What is Selective Laser Trabeculoplasty?

What is Selective Laser Trabeculoplasty?

Selective Laser Trabeculoplasty, or SLT, is a form of laser surgery that is used to lower intraocular pressure (OP) in glaucoma. It is used when eye drop medications are not lowering the eye pressure enough or are not causing significant side effects. It may sometimes be used as initial treatment in glaucoma.

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 one to three months for the results to appear.

How is it done?

• The doctor will put drops in your eye to numb the eye.
• A special microscope (slit lamp) and lens (goniolens) are used to guide the laser beam to the canals (trabecular meshwork) where fluid drains from the eye.
• The doctor makes small burns in the trabecular meshwork.
• At the end of the surgery, the doctor will put drops in your eye to prevent eye pressure from rising right away.

What can I expect during the procedure?

You may feel some pressure in the eye during the surgery. The procedure is painless; however, you may feel some discomfort from the contact lens that is placed on your eye during the duration of the laser procedure.

How long does the procedure take?

It usually takes about 15-20 minutes.

What are the benefits of the procedure?

Laser trabeculoplasty may be helpful in treating people whose glaucoma continues to get worse in spite of medication and treatment. It may also be helpful in treating older adults who have glaucoma and are not able to use medicines to treat it.

This laser procedure is usually done before other surgical procedures are tried.

What are the risks of the procedure?

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.

What are the risks and complication of NOT having the procedure?

If IOP is not controlled, the resulting damage to the optic nerve will likely to result in progressive irreversible vision loss.

What are the possible alternatives to the procedure?

Eye drop medication

Ocular surgery (Trabeculectomy, Valve implantation)

Alternatively, glaucoma medication can be used if the effect wears off over time.

If SLR 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.

Some patient can be controlled with just laser treatment. Others require additional IOP lowering and may therefore need to use glaucoma medication as well.

What are the possible problems related to recovery?

• A brief period of inflammation of the colored part of the eye (iris)
• Cloudiness of the clear covering (cornea) over the iris. This usually does not last long.
• Blockage of the drainage angle when the cornea and the iris stick together
• Pain
• Decreased vision, which is usually a temporary problem unless there is a significant rise in the pressure inside the eye. Very high pressures inside the eye can lead to permanent vision loss.

What is the likelihood of success?

SLT lowers the IOP by about 30% when used as initial therapy. This is comparable to the IOP lowering 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.

The effect will generally last between one to five years, and in rare cases, longer than that. If it does not last at least six to 12 months, it is usually not considered successful.

If SLT is effective at lowering IOP but 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.

How can The Medical City help you?

At The Medical City, we have a complete roster of competent ophthalmologists who can assess and treat patients with eye conditions needing Selective Laser Trabeculoplasty. Call your HMO or contact The Medical City Eye Center for a complete listing of ophthalmologists.

For scheduling and inquiries, please call:

The Medical City Eye Center

2^nd floor, Podium Bldg., The Medical City

Monday-Saturday, 8:00am-5:00pm

Tel. no.: (632) 988-1000 / (632) 988-7000 ext. 6252

REFERENCES:

The Medical City Department of Ophthamology

Eye Center

www.webmd.com

www.glaucoma.org

Note: This information is not intended to be used as a substitute for professional medical advise, diagnosis or treatment.   If you or someone you know have any of the symptoms mentioned above, it is advisable to seek professional help.