Selective Laser Trabeculoplasty (SLT) is already one of the gentlest and easiest of the surgical glaucoma treatments. It’s quick, usually painless, requires almost no modifications in activity, and results in intraocular pressure (IOP) lowering in the majority of those who choose to have this procedure.

Traditionally this laser glaucoma treatment has been done using a gonioscopy lens that must be placed against the eye during application of the laser procedure. For a variety of reasons this is not always easy for the surgeon or comfortable for the patient. Some people are unable to overcome the natural reflex to close the eyelids when something is placed against the surface of the eye. Others simply have eyes that are “too small” (actually, it’s the opening between the eyelids that is too small) to allow comfortable placement of the lens.

In the past, those who could not tolerate placement of a contact lens were simply not candidates for SLT. However, this may no longer be the case according to the findings of a recently published study in the Journal of Glaucoma.[1] In this study Dr. Noa Geffen and colleagues evaluated the effect of “transscleral SLT”. In other words, they applied the glaucoma laser treatment from the outside of the eye without the use of a contact gonioscopy lens.

[Photo Credit: Ocular Latina SLT Gonio Laser via http://www.ocularinc.com]

They compared six-month and one-year results of transscleral SLT (“TS-SLT”) to those of SLT using a gonioscopy lens (“Gonioscopic SLT” or “G-SLT”). The results will surprise many in just how effective the transscleral treatment seemed to be. Six months after surgery the average IOP dropped by 23.4% in the TS-SLT group compared to 27.1% in the G-SLT group. The average IOP reduction one-year after treatment was noted to be 20.8% in the TS-SLT group compared to 33.8% in the G-SLT group. No statistically significant difference in rates of “success” were noted between treatment groups.

Six months after surgery the average IOP dropped by 23.4% in the TS-SLT group compared to 27.1% in the G-SLT group. The average IOP reduction one-year after treatment was noted to be 20.8% in the TS-SLT group compared to 33.8% in the G-SLT group.

Interestingly, for a glaucoma treatment that is already considered to be one of the safest available, the TS-SLT appeared to be even safer than G-SLT. All “complications” in both groups were mild and completely resolved by one week after the glaucoma treatment. Nevertheless, surface irritation and inflammation inside the eye were noted more frequently in the G-SLT group.

The authors of this study should be recognized for their “out of the box” thinking as well as for potentially benefiting glaucoma patients who would otherwise not tolerate Selective Laser Trabeculoplasty with a contact goniolens.

Gonioscopic SLT is already an appropriate glaucoma treatment option for just about anyone with even a partially open angle. Perhaps based on the results of this study SLT laser manufacturers will consider developing a “handpiece” that would allow treatment of those who are confined to wheelchairs or beds. With such a development there would be little reason to deny this treatment to anyone with most forms of open angle glaucoma.

Reference:

  1. Geffen N, Ofir S, Belkin A, et. al. Transscleral Selective Laser Trabeculoplasty Without a Gonioscopy Lens. J Glaucoma. 2017;26:201-207.

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.

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