detach it (tractional retinal detachment);

• grow on the iris and block fluid drainage, raising eye pressure (neovascular glaucoma).

Untreated, PDR is one of the leading causes of blindness in working-age adults. The good news is that PDR is treatable, and serious vision loss is largely preventable if it is treated and followed up properly.

Two things are worth understanding before we talk about treatment:

1. Treatment controls the new vessels; it does not "cure" the diabetes in the eye. The underlying vessel closure can keep progressing over time whichever treatment you choose, so lifelong monitoring is essential no matter what.

2. Why people develop PDR is complex. It reflects how long someone has had diabetes, blood sugar and blood pressure control, kidney health, genetics and access to eye care — not simply whether a person "tried hard enough." This matters because it means the choice below should be offered openly to everyone, with full information.

 

2. The two main treatments

There are two well-proven ways to switch off the abnormal vessels. Both work. They work in different ways and have different trade-offs.

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Treatment A — Laser (panretinal photocoagulation, "PRP")

The laser deliberately burns the oxygen-starved peripheral retina. By destroying the ischaemic tissue, it removes the source of the VEGF signal, and the abnormal vessels shrink. This has been the standard treatment since the 1970s–1980s.

An important point that is often glossed over: "laser" is not one treatment. There are several quite different forms, with different intensity, delivery and results (see Section 4a). Doctors often discuss "PRP" as if it were a single thing, when in fact the version you receive makes a real difference to how durable it is and how much side vision it costs you.

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Treatment B — Injections (anti-VEGF) — the "Protocol S" approach

A very fine needle places a tiny amount of an anti-VEGF drug (such as ranibizumab, brand name Lucentis, or another anti-VEGF medicine) into the eye. This blocks the VEGF signal directly, so the abnormal vessels regress without burning the retina. Because the medicine wears off, injections must be repeated. This injection-based pathway is what the landmark Protocol S trial tested against laser.

How often are injections needed? Injections are not simply "monthly forever." In the Protocol S trial, in eyes withoutmacular swelling, treatment started at roughly one injection every two months (about 8-weekly) and then became less frequent as the eye settled. The average number of injections per year fell steadily over time:

 

This averaged about 19 injections over 5 years. In our own practice, a realistic expectation is around 3–4 injections per year, continuing indefinitely for as long as the eye needs it.

Many people with PDR also have diabetic macular oedema (DME) — swelling of the central retina that blurs reading vision. DME is itself treated with anti-VEGF injections. So a large number of PDR patients will need injections for the macula regardless of which PDR treatment they choose for the periphery. In the Protocol S trial, about 53% of the eyes in the laser group still needed anti-VEGF injections for macular swelling — meaning that choosing laser does not necessarily spare you from injections.

 

3. What the major studies and guidelines tell us

You may want to discuss these with your specialist. The key points, in plain language:

The Diabetic Retinopathy Study (DRS) and the Early Treatment Diabetic Retinopathy Study (ETDRS), 1970s–1990s.

These large trials established laser as the gold standard. Importantly, laser reduced — but did not eliminate — the risk of severe vision loss; it roughly halved it. For example, in high-risk eyes the four-year risk of severe vision loss was around 44% without treatment and around 20% with full laser. Two honest conclusions follow from this: even with the heaviest laser, a meaningful share of eyes still lost vision; and, conversely, roughly half of untreated eyes did not go on to severe vision loss. Laser tilts the odds strongly in your favour, but it is not an absolute guarantee, and it is not free of cost to the eye.

The ETDRS also found that scatter laser has side effects on central vision and on side (peripheral) vision, greatest in the months after treatment. Because of this harm, the studies recommended reserving full laser for high-risk disease rather than treating every ischaemic area early. (This historical caution about over-treating is part of why gentler, more selective "light" and targeted laser approaches were later developed — see Section 4a.)

Protocol S — the trial comparing injections with laser (US; results 2015 and 2018).

About 394 eyes with PDR were randomly assigned to anti-VEGF injections or to laser.

• At 2 years, injections were at least as good as laser for vision.

• At 5 years, vision was very good and essentially equal in both groups (average change of about 3 letters either way — both excellent, around 20/25 on average). Serious vision loss was rare in both.

• The differences were in the secondary outcomes — these are quantified in Sections 4 and 5.

• Important caution: by year 5, only about 61% of eyes were still attending (69% in the injection group, 65% in the laser group) — meaning roughly 4 in 10 had dropped out of the study. This loss to follow-up is itself one of the central issues in this whole decision (see Section 6).

CLARITY (UK, 2017) found a similar result using a different anti-VEGF drug (aflibercept), which was at least as good as laser at one year for PDR.

What the guidelines say. Major guidelines on both sides of the Atlantic regard both laser and anti-VEGF injections as legitimate, evidence-based treatments for PDR, and recommend that the choice be individualised to the patient:

• The American Academy of Ophthalmology Preferred Practice Pattern states that anti-VEGF agents effectively treat PDR and that laser (PRP) remains an important treatment.

• UK and European guidance (the UK National Institute for Health and Care Excellence, and the Royal College of Ophthalmologists) lists observation, laser and anti-VEGF as the options for PDR. These bodies still generally regard laser as the long-standing first-line / mainstay treatment, with anti-VEGF an accepted evidence-based option — used as primary treatment in certain situations and/or alongside laser.

• An international expert consensus (2025) states plainly that both laser and anti-VEGF have proven efficacy and that treatment should be individualised to the patient, including whether macular swelling is present.

The bottom line from the evidence: Both treatments are legitimate, evidence-based choices endorsed by international guidelines. Injections tend to protect side vision and the central retina better; laser is far less demanding in terms of the number of treatments provided it is completed and provided follow-up continues. Neither is simply "better" for everyone.

 

4. Laser (PRP) — what it involves, and its pros and cons

What it is like to have it

It is important to be realistic about the experience, because this is often under-explained:

• In a standard clinic (slit-lamp) setting, full laser is usually not done in one go. It commonly takes around 4–6 visits to complete safely.

• It is uncomfortable, and for many people genuinely painful, especially towards the periphery, and the discomfort can build through the session. This is not a minor issue: in some reports up to around 64% of patients could not complete their laser because of pain, which then left them under-treated and at higher risk of vision loss. Surveys find the large majority of patients describe laser as painful.

• For some people the experience is frightening and distressing, and the bright flashes and after-images can be unpleasant for hours.

• Gentler laser options exist and are discussed in Section 4a and Section 8.

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4a. Not all laser is the same — the four main types

This is one of the most important and least-discussed facts about laser. The four forms differ substantially in how they are applied, how durable they are, and how much side vision they cost:

1. Conventional (ETDRS-style) heavy PRP — the original, heaviest scatter laser. The most thorough and durable, but the most uncomfortable and the most costly to peripheral vision.

2. Single-session complete PRP in an operating theatre — heavy, complete laser delivered in one sitting using an indirect laser under sedation, so the patient is comfortable and the far periphery can be reached. Heavy and durable.

3. Light PASCAL / pattern-scanning laser — rapid, short-pulse "lighter" burns; far more comfortable and quicker, with less collateral damage, but lighter and often less durable per treatment.

4. Selective (targeted) light PRP to areas of retinal ischaemia — only the oxygen-starved zones (mapped on a dye scan) are treated, sparing healthy retina and more side vision; gentler, but again less durable.

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A candid clinical view worth understanding: in general, the heavier, more complete laser (theatre indirect laser, and the endolaser used during vitrectomy surgery) tends to be the most durable and effective. The lighter and more selective approaches are a compromise — kinder to comfort and side vision, but more likely to leave disease that needs re-treatment. The Protocol S trial bears this out: even after "complete" laser, about 45% of laser-treated eyes needed additional (supplemental) laser within 2 years, and about 51% needed more than a single full treatment over 5 years.When you discuss laser, ask specifically which of these four types is being proposed, because the trade-offs are different (this is also why the consent section asks you to specify the type).

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The arguments for PRP laser

• Durable and long-lasting. Once an ischaemic area of retina (an area with reduced blood flow) has been treated, the effect is largely permanent. The eye is not dependent on coming back every few months for an injection.

• Fewer total treatments than injections over the years (Protocol S: about 5 versus about 19).

• Safer if you are likely to miss appointments. This is the single most important point in laser's favour. If follow-up is interrupted, an eye that has had laser is much more protected than an eye relying on injections that have worn off (see Section 6).

• Lower long-term cost and fewer trips to hospital.

• Well understood, with 50 years of experience.

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The arguments against PRP laser

• It works by destroying retina. The treated areas are deliberately scarred and will never function again.

• Loss of side (peripheral) vision. Because the laser burns the peripheral retina, peripheral vision is reduced. In Protocol S the loss of visual field was clearly worse in the laser group than the injection group, and this was still true at 5 years (a cumulative visual-field score change of about −527 dB with laser versus about −330 dB with injections — the laser group lost substantially more field). Although ischaemic retina is not working normally, it is usually not completely blind beforehand — so some genuinely useful side vision and night vision is given up.

• Driving. Loss of peripheral field can take a person below the legal standard for driving in Australia (see Section 7). For some people this is life-changing.

• Reduced night vision and contrast, and sometimes glare.

• It can worsen central swelling (macular oedema) in the short term, which can blur the central vision.

• The scars enlarge over time. Laser scars do not stay the same size. Studies tracking laser scars for several years found that the large majority slowly expand — by roughly 7–13% per year on average, and faster more than four years after treatment. Scars near the centre can, rarely, creep into the central vision and cause delayed sight loss. So some of laser's downside is not felt on day one but accumulates over the following years.

• It often still needs top-ups (see Section 4a — about half of eyes needed more laser), and many eyes still need injections for macular swelling anyway.

• It cannot be undone. This is the most important point about laser and is discussed on its own below.

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Laser is permanent — which is both a benefit and a harm

The permanence of laser cuts both ways, and you should weigh both sides:

• As a benefit: the treatment "stays done." It keeps protecting the eye even if you cannot attend regularly.

• As a harm: once laser is given and completed, it cannot be reversed. The burned retina, the lost peripheral field and any effect on driving are permanent. If, in a few years, gentler or better treatments arrive (Section 9), an eye that has already been fully lasered cannot get that retina back. You cannot change your mind after the retina has been treated.

By contrast, the injection pathway is, in an important sense, reversible as a strategy: you are not destroying retina, and you can revisit and change your decision later — including switching to laser down the track if injections are not suiting you, or if your circumstances change. This asymmetry — injections keep your options open, laser closes them — is one of the most important things to understand before deciding.

 

5. Injections (anti-VEGF / Protocol S) — what it involves, and its pros and cons

What it is like to have it

• The eye is numbed and cleaned. The injection itself is quick and most people find it far more tolerable than laser, though it can sting and the eye may feel gritty afterwards.

• The cost is frequency and commitment: injections start at about one every two months (when there is no macular swelling) and are then spaced out as the eye stabilises, but they continue over years. In the Protocol S trial this averaged about 7 injections in the first year, then about 3 per year thereafter (around 19 over 5 years); in our experience around 3–4 per year continuing indefinitely is realistic.

The arguments for injections (with the trial differences)

• No retina is destroyed. The medicine switches off the signal rather than burning tissue.

• Better side vision preserved — substantially less visual-field loss than laser at 5 years (about −330 dB versus −527 dB).

• Less central swelling (macular oedema). Vision-impairing DME developed in about 22% of injection eyes versus about 38% of laser eyes over 5 years.

• Fewer retinal detachments — about 6% of injection eyes versus about 15% of laser eyes (mostly tractional detachments).

• Fewer vitrectomy operations — vitrectomy was needed in about 11% of injection eyes versus about 19% of laser eyes over 5 years.

• Treats coexisting macular swelling at the same time.

• It keeps your options open — you are not committing to anything irreversible, and you can change course later.

• It may position you for newer, lower-burden treatments that are coming (Section 9).

The arguments against injections

• They wear off and must be repeated — potentially many injections over years (about 19 over 5 years in the trial; commonly 3–4 per year indefinitely in practice). This is a major commitment of time, travel and attendance.

• The disease almost always comes back if injections stop. Anti-VEGF controls the disease while it is being given; it does not reperfuse the retina or remove the underlying drive. There are exceptions — occasionally, a patient who substantially improves their diabetes control and stops smoking can have the disease settle enough that injections can be stopped for a long time — but this is the exception, not the rule.

• Cost and access can be a barrier, although in Australia this is now substantially helped (Section 10).

• Small but real risks of the injection itself (Section 5a).

• "Injection fatigue" is common — the ongoing burden wears people down, which is one reason follow-up can lapse.

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5a. The risks of injection — small, but real

Anti-VEGF injections have an excellent safety record, but no eye procedure is risk-free. You should be told about these even though they are uncommon:

• Serious eye infection (endophthalmitis) — about 1 in 3,000 injections. It is rare but can cause severe, permanent vision loss, so any increasing pain, redness or vision drop in the days after an injection must be reported urgently. (In the entire Protocol S trial, only one eye developed this.)

• Retinal tear or detachment — about 1 in 8,000 injections.

• Bleeding in the eye — about 1 in 1,000 injections — usually minor.

• A sudden tightening of pre-existing scar tissue ("crunch") can pull on the retina and occasionally needs urgent vitrectomy surgery. This can happen with both injections and laser; it is somewhat more associated with injections but is still rare. Notably, looking at the overall picture, the laser group in fact needed more vitrectomy surgery than the injection group (about 19% versus 11% over 5 years), because of bleeding and traction from the disease itself.

• Eye soreness, redness, floaters or a small red patch on the white of the eye — common and harmless.

• A theoretical, small concern about clot-related events from medicine entering the bloodstream; the absolute risk is low, and the trial found no significant difference between groups.

 

6. The single most important thing: follow-up

Dropping out of care is the single biggest risk to your sight — regardless of which treatment you choose. This is the heart of the decision.

The Protocol S (injection) approach works very well — but only when people keep attending and never drop out of care. It is most dangerous precisely when follow-up is interrupted. This is not a flaw in the protocol itself; it is what happens when the medicine wears off and is not renewed. A key study looked at patients with PDR who were lost to follow-up for more than six months:

• Eyes that had received injections only and then dropped out did worse — with more tractional retinal detachments and more abnormal vessels on the iris — than eyes that had received laser and dropped out.

• The laser eyes were comparatively protected during the gap in care, because laser "stays done."

Drop-out is common — and it is common with both treatments. Even inside a carefully run trial with reminder systems, only about 61% of Protocol S eyes were still attending at 5 years (around 4 in 10 had dropped out), and real-world studies show roughly a quarter of PDR patients are lost to follow-up after starting treatment. This is rarely about character; diabetes is a whole-body disease, and kidney problems, foot problems, heart problems, hospital admissions, transport, work and cost all compete for a person's time and energy.

So the honest summary is:

If you choose injections, you must be able to commit to ongoing appointments. If there is a real chance your follow-up will be interrupted, laser is the safer choice — because it protects the eye even when you cannot attend.

This deserves an honest conversation about your real-life situation: how far you live from care, your other health problems, your work and family commitments, and how confident you are that you can keep coming back for years.

 

7. Peripheral vision and driving in Australia

Laser reduces side (peripheral) vision. This is not just about comfort — it can affect your legal ability to drive.

In Australia, the national medical standard (Assessing Fitness to Drive, Austroads) for a private car licence generally requires:

• visual acuity of at least 6/12 with both eyes open; and

• a horizontal field of vision of at least 110 degrees.

If the field falls between 90 and 110 degrees, a conditional licence may sometimes be supported by an eye specialist. Commercial drivers face a stricter standard (around 140 degrees) — so for professional drivers this is especially serious.

There is an extra subtlety that is rarely explained: both laser scars and untreated ischaemic (dead-flow) areas of retina expand over time. This means you might comfortably meet the driving standard today, but fall below it years or decades later as the treated and ischaemic areas slowly enlarge. Most doctors will deliberately try to avoid placing laser within the central field used for driving; but the opposite is also true — leaving ischaemic retina untreated is itself a risk for the disease progressing. This balance is part of why the type and placement of laser matters (Section 4a), and why some people prefer the injection pathway, which does not destroy peripheral retina. If driving is important to you, raise it specifically before agreeing to laser.

 

8. Newer and gentler laser options

If you and your specialist decide laser is right, it does not have to mean the most aggressive version. Ask about:

• Pattern-scanning laser (e.g. PASCAL). Many short, rapid spots; significantly more comfortable, often fewer sittings (sometimes one), and less collateral damage. The trade-off is that lighter laser can be less durable (Section 4a).

• Targeted (selective) laser. A wide-field dye scan maps exactly which areas are ischaemic, and only those areas are treated — sparing healthy retina and more of your side vision. Gentler, but usually needs careful follow-up and sometimes top-up treatment.

• Single-session complete laser under sedation in theatre — heavy, durable laser done comfortably in one go for people who would struggle with multiple clinic visits.

• A combination / sequenced approach — see Section 11 for how this is often done in practice.

 

9. What is coming in the future

One reason some patients and doctors lean towards the injection pathway is that it preserves the retina and keeps options open while the field is changing quickly. Researchers are actively developing treatments designed to reduce or eventually replace frequent injections, including:

• Longer-acting medicines and slow-release implants that could last many months from a single treatment;

• Tyrosine kinase inhibitors (TKIs) — small molecules being tested as long-lasting, slow-release treatments for diabetic retinopathy;

• Gene therapy, aiming for a "one-off" treatment that makes the eye produce its own anti-VEGF.

These are promising but still investigational for diabetic retinopathy and are not yet standard care, so they should not be relied on for a decision today. But the direction of travel is towards lower-burden, retina-sparing treatment — and a patient who keeps the retina intact now may be better placed to benefit later. A fully lasered retina cannot be un-burned. This is a genuine consideration, not a guarantee.

 

10. Cost and access in Australia

There is good news on access for the injection pathway:

• Government subsidy (PBS). The anti-VEGF medicine ranibizumab (Lucentis) is subsidised by the Australian Government through the Pharmaceutical Benefits Scheme for proliferative diabetic retinopathy (and/or diabetic macular oedema), with this listing in effect from 1 October 2025. (Ranibizumab is the anti-VEGF drug specifically registered and PBS-listed for PDR in Australia; other anti-VEGF drugs may be used but can be off-label for PDR.)

• Private health insurance. Patients with private health insurance can use it for their eye injections done in private hospitals and day surgeries. A proposed Medicare reclassification that would have removed this was abandoned by the Federal Health Minister (the Hon. Mark Butler MP) on 6 March 2026, who confirmed there will be no change to patients' ability to make private health insurance claims for these procedures, with funding committed in the 2026 federal budget to protect access.

• Medicare item numbers to ask about. Fees vary between doctors and settings, so ask your doctor directly what they will charge per treatment. The relevant items are 42809 for laser (PRP) and, for injections, 43030 and 43032. Ask about any out-of-pocket "gap," and about facility fees.

• Sedation in theatre. Both laser and injections can be performed under sedation in an operating theatre if needed — useful for anxious patients or those who find clinic treatment difficult.

Your specialist or their staff can explain your eligibility and the likely out-of-pocket costs for each option.

 

11. Your role: this is a shared decision

There is rarely a single "correct" answer. A reasonable, well-informed person could choose either treatment, and international guidelines support both (Section 3). What matters is matching the choice to your eyes, your life and your values.

How this is often done in practice

Many specialists — including in our own practice — will give an anti-VEGF injection first and then take time before deciding about laser. There are good reasons for this:

• it is safer — it settles the active disease and reduces bleeding before any laser;

• it reveals how much macular swelling (DME) is present or was hidden, which guides the rest of the plan; and

• it keeps your options open while you decide.

This is also why Option 3 on the consent page is "one injection first, then reconsider" — that is genuinely how the choice often unfolds.

Questions you may want to ask your specialist

Many of these are answered in the sections above — use them as a checklist and ask your specialist to confirm for your eyes:

• Which of the four types of laser (Section 4a) are you proposing for me, and why?

• How much side vision / driving field am I likely to lose with laser? (The trial evidence — Sections 4 and 7 — is that laser loses substantially more visual field than injections: roughly −527 dB versus −330 dB at 5 years.)

• If I choose injections, how many will I realistically need (Section 2/5), and for how long?

• What happens to my eye if I miss appointments (Section 6), and how worried should I be in my situation?

• Would an injection first, then laser later (above) suit me best?

• What are my out-of-pocket costs for each option, including the Medicare items and my private insurance (Section 10)?

• Can I start with injections and change to laser later if I want to? (Section 4: yes — injections are reversible as a strategy; laser is not.)

You do not have to decide today — but please do not delay the decision to have one of the treatments. Active PDR is dangerous, and delay risks bleeding, retinal detachment and permanent vision loss. It is fine to take a little time, ask more questions, bring a family member, or get a second opinion. If you choose injections, you can revisit and change your decision later. If you choose laser, please be sure, because once it is done it cannot be undone.

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References

1. The Diabetic Retinopathy Study Research Group. Photocoagulation treatment of proliferative diabetic retinopathy: clinical application of DRS findings. Ophthalmology. 1981.

2. Early Treatment Diabetic Retinopathy Study Research Group. Early photocoagulation for diabetic retinopathy. ETDRS report number 9. Ophthalmology. 1991;98(5 Suppl):766–785.

3. Gross JG, Glassman AR, Jampol LM, et al; DRCR.net. Panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial (Protocol S, 2-year). JAMA. 2015;314(20):2137–2146.

4. Gross JG, Glassman AR, Liu D, et al; DRCR.net. Five-year outcomes of panretinal photocoagulation vs intravitreous ranibizumab for proliferative diabetic retinopathy: a randomized clinical trial. JAMA Ophthalmol. 2018;136(10):1138–1148.

5. Sivaprasad S, Prevost AT, Vasconcelos JC, et al; CLARITY Study Group. Aflibercept versus panretinal photocoagulation for best-corrected visual acuity in proliferative diabetic retinopathy at 52 weeks (CLARITY). Lancet.2017;389(10085):2193–2203.

6. Obeid A, Su D, Patel SN, et al. Outcomes of eyes lost to follow-up with proliferative diabetic retinopathy that received panretinal photocoagulation versus intravitreal anti-VEGF. Ophthalmology. 2019;126(3):407–413.

7. Obeid A, Gao X, Ali FS, et al. Loss to follow-up in patients with proliferative diabetic retinopathy after panretinal photocoagulation or intravitreal anti-VEGF injections. Ophthalmology. 2018;125(9):1386–1392.

8. Maeshima K, Utsugi-Sutoh N, Otani T, Kishi S. Progressive enlargement of scattered photocoagulation scars in diabetic retinopathy. Retina. 2004;24(4):507–511.

9. Schatz H, Madeira D, McDonald HR, Johnson RN. Progressive enlargement of laser scars following grid laser photocoagulation for diffuse diabetic macular edema. Arch Ophthalmol. 1991;109(11):1549–1551.

10. Morgan CM, Schatz H. Atrophic creep of the retinal pigment epithelium after focal macular photocoagulation. Ophthalmology. 1989;96(1):96–103.

11. Muraly P, Limbad P, Srinivasan K, Ramasamy K. Single session of Pascal versus multiple sessions of conventional laser for panretinal photocoagulation in proliferative diabetic retinopathy: a comparative study. Retina. 2011;31(7):1359–1365.

12. Muqit MMK, Marcellino GR, Henson DB, et al. Pilot RCT of Pascal targeted retinal versus variable-fluence panretinal 20-ms laser (PETER PAN study). Br J Ophthalmol. 2013;97(2):220–227.

13. Zakrzewski PA, et al. Pain and inability to complete panretinal photocoagulation: oral versus topical diclofenac for PRP pain. Ophthalmology. 2009 (reports up to ~64% unable to complete PRP due to pain).

14. American Academy of Ophthalmology. Diabetic Retinopathy Preferred Practice Pattern (2024/2025).

15. National Institute for Health and Care Excellence (NICE). Diabetic retinopathy management guideline (2024). / The Royal College of Ophthalmologists. Diabetic Retinopathy Clinical Guidelines.

16. Asia-Pacific Vitreo-retina Society / Academy of Asia-Pacific Professors of Ophthalmology / Academia Retina Internationalis. International consensus on management of proliferative diabetic retinopathy (2025).

17. Hutton DW, Stein JD, Glassman AR, et al; DRCR.net. Five-year cost-effectiveness of ranibizumab vs panretinal photocoagulation for proliferative diabetic retinopathy. JAMA Ophthalmol. 2019.

18. Austroads / National Transport Commission. Assessing Fitness to Drive (2022) — vision and eye disorders standards.

19. Australian Government, Pharmaceutical Benefits Scheme / Services Australia. Ranibizumab listing for proliferative diabetic retinopathy and/or diabetic macular oedema (effective 1 October 2025).

20. Australian Government Department of Health, Disability and Ageing. Ministerial statement on intravitreal eye injections and private health insurance (the Hon. Mark Butler MP, 6 March 2026).

Reference details should be checked against the originals before clinical or institutional use. Figures quoted are approximate and drawn from the cited studies; they are for patient education and discussion, not for individual prognosis.

 

This information sheet is general in nature and was prepared to support an informed discussion between a patient and their eye specialist. It does not constitute individual medical advice, and the consent record is intended to supplement — not replace — your clinic's or hospital's approved procedure-specific consent form. Treatment decisions should always be made in consultation with a qualified ophthalmologist who knows your specific situation.