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The Scar Solution Natural Scar Removal

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the laser. Also, remember that if you refer uncharitably to previous laser treatment, it may just be a matter of time before what goes around comes around and your laser spots are being disrespected.

More importantly, patients can be very frightened to learn about "laser scars" in the back of their eye because at some level they may imagine crazed doctors trying to carve up their vision in order to pay for Hummers. They also will assume that any vision problems they have are due to the scars; they usually do not entirely understand that the lasers have, in fact, managed to save what vision they have.

The problem is that when patients draw incorrect conclusions about the effect of laser treatment on their vision, they can become very reluctant to undergo laser treatment by anyone, including your own bad self, when they desperately need it. As subsequent chapters will discuss, it can be hard enough to get a patient to return for follow up, and you don't want to contribute to the problem by carrying on about oodles and scads of spots.

This warning also applies to any primary-eye-care practitioners who may be reading this. It is not uncommon for patients to return from their optometrist somewhat upset because, with the best of intentions, the OD has referred to 'all those scars back there'. Even a casual remark like that can potentially interfere with appropriate follow up. If you are going to talk about laser scars, be sure to remind the patient why they are there in the first place—and where their vision would have ended up without intervention. Perhaps it is better to use the term "treatment" rather than "laser scars" in order to describe the findings.

In fact, carefully placed laser spots usually have nothing to do with a patient's symptoms. For instance, many diabetic patients will complain of microscotomas around the center of their vision as they age—often manifesting as missing parts of words or letters. It is very easy for them (and you) to assume that these scotomas are from laser scars. However, most of the time laser spots are well outside the area where they could interfere with reading. Instead, the "spots" they are seeing are actually caused by capillary dropout around the fovea (Figure 5). If you casually blame the symptoms on the laser, you will have unjustly maligned one of your colleagues and you will be risking the patient's compliance forever. You are managing to do two really bad things at once without even trying.

Of course, there is no question that previous scars can enlarge over time, and you will see patients that were treated years ago with very heavy treatment and who have undergone scar expansion that can look rather frightening.2 Although many times these patients are surprisingly asymptomatic for such scars, some patients will clearly have vision loss due to this process. If you feel that this is indeed the case, then you have to call it as you see it, but it still helps to remind the patient that without treatment, their vision would likely be far worse.

As an aside, here is something else to be aware of. When hard exudates build up in the fovea, they can sometimes leave a focal depigmented scar when they fade away. This scar can look for all the world like someone placed a laser spot right in the fovea. A classic tyro move is to tell the patient that their fovea was lasered when this was not the case at all. This results in a whole bunch of needless grief and once again manages to unjustly malign a colleague and alienate a patient in one fell swoop. Just be careful what you say.

Figure 5. A patient complaining of difficulty seeing parts of words when reading. The laser scars are far away from areas involved in reading. The paracentral scotomas are from the capillary dropout and are not iatrogenic.

Figure 5. A patient complaining of difficulty seeing parts of words when reading. The laser scars are far away from areas involved in reading. The paracentral scotomas are from the capillary dropout and are not iatrogenic.

Figure 6. Hard exudates can build up in the fovea, as in the picture on the left (black arrow). When the exudates resolve, they can leave an area of focal depigmentation that can look just like a laser scar, as in the photo on the right (white arrow). No one lasered this fovea, so don't even think about freaking the patient out by calling this a laser spot. By the way, note the expansion of the real laser scars everywhere else.

Figure 6. Hard exudates can build up in the fovea, as in the picture on the left (black arrow). When the exudates resolve, they can leave an area of focal depigmentation that can look just like a laser scar, as in the photo on the right (white arrow). No one lasered this fovea, so don't even think about freaking the patient out by calling this a laser spot. By the way, note the expansion of the real laser scars everywhere else.

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