Which Glaucoma Patients Can Benefit from SLT as Primary Therapy?
By I. Paul Singh, MD
While selective laser trabeculoplasty (SLT) has established itself as an effective adjunctive therapy in glaucoma, many ophthalmologists may not realize SLT can also be an excellent primary therapy for many — if not most — of these patients.
SLT Candidate Selection
Indeed, there are few hurdles to clear with respect to meeting “eligibility requirements” for primary SLT. Perhaps, the most important is that the trabecular meshwork must be clearly visible on gonioscopy. As long as that’s the case, chances are good that you’re dealing with open-angle glaucoma, ocular hypertension, or a secondary open-angle glaucoma, such as steroid-induced, pseudoexfoliation, or pigmentary glaucoma. These are among the open-angle glaucomas in which SLT is proven to be highly effective in reducing IOP and helping to halt the progression of optic neuropathy.
There must also be no active inflammation and/or neovascular glaucoma. Patients with blood vessels actively growing in areas where they shouldn’t (i.e., NVG), effectively preventing a good view of the trabecular meshwork, are not good candidates for SLT. Nor are patients with active uveitis or iritis, which may be exacerbated by SLT. Finally, SLT may not be as effective in patients with Sturge-Weber syndrome, in which the increased epscleral venous pressure (EVP) is the primary source of elevated IOP.
Ultimately, however, such patients comprise a small proportion of cases. The majority of open-angle glaucoma patients should be good candidates for SLT, especially those who have trouble administering drops, of which there are many. The act of putting a drop into their eyes is not intuitive for most of patients.
Evaluate Your Patients
The bottom line for me: When certain factors, such as cost, side effects, and even forgetfulness, all affect our patients’ ability to comply with eyedrop-based treatment, virtually every glaucoma patient can — and should — be evaluated for treatment with SLT as early as possible.
Dr. Singh is president of the Eye Centers of Racine & Kenosha, based in Kenosha, WI.