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

 

http://www.reviewofoptometry.com/CMSDocuments/2015/7/ro0715i.v2.pdf

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
1/15/2016

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,
6/14/2007

Read the full article here: 
More surgeons are trying selective laser trabeculoplasty as front-line therapy for glaucoma—and the results have been excellent.

excerpts:
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."

Read the full article here: 

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: http://www.eyeworld.org/article.php?sid=8117&strict=0&morphologic=0&query=

#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

 

SLT Laser Treatment After-Care

After the 5 minute SLT Laser Treatment, there is little if any discomfort to the patient. Mild discomfort can be treated by the patient with a clean cool compress lightly pressed over the treated eye, and an aspirin or other over the counter non-steroidal anti-inflammatory pill (NSAID).

 A prescription for kertolac or bromfenac can be written and given to the patient to fill at their own discretion if the discomfort warrants it. If used, the patient and pharmacist can choose which of the two to fill, based on whichever is more cost-effective, and it can be used for 3 days. If the patient does not need to fill the prescription he or she can throw out the written prescription after four days since any discomfort should have passed by that time. If redness or discomfort persists, patients should call their doctor.

Thanks to Seth A. Biser, M.D* (see below) for consulting on this article.


Below, an excerpt from the article:
"Selective Laser Trabeculoplasty: 10 Commonly Asked Questions
by Brian A. Francis, MD
Read the full article here.

What are the risks?
One key aspect of SLT is a favorable side effect profile, even when compared with glaucoma medications. Post-operative inflammation is common but generally mild, and treated with observation or eye drops or an oral non-steroidal anti-inflammatory drug. There is an approximately 5% incidence of IOP elevation after laser, which can be managed by glaucoma medications and usually goes away after 24 hours.

From the article by Brian A. Francis, MD, Associate Professor of Ophthalmology at the Doheny Eye Institute, Keck School of Medicine, University of Southern California in Los Angeles, California

* Dr. Biser of Fleetwood Ophthalmology, Fleetwood, NY  is a Fellow of the American Academy of Ophthalmology, and is a member of the Medical Advisory Board of The Eye Bank for Sight Restoration (New York). He has published articles, abstracts, and book chapters; presented findings at national and international meetings; and received several awards for his research.

SLT Laser Effective for Normal Tension Glaucoma

Efficacy of Selective Laser Trabeculoplasty for Normal Tension Glaucoma

Jacky WY Lee; Wing Lau Ho; Jonathan CH Chan; Jimmy SM Lai
BMC Ophthalmol. 2015;15(1)  

Conclusions A single session of SLT for NTG achieved an additional 15% IOP reduction while using 27% less medication at 1 year compared to pre-study levels.

Read the article on Medscape here.

Mobile SLT laser rental is available for treating your patients with open angle glaucoma.
We bring the laser to your office for the day.

Contact
Lauren Teton
LTeton@Option3.biz
Marketing Manager, Option3 LLC
Westchester County, NY
914 764-0115

Slit Lamps Compatible with SLT Laser

The following is a list of Slit Lamps known to Lumenis to be compatible with the Selecta II SLT Laser, which is available for daily rental from Option3 LLC

Mobile SLT laser rental is available for treating your patients with open angle glaucoma.
We bring the laser to your office for the day.

Contact Lauren Teton   LTeton@Option3.biz   www.Option3.biz      NY 914 764-0115

 

Slit Lamp Model

Selecta II

Haag-Streit® 900® BM

Yes

Haag-Streit® 900® BQ

Yes

Topcon SL-3C

Yes

Topcon SL-D7

Yes

Topcon SL-3E

Yes

Topcon SL- 3G

Yes

Topcon SL-7E

Yes

Marco Ultra 2B

Yes

Marco Ultra 5

Yes

Marco Ultra G5

Yes

Nidek SL-450

Yes

Nikon NS-IV

Yes

Mentor 4200 SL-SH12

Yes

Mentor 253

Yes

Reichert XCEL 300

Yes

Reichert XCEL 400

Yes

Reichert XCEL 700

Yes

SLT Shows significantly higher five-year efficacy rate with SLT compared with ALT

“I have performed more than 4300 SLT procedures
since 2001 and have found a significantly higher five-year
efficacy rate with SLT compared with ALT.

Specifically, when my colleagues and I used a Kaplan
Meier analysis to measure the cumulative probability of
success of SLT as primary therapy based on our 4,000
patient data set we found a cumulative probability of
success of over 90% at ten years post-treatment when
SLT was used as a primary treatment."

Lawrence F. Jindra, MD, Floral Park Ophthalmology, New York, USA


Read Dr. Jindra's e-BOOK on SLT Results - free

DELIVERING RESULTS THAT

STAND THE TEST OF TIME

Lawrence F. Jindra, MD, Floral Park Ophthalmology, New York, USA

Long-term control of intraocular pressure (IOP) is key to minimizing the

ocular damage that eventually occurs in glaucoma patients. The effects of

traditional anti-glaucoma eyedrops are short-lived and therefore require

diligent, long-term use. Even argon laser trabeculoplasty (ALT),

which is known to deliver effective results, starts to lose efficacy

within several years. In contrast, selective laser

trabeculoplasty (SLT) delivers effective IOP reduction

that lasts far longer than any other treatment.

Read Dr. Jindra's e-BOOK on SLT Results - free

_______________________________________________________
Mobile SLT laser rental is available for treating your patients with open angle glaucoma.
We bring the laser to your office for the day.

Contact

Lauren Teton

LTeton@Option3.biz

Marketing Manager, Option3 LLC

Westchester County, NY

914 764-0115

Glaucoma in the Clinic: What Not to Miss

Glaucoma in the Clinic: What Not to Miss
A high priority Checklist to make sure nothing important is overlooked.
by Jeffrey M. Liebman, MD, New York City

March 2014
Review of Ophthalmology
Read the article here!

In this article, these are the main topics covered:

Normal-tension glaucoma
Angle-closure-glaucoma
Exfoliation glaucoma
Progression
Screening

____________________________________________
SLT laser is available for treating your patients with open angle glaucoma.
We bring the laser to your office for the day.

Contact

Lauren Teton

LTeton@Option3.biz

Marketing Manager, Option3 LLC

Westchester County, NY

914 764-0115

SLT: A new stanadard in glaucoma treatment on September 1, 2013.

Ophthalmology Times Article

SLT: A new standard in glaucoma treatment 
September 1, 2013.

Read it here! 
http://ophthalmologytimes.modernmedicine.com/ophthalmologytimes/news/slt-new-standard-glaucoma-treatment

Excerpt from: In-Clinic IOP: How Much Does It Tell Us? Review of Ophthalmology

Review of Ophthalmology
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.

cker.#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

• 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

SLT Laser Best Response as First Treatment Modality

Review of Ophthalmology Article
6/13/2011
by Walter Berthke, Managing Editor     read the full article here

SLT on the Front Lines of Treatment

Some surgeons say SLT's safety and efficacy make it a good candidate for first-line therapy.

( We do not have permission to reproduce portions of the article, so this is a short description of the results that we read.   read the full article here)

Success factors for SLT were studied, considering medications, previous treatments, and pigmentation, and the only consistent factor predictive of SLT response was "you get your biggest response when the pressure's high and the patient is treatment naive."

Cindy Hutnik, MD, PhD, associate professor of ophthalmology and pathology at the University of Western Ontario

Here, glaucoma experts explain why they think it’s reasonable to offer SLT alongside prostaglandins as an option for initial therapy. - See more at: http://www.revophth.com/content/i/1533/c/28664/#sthash.JblcRvqB.dpuf

Here, glaucoma experts explain why they think it’s reasonable to offer SLT alongside prostaglandins as an option for initial therapy. - See more at: http://www.revophth.com/content/i/1533/c/28664/#sthash.JblcRvqB.dpuf

SLT’s Acceptance

The prostaglandin analogs are very effective,

The prostaglandin analogs are very effective,

The prostaglandin analogs are very effective,

The prostaglandin analogs are very effective,

Walter Bethke, Managing Editor

Walter Bethke, Managing Editor

Walter Bethke, Managing Editorv

Walter Bethke, Managing Editor

Walter Bethke, Managing Editor

The prostaglandin analogs are very e

The prostaglandin analogs are very e

SLT on the Front Lines of Treatment

Some surgeons say SLT's safety and efficacy make it a good candidate for first-line therapy.

Walter Bethke, Managing Editor
6/13/2011

- See more at: http://www.revophth.com/content/i/1533/c/28664/#sthash.JblcRvqB.dpuf

SLT on the Front Lines of Treatment

Some surgeons say SLT's safety and efficacy make it a good candidate for first-line therapy.

Walter Bethke, Managing Editor
6/13/2011

- See more at: http://www.revophth.com/content/i/1533/c/28664/#sthash.JblcRvqB.dpuf

SLT on the Front Lines of Treatment

Some surgeons say SLT's safety and efficacy make it a good candidate for first-line therapy.

Walter Bethke, Managing Editor
6/13/2011

- See more at: http://www.revophth.com/content/i/1533/c/28664/#sthash.JblcRvqB.dpuf

Pseudotumor Prevalent? Pseudotumor cerebri

I was speaking to a neuro-ophthalmologist as my SLT laser was in use at Fletcher Allen Medical Center in Burlington, VT the other day, and he said he is seeing 3 or 4 cases of Pseudotumor A DAY!!

What is pseudotumor? 

From Mayoclinic.com.

Pseudotumor cerebri occurs when the pressure inside your skull (intracranial pressure) increases for no obvious reason. Symptoms mimic those of a brain tumor, but no tumor is present. Pseudotumor cerebri can occur in children and adults, but it's most common in obese women of childbearing age.

Symptoms of Pseudotumor

By Mayo Clinic staff
Pseudotumor cerebri signs and symptoms may include:

• Moderate to severe headaches that may originate behind your eyes, wake you from sleep and worsen with eye movement
• Ringing in the ears that pulses in time with your heartbeat
• Nausea, vomiting or dizziness
• Blurred or dimmed vision
• Brief episodes of blindness, lasting only a few seconds and affecting one or both eyes (visual obscurations)
• Difficulty seeing to the side
• Double vision (diplopia)
• Seeing light flashes (photopsia)
• Neck, shoulder or back pain

Mayo Clinic this page online here.
More on pseudotumor online at
North American Neuro-Ophthalmology 
Society

-----------------------------------------------------------------------------------------------------------------------------------
Doctors, rent an SLT Laser for the day from us.
Contact

Lauren Teton

LTeton@Option3.biz

Marketing Manager, Option3 LLC

Westchester County, NY

914 764-0115

SLT Laser FAQs for Patients

SLT or Selective Laser Trabeculoplasty is a quick, simple, bloodless, laser procedure with a high degree of success for lowering high intraocular pressure in the eye, which can be a sign or symptom of glaucoma. The procedure is an outpatient surgery, and patients can return to regular activities the same day.




Find the answer to these Frequently Asked Questions about SLT here.

• What is SLT?
• What are the advantages of SLT?
• How is SLT performed?
• Will I feel anything with the laser treatment?
• How often do I need to receive SLT treatments?
• How does SLT work?
• How do I know SLT has worked?
• Is SLT right for me?
• Are there other options available?
• Does SLT work for all types of Glaucoma?
• Will I still need to continue using my eyedrops following the SLT procedure?
• How long will I have to wait to experience the full treatment effect of the SLT laser?
• How long is the recovery time?
• What are the side effects?

Find the answer to these Frequently Asked Questions about SLT here at http://www.glaucomaslt.com/faqs

Find a physician who offers SLT here.

Doctors, rent an SLT Laser for the day.
Contact

Lauren Teton

LTeton@Option3.biz

Marketing Manager, Option3 LLC

Westchester County, NY

914 764-0115

SLT Technology is Changing How Surgeons Lower IOP

Paul Krawitz, MD of Huntington Eye Care Associates on Long Island was a twice-a-month customer of our Option3 LLC Mobile SLT Rental Service, and saw better results using SLT than ALT.  Here are excerpts from a recent article in
Ophthalmology Management.

Lumenis Laser Grows Surgical Repertoire
By Bill Kekevian, Senior Associate Editor
June 2013 Ophthalmology Management

Read the article here.

From the article

"He estimates that 90% of his patients are getting a meaningful lowering of IOP after the SLT procedure."
"The Lumenis has far exceeded our expectations," Dr. Krawitz says. Besides patients embracing the procedure, IOP control has also improved beyond what he anticipated.

Read the article here.


See Dr. Paul Krawitz in video here

"Dr. Paul Krawitz discusses the benefits and results of SLT rather than eyedrops for glaucoma" (video)

4:34 "In new glaucoma patients, when given both options, drops, vs. laser, and presented with the evidence, nearly 100% of my patients are opting for SLT."

See Dr. Paul Krawitz in video here

Use SLT in your office with a daily rental. Contact us here. 

SLT Laser Testimonial for Glaucoma Treatment - Patient Video Testimonial

SLT Laser Patient Testimonial - Patient is Very Pleased

Barry Margolin is a patient who is very pleased after having one eye treated with SLT Laser. He says "it is a very worthwhile procedure, virtually painless very quick recovery, nothing invasive, no concern as to pain or additional medications, and almost immediate positive effect. I dropped at least 4 points in one eye, and I should be on the path to getting off drops completely."
Dr. Meredith Prevor-Weiss of performed the procedure using the Lumenis Selecta II SLT laser, working with the Option3 LLC SLT laser in Westchester County, NY.  http://option3.biz

SLT Laser Patient Testimonial - Improved Visual Field says Patient

SLT Laser - Selective Laser Trabeculoplasty Glaucoma treatment was performed on this patient 6 weeks earlier on both eyes and his intraocular pressure had dropped from 18 and 19 mm Hg to 13 in both eyes. The patient is happy with the procedure and says that using his own vision measurement, his field of vision has also improved.

Dr. Meredith Prevor-Weiss performed the procedures using the Lumenis Selecta II SLT laser, working with the Option3 LLC SLT laser in Westchester County, NY. http://option3.biz/


For SLT Laser contact Lauren Traub Teton, 
For videos contact RealPeopleMarketing. 
914 764-0115 in NY.

Reducing Intraocular Pressure by Eliminating Wheat from the Diet?

I was scrolling through comments on the Wheat Belly Blog, because I have been off wheat for years and it has been very positive for me. Now another family member is exploring a wheat-free diet to ameliorate stomach pain, with success. I came across this question about Glaucoma and possible benefits of a wheat free diet to reduce intraocular pressure in the eye. Although it sounds strange, there could be something to it. Wheat can cause inflammation, and inflammation may be behind the increased eye pressure that can be a symptom of Glaucoma. The reader said her dad had Lasik surgery to reduce the pressure, and I suggested that instead perhaps it was SLT or ALT laser treatment. Read it below.

Debbie Micev says:
 

November 16, 2012 at 10:31 pm

I just read your book and sent a copy to my parents. In just a few weeks I’ve lost 8 pounds and my hunger has changed from insatiable to mild. I’ve also told a number of my friends about your research.
I didn’t see a section for eye problems, but I was wondering if you had any information about the effect of wheat on glaucoma or increased pressure behind the eye. My dad recently had lasik surgery to relieve the pressure and it didn’t seem to work. I am concerned about him.


Response by Lauren Teton, Marketing Manager of Option3 SLT Laser Service: 
See an interview with an SLT patient who tells about the procedure.

Hi Debbie Micev, (November 16, 2012)
I was reading this forum because I have been off wheat for many years and it has changed my life so much for the better. I got off wheat because my chiropractor said my knee pain was from wheat inflammation. Of course I said "NO WAY" but years later I am lighter, fitter, and have no knee pain since cuttign out the wheat (now mostly off dairy too!)

Anyway,  I'm writing to you because I also happen to be in the Glaucoma Laser business. I am pretty sure the laser your Dad had was SLT laser, not Lasik.

SLT laser uses gentle cold laser energy to create a biologic response to help reduce elevated intraocular pressure, and in the majority of cases it does work. In other words, it stimulates the body's defense system to help clean out the clogged "drain" in the eye, so the fluid can flow and the pressure can go down. It can be used instead of or with eye drops, and sometimes helps patients reduce or get off the drops completely.
Or your Dad may have had the older, hot laser "ALT" procedure.

Just wanted you to know!!
Lauren Teton
Option3 SLT Laser Center
New York and the Northeast US


See an interview with an SLT patient who tells about the procedure.

SLT Laser Testimonials for Option3 LLC

I've been having good results with SLT. Patients are dong better than expected. I don't need to purchase an SLT when we can rent the laser easily from Option3 Mobile Laser Service each month. Alexander Hatsis, MD Hatsis Laser Vision Rockville Center, NY I have been scheduling monthly laser sessions with Bob and Dana. The SLT service has been extremely convenient for both my practice and my patients. The business model makes great economic sense, allowing me to have the laser in my office only when I need it, and to pay for it only when I use it. I highly recommend Option3. Ayman Z. Matta, MD, FACS Langerman Matta Eye Institute I have been quite impressed with the high quality professional service Option3 has consistently provided. I especially like their sliding scale payment system which allows me to build profitability without a large capital outlay. Our patients are pleased with the comfort and results of their SLT procedure. Cathy Liggieri, COA Clinical director Langerman Matta Eye Institute Orangeburg, NY I highly recommend Option3’s mobile laser service for their professionalism, state of the art equipment, punctuality and service. I can now offer SLT to my patients in the convenience of my office on a monthly basis. Norman Reinach, MD New Hyde Park, NY Option3’s mobile laser service allows me to provide this procedure to my patients without having to purchase another expensive piece of equipment. The non-invasive SLT procedure is quick, comfortable for patients, and eliminates patient non-compliance issues. SLT reduces operator variability, as well as giving more consistent results compared to ALT. Robert Block, MD Fichman Eye Center Manchester, CT Option3’s Mobile SLT laser service is a cost effective way of providing advanced technology to single or dual practitioner offices that might not have the patient volume to justify a purchase. SLT is proven to be quite effective, convenient, and economical for glaucoma patients, often allowing them to remove one or more medications from their armamentarium. Todd Bragin, MD Hewlett, NY The larger target that the SLT presents allows for more rapid and accurate placement of the laser aiming spots. The older ALT process may be slightly more painful to patients and less forgiving in aiming, for marginal angles. And it's not repeatable like SLT. I also enjoy working with Lauren and Dana at Option3. Edward Palmer, MD Palmer Eye Care and Laser Center Bronx, NY

10 Quick Points Regarding SLT - Selective Laser Trabeculoplasty

Ten Quick Key Points Regarding SLT
by Brian A. Francis, M.D., M.S

In the ten years since the FDA approval of selective laser trabeculoplasty for the treatment of open-angle glaucomas, the 10 unique features that have emerged are:

1. Selectivity and minimal tissue damage of target tissue,
2. Mechanism of action of increasing trabecular aqueous outflow facility,
3. Efficacy equal to that of the most potent class of glaucoma medications,
4. Excellent safety and side effect profile,
5. Ability to improve patient compliance,
6. Ability to decrease patient cost of treatment as well as societal economic burden of glaucoma treatment,
7. Success as an adjunctive treatment in patients who have failed medical or prior laser therapy,
8. Reduction of glaucoma medications in patients with medically controlled IOP (replacement therapy),
9. Reduction in diurnal IOP fluctuation, and
10. Repeatability of SLT in previously treated patients.

From the article "Ten Years of Selective Laser Trabeculoplasty" by Brian A. Francis, M.D., M.S., Associate Professor of Ophthalmology at the Doheny Eye Institute, Keck School of Medicine, University of Southern California.
Posted Tuesday, October 04, 2011 at
http://www.ophthalmologyweb.com/1319-AuthorProfile/1313-Brian-A-Francis-M-D-M-S/

**************************************************************

The Lumenis SLT Laser is available to ophthalmologists as a short- term laser rental.

Visit www.Option3.Biz

or call

Lauren Teton

Marketing Manager Option3 LLC

Westchester County, NY

914 764-0115

Ten Years of Selective Laser Trabeculoplasty

Brian A. Francis, M.D., M.S. 

Tuesday, October 04, 2011  

This is a condensed version of the full article which can be seen here.

Ten Key Points Regarding SLT

In the ten years since the FDA approval of selective laser trabeculoplasty for the treatment of open-angle glaucomas, the 10 unique features that have emerged are: 1) selectivity and minimal tissue damage of target tissue, 2) mechanism of action of increasing trabecular aqueous outflow facility, 3) efficacy equal to that of the most potent class of glaucoma medications, 4) excellent safety and side effect profile, 5) ability to improve patient compliance, 6) ability to decrease patient cost of treatment as well as societal economic burden of glaucoma treatment, 7) success as an adjunctive treatment in patients who have failed medical or prior laser therapy, 8) reduction of glaucoma medications in patients with medically controlled IOP (replacement therapy), 9) reduction in diurnal IOP fluctuation, and 10) repeatability of SLT in previously treated patients.

1. Selectivity and Minimal Damage of Target Tissue

"The pulse duration is very short, so it’s below the thermal relaxation time and there is really no appreciable heating occurring in the cells that are targeted" says Dr. Robert Noecker who published some of the original histological comparisons of ALT and SLT,

2.  Mechanism of Action: Trabecular Outflow

Laser trabeculoplasty is one of the few glaucoma treatments that address the key problem in open-angle glaucomas: decreased trabecular outflow facility. There are several theories of how it exerts this effect, but it is agreed that this is a biologic response.

3. Clinical Efficacy of SLT

SLT is quite effective as primary or adjunctive treatment to lower IOP. Many clinical trials have shown an IOP reduction of approximately 30%, and demonstrate equality to the most potent class of glaucoma medical therapy: prostaglandin analogues.

4. Minimal Side Effects and Excellent Risk Profile

One key aspect of SLT is a favorable side-effect profile, even when compared with glaucoma medications. Most experts agree that a lower power level (barely enough to elicit cavitation bubbles 50% of the time or less) with more treatment spots (up to 200) gives the best ratio of efficacy to side effects. In patients with excessive angle pigmentation such as pigment dispersion glaucoma and pseudoexfoliation glaucoma, much lower powers are used and the treatment can be performed segmentally.

Dr. Frank Howes had several comments related to side effects of medications compared to SLT. “As ophthalmologists I think we tend to forget the rare but potentially serious systemic risks of some glaucoma medications such as reduced cardiac and pulmonary function. In addition, ocular surface disease is a real issue with topical therapy. I think with SLT there is a diminishment of conjunctival scarring by the regular use of this modality as opposed to a treatment (medications) that you’re putting a toxin onto the surface of the eye. From the moment patients use it, you are beginning a scarring crisis. With SLT, then, we’re increasing the chance of surgical success. The patients see better and they get less corneal disease: It’s a positive benefit cycle.”

5. Eliminate Compliance Issues

While medical therapy for glaucoma is quite effective, it still relies on the regular and proper administration of the drug to achieve its effect. The use of SLT gives 100% compliance: The physician performs the treatment and knows whether it is effective or not without wondering if glaucoma therapy is being applied correctly.

Dr. Jay Katz notes, “I think you can make a strong argument in favor of primary therapy with SLT because we know what a huge problem there is with adherence to medical therapy. The best assumption we have out there is that 50% of our patients are truly compliant with medical therapy.”

6. Favorable Individual and Societal Cost Profile

"If you’re picking up a treatment that is cost effective to roll out in a supervised fashion at a triage level to a much larger volume of patients, and if you’re going to prevent those patients from entering into the dependency sector for their needs with blindness at an earlier stage, that’s worth billions to the economy"
says Dr. Kate Coleman, Head of the African Multicenter Glaucoma Study and African Glaucoma SLT Trial.

7. Effectiveness of SLT as Adjunctive Treatment

SLT is also useful as an adjunct to medical therapy and prior failed argon laser trabeculoplasty. Those groups of patients who are uncontrolled despite medical and possibly prior laser therapy are the most challenging, and are often being considered for glaucoma filtration surgery.

Dr. Mark Latina, the inventor of SLT and primary investigator in the pivotal trial, discussed the patients treated in this initial clinical study.7 “We enrolled two groups of patients: both with uncontrolled IOP on maximally tolerated medical therapy, but the second also with prior failed ALT. Even in these patients with glaucoma refractory to medical and laser therapy, the results did show that there was about a 65 percent success rate in both groups. Based on those results, we feel that SLT is a viable alternative in patients who have had prior argon laser trabeculoplasty and those that have failed medical therapy.”

8. Replacing Medical Treatment

The typical glaucoma practice consists of treatment naïve patients, those uncontrolled with medical therapy, and the majority group of those controlled with medical therapy. SLT can be used in this latter group as a replacement therapy to reduce dependence on medications.

According to Dr. Rob Noecker, “Even glaucoma patients who have good IOP on medications are candidates for SLT. The concept of medical substitution was explored in an early paper by Francis and colleagues.11 The laser may be useful in getting patients off of drops. Even if the IOP is controlled, you’re trying to improve quality of life both economically or with regards to side effects.”

9. Reducing IOP Fluctuation
As shown in sleep studies by Weinreb, selective laser trabeculoplasty may help to limit the IOP fluctuation that can lead to progressive optic nerve damage and vision loss.

10. Repeatability of SLT
The ability to repeat the laser sets SLT apart from ALT and increases its usefulness in the lifetime treatment of a glaucoma patient.

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The Lumenis SLT Laser is available to ophthalmologists as a laser rental by the day.

Visit www.Option3.Biz

or call

Lauren Teton

Marketing Manager, Option3 LLC

Westchester County, NY

914 764-0115