IRMAs are by definition intra-retinal whereas neovessels typically proliferate into the vitreous. They can also contract due to the fibrous component in them, pulling the vessels and the retina, resulting into a tractional retinal detachment. If the hemorrhage occur superficially at the nerve fiber layer-typical in hypertension rather than diabetes, it produces a flame shape hemorrhage. Leakage from the blood vessels will also lead to lipid deposition later on. This is known as hard exudates.
Leakage can be focal, or diffuse.
Diffuse leakage around the macula would produce macular edema from the excess fluid as well as the exudates. The laser shots are delivered in a grid manner over the diffusely edematous area, avoiding the perifoveal area. The shots are spaced half a shot distance from each other. The laser is delivered to the retinal periphery, sparing the posterior pole. The rationale behind such a treatment is to literally to kill as much as possible of the ischemic retina, to decrease the production of the angiogenic factors.