Pattern Scanning Laser Trabeculoplasty (PSLT) Treatment for Glaucoma

Sep 22, 2015

Watch: PSLT (Pattern Scanning Laser Trabeculoplasty) treatment video. Credit:TopconEuropeMedical. PSLT treatment [Internet]. 2015 [cited 2015 Sep 22]. Available from: https://youtu.be/WVsL_lk4nlw

What is Pattern Scanning Laser Trabeculoplasty (PSLT)

Another device joins the Laser Trabeculoplasty glaucoma treatment party! “ALT, SLT, MLT, meet PSLT (Pattern Scanning Laser Trabeculoplasty).” PSLT uses a pre-set pattern of laser spots to automate and speed up the laser application. If you know anything about currently available laser trabeculoplasty platforms you know that this glaucoma treatment takes all of ten minutes to complete. “Why,” you might well ask, “do we need or care about speeding up what is already a fast and effective laser treatment of glaucoma?” [Related article: Introduction To Laser Trabeculoplasty]

And you’d be right to ask.

The idea of using pre-set patterns of laser spots to reduce treatment time was initially developed to be used in the treatment of diabetic retinopathy. This treatment requires placement of hundreds (or even over a thousand) spots of laser over most of the retina. In this case the time savings to perform the laser treatment was clear.

Glaucoma treatment with laser trabeculoplasty, however, requires placement of only 50-100 laser spots in the area of the trabecular meshwork. Most surgeons can easily place one spot every five seconds which would result in a total treatment time of less than 10 minutes. Even if PSLT were to cut the procedure time in half, would it matter? Not to me, and probably not to most patients.

Does Pattern Scanning Laser Trabeculoplasty (PSLT) Work?

Because PSLT uses the same Nd:YAG Q-Switched laser as is used in SLT, there’s no reason to believe that PSLT would perform better than SLT. Faster? Sure. Better? Probably not.

Indeed, to date the evidence supports only that PSLT may work as well as SLT. According to a study recently presented at the American Glaucoma Society, two months after surgery intraocular pressure (IOP) was reduced by 28% with SLT and 24% with PSLT. Treatment time was, as expected, cut in half from just under ten minutes with SLT to just under five minutes with PSLT.

According to this study, the PSLT treatment was more comfortable than the SLT treatment. However, SLT is generally very well tolerated with minimal, if any, discomfort.

In summary, I wouldn’t expect to see these PSLT units flying off the shelves into your eye surgeons’ offices anytime soon. Yes, there will be a few surgeons who, like golfers who believe that purchasing a $2,000 set of golf clubs will shave points off their score, will purchase these more expensive PSLT units to shave a few minutes off their procedure times. Most of us, however, will be content using what is already effective and expensive enough, if slightly slower, established SLT technology.

References
  1. Mansouri T, Shaarawy T. Randomized, Controlled Trial to Compare Safety, Tolerability and Efficacy of Pattern Scanning Laser Trabeculoplasty (PSLT) to Selective Laser Trabeculoplasty (SLT). Poster session presented at: the 25th Annual Meeting of the American Glaucoma Society; 2015 Feb 26 – Mar 1; Coronado, CA.

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.

David Richardson, MD

Medical Director, San Marino Eye

David Richardson, MD is widely recognized as one of the top cataract and glaucoma surgeons in the US and is among an elite group of glaucoma surgeons in the country performing the highly specialized canaloplasty procedure. Morever, Dr. Richardson is one of only a few surgeons in the greater Los Angeles area that performs Micropulse® "Cyclophotocoagulation" (MP3) glaucoma laser surgery. Dr. Richardson graduated Magna Cum Laude from University of Southern California and earned his Medical Degree from Harvard Medical School. He completed his ophthalmology residency at the LAC+USC Medical Center/ Doheny Institute. Dr. David Richardson is also an Adjunct Assistant Professor of Clinical Ophthalmology at Keck School of Medicine of USC. Twice weekly, he treats veterans at the VA Greater Los Angeles Veterans Healthcare System. → Learn more about Dr. David Richardson

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