Laser First: SLT as Primary Therapy
Christopher Kent, Senior Editor
from Review of
Read the full article here:
More surgeons are trying selective laser trabeculoplasty as front-line therapy for glaucoma—and the results have been excellent.
In addition to its apparent efficacy, users list several other advantages of the procedure:
"Of all of the patients that we've done so far, not a single one is
having trouble with vision, uncontrolled pressures or inflammation,"
says Dr. Hutnik. "I have not seen any harmful side effects of this
safety profile of SLT is superb," agrees Dr. Melamed. "We've seen no
complications. Even the pressure spikes we sometimes see, which
different studies have reported in 11 to 31 percent of patients, are
very transient." (For more information on pressure spikes, see "Avoiding
a Post-Surgery IOP Spike" further down.)
• It avoids compliance problems.
Because the patient doesn't have to remember to purchase or instill
drops, efficacy is independent of the patient's behavior. "If you
suspect the patient will have a compliance problem, this is a really
good way to start treatment," says Dr. Hutnik.
• It may be as effective as medication.
"In general, laser trabeculoplasty is one of the few areas in which we
do have clinical evidence that suggests it's as good as starting with
medical therapy—at least the medical therapy we had 15 or 20 years ago,"
observes Dale K. Heuer, MD, professor and chairman of ophthalmology at
the Medical College of Wisconsin and director of the Froedtert &
Medical College of Wisconsin Eye Institute, who has been performing
laser trabeculoplasty for more than 20 years. "Whether it's as good as
the medical therapy we have now remains to be determined, but it's
certainly safe and it avoids the problems of non-adherence to
medications, which is a huge problem with topical drops."
• It may be less expensive than medications over the long run. For more on this, see "Which Option Costs More?" below.
• It doesn't prevent future canal-related procedures.
"I've now switched from ALT to SLT," says Dr. Heuer, "primarily because
I'm hopeful that within the next five years or so we'll be able to
treat glaucoma with an incisional technique that works on Schlemm's
canal. Unlike ALT, SLT is gentle to the canal. It doesn't complicate
potential future options."
• It may mitigate higher nocturnal IOP. "A paper just published in Ophthalmology3 reports
data indicating that SLT helps to blunt the natural pressure rise that
occurs when we sleep," notes Dr. Heuer. "Some medications don't do