Abstract: Improved optical therapy is provided. In a first aspect, improved dosimetry is provided by the use of spectrally resolved tissue reflectance as a real-time dosimetry signal. Spectrally resolving the reflectance substantially improves the sensitivity for dosimetry. An increase of spectrally resolved tissue reflectance (relative to a pre-treatment baseline) is indicative of a reversible tissue response to therapy, while a decrease of spectrally resolved tissue reflectance is indicative of approach to a threshold for irreversible tissue damage. In a second aspect, improved temperature uniformity within laser treated tissue is provided by using a treatment beam having an on-axis beam intensity substantially less than an off-axis beam intensity. The combined effects of heat flow within the treated tissue and illumination with such a beam profile can provide improved temperature uniformity compared to illumination with a conventional “top-hat” beam profile.