Introducing The SLT Option
A well-planned approach can help you educate your patients about this procedure. Here are some tips from the experts.
Most physicians consider glaucoma treatment successful if their patients consistently achieve and maintain target IOPs. However, a recent study1 shows that quality of life is as important an endpoint in glaucoma treatment as controlling IOP.
Selective laser trabeculoplasty (SLT), which is performed with the Lumenis Selecta II Glaucoma Laser System, offers another option to patients who use multiple glaucoma medications. SLT may reduce the need for medications along with the high costs and risks of systemic side effects. SLT also is safer, offering the benefits of argon laser trabeculoplasty (ALT) without the tissue destruction and discomfort that accompany that procedure.
Nevertheless, glaucoma patients often are hesitant to undergo laser surgery, for fear of losing their sight.
Describing how SLT restores fluid circulation through the eye helps patients understand how this procedure lowers IOP.
"Many elderly patients are deathly afraid of lasers because friends who've had laser surgery for age-related macular degeneration (AMD) or diabetic retinopathy have said they couldn't see after their laser surgery," says Brian A. Francis, M.D., from the Doheny Eye Institute at the University of Southern California Keck School of Medicine in Los Angeles.
Mark A. Latina, M.D., associate clinical professor at Tufts University School of Medicine in Boston, also has encountered this reluctance.
"When we offer patients the choice between SLT and medications, they're sometimes fearful of undergoing a laser procedure," he says. "But we feel it's important that they understand how laser surgery can improve their quality of life by potentially reducing or eliminating their need for glaucoma medication."
Dr. Francis uses pamphlets provided by Lumenis to help educate candidates about SLT.
"If a patient is undecided when I first describe SLT, I tell him to take the pamphlet home, continue his medications and think about it. That usually helps patients make an informed decision to proceed with SLT," he says.
Patient education pamphlets also are useful for family members of patients who've decided to undergo SLT. "Glaucoma patients are in it for the long haul, and they seem to try every available therapy eventually. I view SLT as an option akin to using a strong drug," says Robert J. Noecker, M.D., vice-chair of the department of ophthalmology and director of the glaucoma service at the University of Pittsburgh.
According to a study by Dr. Francis and his associates2 at Doheny Eye Institute, the happiest SLT patients are those who previously used IOP-lowering medications and were familiar with the cost, ocular side effects, discomfort and the inconvenience of instilling eye drops every day. Decreased dependence on medications really made a difference in the quality of these patients' lives, says Dr. Francis.
Choosing the Right Language
Using easily understood terminology, such as "cold laser," to describe SLT can make the procedure sound more inviting to patients.
"Many patients are confused about how ophthalmologists use lasers, especially among my primarily Native American population, who tend to be wary of medical providers in general," says Monte Dirks, M.D., of Blackhills Regional Eye Institute in Rapid City, S.D. "Everybody knows somebody who had unsatisfactory results with panretinal photocoagulation or focal laser for AMD, making it difficult to convince some of these people that SLT is a completely different procedure."
Dr. Latina concurs. "We described the difference between hot and cold lasers in several well-received trade publications. Patients were very open to this kind of information, catching onto the key terms quite readily, ultimately generating several referrals," he says.
James B. Wise, M.D., of Glaucoma and Laser Surgery Associates in Oklahoma City, uses simple terms to describe SLT to his patients.
"I tell them that the eye makes fluid that leaves the eye through this ring of spongy tissue, similar to water soaking through blotting paper," he explains. "In glaucoma patients, this tissue becomes stiff and clogged, blocking fluid drainage and causing increased IOP. I use the SLT laser to break up the pigment trapped in this tissue, which restores fluid circulation without causing damage," he says.
Using understandable language to explain SLT educates prospective laser surgery candidates and also helps alleviate their fears, says Dr. Wise.
Accepting the Challenge
Mounting evidence suggests that patients who have overcome their fear of lasers and experienced SLT are pleased with their results. Dr. Dirks notes that word-of-mouth recommendations from happy patients have generated quite a few referrals in his practice. But nobody would contest that the prospect of getting rid of daily eye drops and improving overall quality of life is likely to dispel the misgivings of even the most fearful patient.
1. Glaucoma Research Foundation Patient Perspectives Survey. 2003; San Francisco, Calif.
2. Francis BA, Ianchulev T, Minckler DS. Selective laser trabeculoplasty as replacement therapy for medically controlled open angle glaucoma. Presented at: Annual Meeting of the American Academy of Ophthalmology; October 2023, 2002; Orlando, Fla.