Recommending SLT Over Drops to Family and Friends With Glaucoma
By E. Randy Craven, MD
People sometimes ask me what treatment I would recommend to my own friends and relatives with a new diagnosis of primary open angle glaucoma. Without hesitation and for several reasons, I would advise them to consider selective laser trabeculoplasty (SLT).
Why SLT as the First-Line Therapy?
To start, I would tell them that going with SLT as their initial treatment could reduce the overall amount of treatments, such as surgery, they might need in the future. The LiGHT trial, conducted between 2012 and 2014, showed that none of the patients who chose SLT as their first-line therapy required glaucoma incisional surgery during the three-year duration of the trial.1 In contrast, 11 patients who chose drops as their initial treatment did require surgery during the same time frame. That suggests SLT is changing treatment management for the better.
If the results of the LiGHT trial didn’t convince them, I would tell them that SLT is a significantly more convenient option. Once they undergo the treatment, many patients no longer have to worry about remembering to use drops day in and day out, and it may eliminate the need for them completely!
Lastly, when Lee et al. looked at the effect that SLT provides on 24-hour intraocular pressure (IOP) control, they found it delivers significantly more consistent IOP control than drops over a longer period of time.2 Drops don’t always provide this IOP control, especially overnight.
Much Like an Eye Exam
Most patients find SLT similar to undergoing a typical eye exam with the slit lamp, and SLT itself typically takes about 10 minutes from start to finish. Following the procedure, I have my patients stay for about an hour so I can check their IOP before sending them home.
So, there you have it: four good reasons to go with SLT to treat primary open angle glaucoma—whether the patient is one of your relatives or not.
Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Laser in glaucoma and ocular hypertension (LiGHT) trial. A multicenter, randomized controlled trial: design and methodology. Br J Ophthalmol. 2018 May;102(5):593-598.
Lee AC, Mosaed S, Weinrab RN, Kripke DF, Liu JH. Effect of laser trabeculoplasty on nocturnal intraocular pressure in medically treated glaucoma patients. Ophthalmology. 2007 Apr;114(4):666-70.
Dr. Craven is chief of the Wilmer Eye Institute-Bethesda and associate professor of ophthalmology at Johns Hopkins School of Medicine, Baltimore.