Dynamic optical property changes: implications for reflectance feedback control of photocoagulation.

During laser treatment, coagulation affects the optical properties of the tissue. In particular, the formation of a white lesion significantly increases the scattering coefficient. This change in the optical properties in turn affects the laser light distribution in the tissue. The white lesion formed during photocoagulation of the retina has a dynamic effect upon reflection and fluence rate. This problem has been simulated on a model medium consisting of a thin absorbing layer covered with a 1 cm thick layer of albumin. The albumin layer is subdivided into coagulated (white) and uncoagulated (clear) layers. The optical properties of each layer have been determined and these values have been used to model light distribution in the medium. One-dimensional adding-doubling and three-dimensional Monte Carlo methods have provided light distributions in the medium for varying thicknesses of the coagulated albumin. Computed fluence reaching the absorbing layer decreased in the presence of a 275 microns or thicker coagulated layer. The coagulated layer attenuates light because it is highly scattering; however, this scattering also leads to a sub-surface peak in fluence rate at a level higher than the incident fluence. The latter effect outweighed the former for coagulated layer thicknesses less than 275 microns. Computed reflectance of argon laser light from a semi-infinite coagulated region initially increased linearly as a function of thickness. As the coagulation thickness increased beyond 4-5 optical depths, the reflectance approached a constant value, R infinity, at 9 optical depths (2 mm). Experimentally measured total reflectance is shown to be an inadequate indicator of the thickness of a lesion (finite coagulated volume); however, central reflectance from a lesion measured with a CCD camera confirmed the computed trends. These results provide a theoretical foundation for control of lesion thickness using reflectance images.