Selective laser trabeculoplasty or SLT is a new gentle, non-invasive treatment for glaucoma which is especially suited to patients who cant tolerate or are unable to self-administer glaucoma medications,
By DR BRIAN VAN ONSELEN
Published in Mims OPTIMAG Volume 1 / 2013

Laser surgeries have become important in the treatment of different eye problems and diseases, including glaucoma.

Of course, there are several types of laser surgery used to treat glaucoma and the type of laser surgery used by an ophthalmologist will depend on the form of glaucoma presented by the patient and how severe it is.

Lasers produce a focused beam of light that can make a very small burn or opening in the eye tissue, depending on the strength of the light beam, and treatments are performed in an outpatient setting in the doctor's office or in a hospital clinic.

Selective laser trabeculoplasty, or SLT, is a gentle and non-invasive treatment for glaucoma which has received a lot of interest from ophthalmologists in the recent year or so. This quick and simple procedure is an effective option for most glaucoma patients, but is especially suited to patients who cannot tolerate or are unable to self-administer glaucoma medications. Highly effective, SLT is used as a primary treatment for the early stages of open angle glaucoma, and can also be used in combination with drug therapy, or as an alternative therapy when drugs fail. It is also a flexible treatment option, because it can be repeated, if necessary, depending on the individual patient's response.

The SLT technique is not associated with adverse side effects and is a pain-free, outpatient-based procedure performed in the ophthalmologist's office.

HOW IT WORKS

SLT uses short pulses of low-energy light to target the melanin, or pigment, in specific cells of the affected eye. In response, the body's natural healing mechanisms go to work to rebuild these cells - a process that improves drainage and lowers intraocular pressure. The surrounding, non-pigmented cells - as well as the rest of the eye - are untouched and undamaged.

WHAT TO EXPECT

In 80 percent of patients treated, SLT lowers intraocular pressure by an average of 25 percent. There are no major risks or complications associated with SLT - the worst that can happen is that the patient does not respond to the treatment.

Before treatment

Prior to treatment, the ophthalmologist conducts a pressure measurement to determine the eye's pressure. Topical ocular drops are then administered to prepare the eye for treatment and to provide mild anesthesia.

During treatment

During treatment, gentle pulses of light are delivered through a specially designed microscope. The ophthalmologist will hold a Lens to the eye for better viewing, and the patient will likely hear the laser pulses as short ticking sounds and may see bright flashes of light. The entire procedure will take approximately three to five minutes. When it's complete, the ophthalmologist may treat the patient's eye with anti-inflammatory eye drops.

After treatment

In the majority of patients, there is often an immediate response to SLT - one to three days after the procedure, the intraocular pressure should drop significantly. However, in some patients, SLT treatment may take from weeks to a few months before impacting eye pressure. The ophthalmologist will want to re-check the treated eye during periodic follow-up visits. OM

WHO WILL BENEFIT FROM SLT?

Patients in any of the following categories are a good candidate for SLT:
  • Primary open angle, pseudoexfoliation, or pigmentary glaucoma. (If you're not sure, ask your ophthalmologist.)
  • Patients with an intolerance of glaucoma medications, or who have difficulty taking them as prescribed.
  • Patients who are currently undergoing glaucoma drug therapy and wish to combine it with SLT.
  • Patients with a history of failed ALT (argon laser trabeculoplasty) treatments.