How To Choose Which Type Of Laser Trabeculoplasty To Have

Feb 8, 2015

How To Choose Which Type Of Laser Trabeculoplasty To Have

For those who are candidates for Laser Trabeculoplasty, Selective Laser Trabeculoplasty (SLT) or Micropulse Laser Trabeculoplasty (MLT) is generally preferable to Argon Laser Trabeculoplasty (ALT) as they are less likely to result in scarring of the trabecular meshwork and Schlemm’s (drainage) Canal.

Why, then, would anyone choose to have ALT?

Certain types of glaucoma may respond very well to ALT. Pigmentary glaucoma is one of these. Of note is that eyes with heavily pigmented drainage angles are more likely to have an IOP spike after SLT. Rarely such IOP elevations have required non-laser surgery to control.^{^[1]} For these reasons, patients with heavily pigmented angles may be better served by ALT than SLT.

Additionally, up until just recently the SLT laser had a price tag in the USA of about $70,000! Argon units, on the other hand, could be purchased for between $20,000-40,000. Additionally, an Argon laser can be used for many different types of eye treatment whereas an SLT laser is a “one trick pony”.

As you can imagine, not every eye surgeon could afford to place one of these units in the office. Now, however, both SLT and MLT lasers can be purchased for around $30,000-40,000. Although not an “impulse purchase”, a busy glaucoma surgeon can now expect to be able to afford to pay down the price of these units over a few years.

Summary

Laser Trabeculoplasty has a long track record of effectively lowering the IOP while presenting relatively low risk to those receiving this treatment. Selective Laser Trabeculoplasty has two key advantages over Argon Laser Trabeculoplasty: (1) it is repeatable; (2) it is less likely to limit future glaucoma surgical options such as the expanding number of available minimally invasive glaucoma surgeries (MIGS).

Laser Trabeculoplasty works about as well as a single glaucoma drop. Given the long-term side effects associated with chronic glaucoma drop use as well as the cost of medications most patients with open angle glaucoma should at least consider the option of SLT.

References

Harasymowycz PJ, Papamatheakis DG, Latina M, et al. Selective laser trabeculoplasty (SLT) complicated by intraocular pressure elevation in eyes with heavily pigmented trabecular meshworks. Am J Ophthalmol. 2005;139:1110-3.

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