How Well Does Laser Trabeculoplasty Work?
How Well Does Laser Trabeculoplasty Work?
Argon Laser Trabeculoplasty (ALT)
Argon Laser Trabeculoplasty (ALT) successfully lowers the intraocular pressure (IOP) in just over 80% of the eyes that receive this treatment.[1] IOP lowering may not be realized for up to a month after the treatment. On average the IOP is reduced by 6-9mmHg.[2] Unfortunately, the effect does not last. After a few years additional treatment is generally needed to lower the IOP.[3]
Selective Laser Trabeculoplasty (SLT)
Selective Laser Trabeculoplasty (SLT) success is dependent upon how much of the trabecular meshwork is treated. When only half of the trabecular meshwork is treated (180 degrees) SLT successfully lowers the intraocular pressure (IOP) 65% of the time with an average reduction in IOP of just over 4mmHg (range of 2 to 18mmHg).[4] However, when a full 360 degree treatment is applied the IOP can be expected to be reduced in almost all eyes by 11-40%.[5] In general SLT appears to work as well as ALT.[6]
Micropulse Laser Trabeculoplasty (MLT)
Although this is relatively new technology, it does appear promising. Initial studies (though small) demonstrated reductions in IOP and need for medications that are similar to those seen with ALT.[7] Larger studies are underway.
References
1) Wise JB, Witter SL. Argon laser therapy for open-angle glaucoma. A pilot study. Arch Ophthalmol. 1979;97(2):319-322.
Wise JB. Long-term control of adult open angle glaucoma by argon laser treatment. Ophthalmology. 1981;88(3):197-202.
Schwartz AL, Whittn ME, Bleiman B, et al. Argon laser trabecular surgery in uncontrolled phakic open angle glaucoma. Ophthalmology. 1981;88(3):203-212.
Wilensky JT, Jampol LM. Laser therapy for open angle glaucoma. Ophthalmology. 1981;88(3):213-217.
Forbes M, Bansal RK. Argon laser goniophotocoagulation of the trabecular meshwork in open-angle glaucoma. Trans Am Ophthalmol Soc. 1981;79:257-275.
Lichter PR. Argon laser trabeculoplasty. Trans Am Ophthalmol Soc. 1982;80:288-301.
Thomas JV, Simmons RJ, Belcher CD III. Argon laser trabeculoplasty in the presurgical glaucoma patient. Ophthalmology. 1982;89(3):187-197.
2) Pollack IP, Robin AL, Sax H. The effect of argon laser trabeculoplasty on the medical control of primary open-angle glaucoma. Ophthalmology. 1983;90(7):785-789.
3) Schwartz AL, Kopelman J. Four-year experience with argon laser trabecular surgery in uncontrolled open-angle glaucoma. Ophthalmology. 1983;90(7):771-780.
Tuulonen A, Niva AK, Alanko HI. A controlled five-year follow-up study of laser trabeculoplasty as primary therapy for open-angle glaucoma. Am J Ophthalmol. 1987;104(4):334-338.
Grinich NP, Van Buskirk EM, Samples JR. Three-year efficacy of argon laser trabeculoplasty. Ophthalmology. 1987;94(7):858-861.
Shingleton BJ, Richter CU, Bellows AR, et al. Long-term efficacy of argon laser trabeculoplasty. Ophthalmology. 1987;94(12):1513-1518.
Ticho U, Nesher R. Laser trabeculoplasty in glaucoma. Ten-year evaluation. Arch Ophthalmol. 1989;107(6):844-846.
Spaeth GL, Baez KA. Argon laser trabeculoplasty controls one third of cases of progressive, uncontrolled, open angle glaucoma for 5 years. Arch Ophthalmol. 1992;110(4):491-494.
Spiegel D, Wegscheider E, Lund OE. Argon laser trabeculoplasty: long-term follow-up of at least 5 years. Ger J Ophthalmol. 1992;1(3-4):156-158.
Shingleton BJ, Richter CU, Dharma SK, et al. Long-term efficacy of argon laser trabeculoplasty. A 10-year follow-up study. Ophthalmology. 1993;100(9):1324-1329.
4) Kajiya S, Hayakawa K, Sawaguchi S. Clinical results of selective laser trabeculoplasty. Jpn J Ophthalmol. 2000;44(5):574-575
5) Lanzetta P, Menchini U, Virgili G. Immediate intraocular pressure response to selective laser trabeculoplasty. Br J Ophthalmol. 1999;83(1):29-32.
Stein JD, Challa P. Mechanisms of action and efficacy of argon laser trabeculoplasty and selective laser trabeculoplasty. Curr Opin Ophthalmol. 2007;18:140-5.
6) Wong MOM, Lee JWY, Choy BNK, et al. Systematic review and meta-analysis on the efficacy of selective laser trabeculoplasty in o pen-angle glaucoma. Surv Ophthalmol. 2014[Published online].
7) Ingvoldstad DD, Krishna R, Willoughby L. Micropulse diode laser trabeculoplasty versus argon laser trabeculoplasty in the treatment of open angle glaucoma. Invest Ophthalmol Vis Sci. 2005;46:e-abstract 123.
Detry-Morel M, Muschart F, Pourjavan S. Micropulse diode laser (810 nm) versus argon laser trabeculoplasty in the treatment of open-angle glaucoma: comparative short-term safety and efficacy profile. Bull Soc Belge Ophthalmol. 2008;308:21-28.
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SLT: The Gentler Glaucoma Laser Surgery
Dr. David Richardson offers Selective Laser Trabeculoplasty (SLT) as an outpatient procedure in his San Marino Eye office. SLT can be performed on the same day as most examinations and the whole procedure takes 5 minutes of less. SLT is a gentler glaucoma laser surgery. Contact Dr. David Richardson immediately to see if SLT is for you. Call today to schedule an appointment with Dr. Richardson at 626.289.7856.
