Monday, March 28, 2016

IOP Fluctuation is a Risk Factor in Visual Field Loss

From Review of Optometry, July 15, 2015:
    "We have all encountered patients who insist that they comply with their eye drops, yet have not filled the order since treatment was initiated.
     That lack of adherence, a study shows, turns out to be one of the primary causes of IOP flucutation. And IOP fluctuation is associated with increased risk of visual field progression, particularly in patients with a lower initial mean IOP."
Read the full arcticle here: An OD's Guide to Glaucoma Surgery

Wednesday, February 3, 2016

SLT Procedural Guide

Get Laser Focused on the Appropriate Glaucoma Treatment

SLT—once the exclusive domain of ophthalmology—is becoming a first-line treatment as states allow optometrists to perform it.
By Nathan Lighthizer, OD
Review of Optometry

Ten steps for doctors performing SLT explained.
Read the full article here.

Laser First: SLT as Primary Therapy

Laser First: SLT as Primary Therapy 
Christopher Kent, Senior Editor

from Review of Ophthalmology,

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:

Safety. "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 laser."

"The 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 that."

SLT is for These Patients

Ten patient types who can benefit from SLT
by Nathan Radcliffe, MD
Thanks to ASCRS EyeWorld Newsmagazine, Dec. 2015
full article here:

#1: SLT as a replacement for drop therapy

#2: SLT as primary therapy

#3 + 4: Previously successful SLT … and previously unsuccessful SLT

#5: Adjunctive therapy as an alternate to more drops

#6: Trouble with compliance

#7: Patients with insurance issues

#8: MIGS patients

#9: Steroid responders

#10: Patients with narrow angles who undergo unsuccessful laser iridotomy