Laser Treatment for Glaucoma
Various laser surgeries are available for patients with glaucoma. The goal and purpose of the procedure depends on the patients type of glaucoma and the level of damage.
Selective Laser Trabeculoplasty
Patients with open angle glaucoma may be candidates for a laser treatment called SLT (selective laser trabeculoplasty). SLT is used as an initial therapy and as a supplemental therapy. It also works well in patients who cannot tolerated medications or have difficulty instilling eye drops.
Laser Peripheral Iridotomy
Patients with narrow angle glaucoma, anatomic narrow angles or acute angle closure may benefit from a laser peripheral iridotomy (LPI). A laser is used to create a small hole in the iris to improve the circulation of the aqueous fluid inside the eye. The hole is only several hundred microns and is frequently not visible unless viewed through a microscope.
10 Common SLT questions
- Who is a candidate for SLT?
Patients who have open-angle glaucoma (the drainage system in the front part of the eye is open) and are in need of lowering of their intraocular pressure (IOP) are eligible for the procedure. Your eye doctor will make the final determination if you are a candidate.
- How does it work?
Laser energy is applied to the drainage tissue in the eye. This starts a chemical and biological change in the tissue that results in better drainage of fluid through the drain and out of the eye. This eventually results in lowering of IOP. It may take 1-3 months for the results to appear.
- Why is it called Selective?
The type of laser used has minimal heat energy absorption because it is only taken up by selected pigmented tissue in the eye. Sometimes it is referred to as a “cold laser.” Because of this, the procedure produces less scar tissue and has minimal pain.
- 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.
- How effective is it?
SLT lowers the IOP by about 30% when used as initial therapy. This is comparable to the IOPlowering of the most powerful and commonly used class of glaucoma medication (prostaglandin analogs). This effect may be reduced if the patient is already on glaucoma medications.
- How long does the effect last?
The effect will generally last between 1-5 years, and in rare cases, longer than that. If it does not last at least 6-12 months, it is usually not considered successful.
- What happens if it wears off?
If SLT is effective at lowering IOP but this wears off over several years, the procedure can be repeated But the second treatment may not be as effective as the first and may not last as long. If SLT is not initially successful, repeat treatment is not likely to be effective. Alternatively, glaucoma medication can be used if the effect wears off over time.
- What happens if it doesn’t work?
If SLT fails to lower the IOP, then the glaucoma is treated by other means such as medications or conventional surgery. The laser does not affect the success of these other types of treatment.
- What is the cost?
Since the procedure is an accepted glaucoma treatment, and is FDA approved, it is covered by Medicare and medical insurance. The cost for an uninsured individual or with an insurance co-pay will vary.
- Will I still need to use glaucoma medications?
Some patients can be controlled with just laser treatment. Others require additional IOPlowering and may therefore need to use glaucoma medication as well. Think of the SLT as equivalent to one glaucoma medication. Just as some patients will require more than one glaucoma medication to control their IOP, some may also require laser plus one or more glaucoma medications. It is important to remember that SLT is not a cure for glaucoma, just as medication and surgery are not. Whatever method is used to treat glaucoma, appropriate follow up and testing with your eye care professional is critical.
“Selective Laser Trabeculoplasty: 10 Commonly Asked Questions” by Brian A. Francis, MD. Information on this page is adapted from www.glaucoma.org — the website of the Glaucoma Research Foundation in San Francisco, California — and is copyrighted by the Glaucoma Research Foundation.”