All of the experts interviewed say that they present patients with the option of SLT as a first-line treatment but that most patients opt for drops. Dr. Lin, who mentions laser but doesn’t push it, tells patients that most people choose drops and that prostaglandin analogues probably are slightly more effective than SLT for lowering IOP. By the time he adds that the effect of laser often wears off, most patients choose drops. Dr. Law tells patients that if one medication doesn’t work, others are available. The downside is that medication needs to be taken long term and has potential side effects. SLT, he tells patients, may lower IOP enough to avoid the need for eyedrops, but it’s not 100 percent effective; and, for about 25 percent, it’s “not effective at all.” Also, SLT takes four to five weeks to kick in, which may be inadequate for treating high pressures. Finally, he warns that SLT may induce a pressure spike. Dr. Latina’s message to patients: “We can do a laser on your eye in the office, which helps to improve drainage of fluid to lower pressure. It can last between two and five years. If SLT is successful, you don’t have to take medications. Or you can take medication every day, and you pay for it. Somebody pays for it.” The bottom line, said Dr. Law, is that SLT is an effective primary treatment, but “treatment has to be individualized.” The patient’s type of glaucoma, IOP and preference all come into play.
Selective Laser Trabeculoplasty, or SLT, is a form of laser surgery that is used to lower intraocular pressure in glaucoma. It is used when eye drop medications are not lowering the eye pressure enough or are causing significant side effects. It may sometimes be used as initial treatment in glaucoma. SLT has been in use for 12 years in the United States and around the world. In this article we present some of the unique aspects of this treatment along with observations from years of experience and treatment of patients. The article is designed as a discussion to answer the most common patient questions and concerns regarding the procedure.
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 Last reviewed on June 25, 2013
SLT: How & Why It Works