Who Should Consider Glaucoma Treatments Other Than Laser Trabeculoplasty (LT)?

Feb 6, 2015

Laser Trabeculoplasty, by definition, requires that the trabecular meshwork be visible in order to apply laser to it. Those with closed or scarred angles cannot expect to benefit from this treatment. Because Argon Laser Trabeculoplasty results in post-operative inflammation it is generally not recommended for those who already have active inflammation (iritis, uveitis) in the eye.[1]  Selective Laser Trabeculoplasty (SLT), however, may be considered even in those with a history of inflammation in the eye.[2]  Laser Trabeculoplasty is also not expected to benefit those with angle-recession glaucoma (usually seen after trauma to the eye) or in infant and childhood glaucomas.[3]  Finally, its effect may be limited in eyes that have had multiple prior glaucoma operations.

The response to Laser Trabeculoplasty appears to be dependent upon the pre-treatment intraocular pressure (IOP). In other words, the higher the IOP before treatment, the better the response to Laser Trabeculoplasty.[4] For example, Laser Trabeculoplasty can only be expected to lower the IOP by 14-16% in those with Normal Tension Glaucoma.[5] At the other extreme, when the pre-treatment IOP is higher than 30mmHg Laser Trabeculoplasty is more likely to fail.[6] Thus, patients with an IOP greater than 30mmHg may not be the best candidates for Laser Trabeculoplasty.

References
  1. Siddique SS, Suelves AM, Baheti U, Foster CS. Glaucoma and Uveitis. Surv Ophthalmol. 2013;58(1):1-10.
  2. Pujari S, Siddique SS, Zakka F et al. Selective LaserTrabeculoplasty for Uveitic Glaucoma: A One-Year Follow Up. Submitted to Ocular Immunology and Inflammation.
  3. Robin AL, Pollack IP. Argon laser trabeculoplasty in secondary forms of open-angle glaucoma. Arch Ophthalmol. 1983;101(3):382-384.
    Lieberman MF, Hoskins HD Jr, Hetherington J Jr. Laser trabeculoplasty and the glaucomas. Ophthalomology. 1983;90(7):790-795.
  4. Kano K, Kuwayama Y, Mizoue S, et al. Clinical results of selective laser trabeculoplasty [in Japanese]. Nippon Ganka Gakkai Zasshi. 1999;103(8):612-616.
  5. El Mallah MK, Walsh MM, Stinnett SS, et al. Selective laser trabeculoplasty reduces mean IOP and IOP variation in normal tension glaucoma patients. Clin Ophthalmol. 2010;4:8 89-93.
    Nitta K, Sugiyama K, Mawatari Y, et al. Results of selective laser trabeculoplasty (SLT) as initial treatment for normal tension glaucoma. Nihon Ganka Gakkai Zasshi. 2013;117:335-43.
  6. Tuulonen A, Airaksinen PJ, Kuulasmaa K. Factors influencing the outcome of laser trabeculoplasty. Am J Ophthalmol. 1985;99(4):388-391.
    The AGIS Investigators. The Advanced Glaucoma Intervention Study (AGIS): 11. Risk factors for failure of trabeculectomy and argon laser trabeculoplasty. A J Ophthalmol. 2002;134(4):481-498.

About the Author: David Richardson, MD

Medical Director, San Marino Eye

David Richardson MD - Top Glaucoma SurgeonDavid Richardson, M.D. 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.

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