In this Evidence Based Retina episode, Rishi Singh, MD, FASRS, sits down with Louis Cai, MD, founder of Cai Retina in Sunnyvale, California, to discuss the equipment decisions behind opening a solo retina practice.
Dr. Cai, who opened his doors at the start of this month, explains how he prioritized diagnostic and laser equipment for patient care while sourcing lower-impact items secondhand to control startup costs.
Selecting a laser device for PRP fast facts
- Diabetic retinopathy is a leading cause of vision loss among working-age adults, and panretinal photocoagulation (PRP) delivered via a laser indirect ophthalmoscope (LIO) remains a mainstay treatment—LIOs are generally favored over slit-lamp delivery because they accommodate the scleral depression and globe manipulation that far-peripheral pathology requires.1,2
- New retina practices commonly prioritize optical coherence tomography (OCT) imaging and treatment lasers as day-one purchases since they directly affect diagnostic accuracy and outcomes, reserving secondhand or discounted buying for lower-impact items such as waiting room furnishings.
- Peer-reviewed, within-patient comparisons show pattern-scanning PRP delivers visual field and visual acuity outcomes comparable to conventional single-spot laser, with less patient discomfort and meaningfully shorter treatment sessions—the subject of this issue's deep dive.2,3
A deeper dive into pattern-scanning PRP
Pattern-scanning platforms such as PASCAL deliver arrays of 4 to 56 burns in under one second using 10- to 30-millisecond pulses, versus the 100- to 200-millisecond, single-spot exposures of conventional laser—confining thermal spread to smaller, more uniform lesions with less collateral damage to the inner retina.2 For high-volume PRP, that translates directly into time savings.
“A PRP that might have taken you 15 to 20 minutes can get down to five minutes because all of a sudden you're thinking not as single shots at a time, you're thinking about grids at a time.”
A 2022 randomized, single-blind trial compared conventional and pattern-scanning PRP within the same patients—one eye received each—and found at 1 month:3
- Pattern standard deviation (visual field variability) rose significantly in both groups, with no significant difference between them.
- Mean deviation declined significantly only in conventional-laser eyes, though the between-group difference wasn't significant.
- Best-corrected visual acuity change didn't differ significantly between laser types.
- Pattern PRP caused a smaller overall reduction in visual field sensitivity.
Tolerability findings point the same direction: a systematic review of 13 randomized controlled trials and four controlled trials (1,961 eyes) found multispot laser scored roughly 2.7 points lower on a visual analog pain scale than single-spot laser, corresponding to about 40% fewer patients requiring peri-procedural analgesia.2
Choosing the right laser for your practice
New solo practices must balance patient volume against overhead, session length, and patient tolerance. That calculus shaped Dr. Cai's decision to pay a premium for a pattern-capable laser over a standard single-shot unit.
For the laser itself, Dr. Cai weighed affordability against features rather than defaulting to whatever he'd trained on. He'd used pattern lasers in fellowship and at prior clinics, but wanted a device that also matched a solo-practice workflow: portable, space-efficient, and built around a modern viewing system.
That combination led him to a newer-generation pattern LIO from Norlase, the LYNX, which integrates the laser and pattern module into a wearable, battery-powered headset rather than a separate console.4
“Norlase has the most modern viewing system, and it's readily portable. Having the pattern feature makes it the only one of its kind, and I had to splurge.”
A closer look at the Norlase LYNX
- LYNX received FDA 510(k) clearance and CE Mark in January 2025 as the world's first and only pattern-scanning LIO, integrating the laser and pattern module directly into a wearable, battery-powered headset—eliminating the external console and cabling conventional pattern-scanning platforms require.4,5
- The device offers grid patterns up to 5×5, one to three concentric circles, and adjustable arc patterns, controlled wirelessly via a tablet with multilingual voice control; its footswitch-integrated battery delivers more than a full day of use on a single charge.5,6
- Unlike conventional pattern lasers, which fix the position of the laser beam and eyelids during treatment, LYNX allows unrestricted movement of the lens, eye, and laser beam.7
Test before you buy
Dr. Cai's advice to colleagues shopping for any piece of equipment, laser included, is to insist on hands-on time before purchasing.
After reaching out to a company representative, he arranged to have a demo unit shipped to his office—the first shipment he ever received there—and used it on a handful of straightforward patients before deciding. A demo lets a surgeon confirm the optics and workflow fit under real clinical conditions, not just a showroom demonstration.
“If you haven't used a new laser...it's hard to trust a new laser, and the first thing I would ask for is just a demo.”
In closing
For a solo practice built on volume and reputation, laser choice isn't a cosmetic upgrade. The evidence shows pattern-scanning PRP matches conventional single-spot laser on efficacy while meaningfully cutting treatment time and discomfort.
For anyone building a practice from the ground up, prioritizing devices that influence outcomes—while sourcing lower-stakes purchases secondhand—is a reasonable framework for controlling costs without compromising care.
