11/7/2013
Arthur J. Sit, SM, MD, Rochester, Minn.
Read the full article here.
Excerpt from: In-Clinic IOP: How Much Does It Tell Us?
Determining the clinical value of mean vs. peak IOP-and the possible importance of IOP fluctuation-remains a challenge.
(excerpted from the article)
Consider performing laser trabeculoplasty. One of the less-often discussed results of using a procedure such as selective laser trabeculoplasty is that IOP fluctuation is reduced. The likely explanation is that it enhances outflow facility, leading to a more consistent IOP over the course of the day. In addition, it's a very low risk procedure. Given that it smooths out IOP fluctuation, it makes sense to try it in patients whose IOP seems well-controlled but who continue to get worse.
In the United States, clinicians still don't perform SLT very frequently, often because of the perception that it doesn't reduce IOP as much as other alternatives. I believe that perception is partly the result of the frequent use of SLT as a last resort. Once a patient is already on maximum medical therapy, even adding another drop will have minimal effect, so it shouldn't be a surprise that SLT doesn't cause a major change under these conditions.
In my experience, you'll see a larger effect if you perform SLT earlier in the course of treatment, before the patient is on multiple medications. I think it's a reasonable option to offer earlier in the treatment spectrum, not only to reduce IOP, but also to achieve a better quality of IOP control -i.e., reduced fluctuation-than you might get with something like a beta-blocker.
Read the full article here.
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• Consider performing laser trabeculoplasty. One of the less-often discussed results of using a procedure such as selective laser trabeculoplasty is that IOP fluctuation is reduced.6,7 The likely explanation is that it enhances outflow facility, leading to a more consistent IOP over the course of the day. In addition, it’s a very low-risk procedure. Given that it smoothes out IOP fluctuation, it makes sense to try it in patients whose IOP seems well-controlled but who continue to get worse.
In the United States, clinicians still don’t perform SLT very frequently, often because of the perception that it doesn’t reduce IOP as much as other alternatives.I believe that perception is partly the result of the frequent use of SLT as a last resort. Once a patient is already on maximum medical therapy, even adding another drop will have minimal effect, so it shouldn’t be a surprise that SLT doesn’t cause a major change under these conditions.
In my experience, you’ll see a larger effect if you perform SLT earlier in the course of treatment, before the patient is on multiple medications. I think it’s a reasonable option to offer earlier in the treatment spectrum, not only to reduce IOP, but also to achieve a better quality of IOP control—i.e., reduced fluctuation—than you might get with something like a beta-blocker. - See more at: http://www.revophth.com/content/d/glaucoma_management/i/2625/c/44885/#sthash.9JfS9SjG.dpuf
• Consider performing laser trabeculoplasty. One of the less-often discussed results of using a procedure such as selective laser trabeculoplasty is that IOP fluctuation is reduced.6,7 The likely explanation is that it enhances outflow facility, leading to a more consistent IOP over the course of the day. In addition, it’s a very low-risk procedure. Given that it smoothes out IOP fluctuation, it makes sense to try it in patients whose IOP seems well-controlled but who continue to get worse.
In the United States, clinicians still don’t perform SLT very frequently, often because of the perception that it doesn’t reduce IOP as much as other alternatives.I believe that perception is partly the result of the frequent use of SLT as a last resort. Once a patient is already on maximum medical therapy, even adding another drop will have minimal effect, so it shouldn’t be a surprise that SLT doesn’t cause a major change under these conditions.
In my experience, you’ll see a larger effect if you perform SLT earlier in the course of treatment, before the patient is on multiple medications. I think it’s a reasonable option to offer earlier in the treatment spectrum, not only to reduce IOP, but also to achieve a better quality of IOP control—i.e., reduced fluctuation—than you might get with something like a beta-blocker. - See more at: http://www.revophth.com/content/d/glaucoma_management/i/2625/c/44885/#sthash.9JfS9SjG.dpuf
