For people with glaucoma, a laser procedure called selective laser trabeculoplasty (SLT) may be an effective treatment option. Due to its 80% success rate and few side effects, more doctors are supporting SLT as a first-line glaucoma therapy over eye drops. Learn more about the benefits and drawbacks of SLT from the experts at MyVision.org.*

Since 1995, SLT has been a “simple yet effective” method for lowering intraocular (internal eye) pressure, or IOP, in people with glaucoma.

An outpatient procedure, SLT typically takes just 5-10 minutes in an ophthalmologist’s office, and is frequently used when medicated eye drops either fail to lower IOP, or produce intolerable side effects.

That said, research shows that when used as a first-line glaucoma treatment, SLT lowers IOP about 30% roughly 80% of the time.

• SLT lowers IOP by increasing fluid outflow through the eye’s natural drainage system, the trabecular meshwork, to lower pressure and prevent further damage to the optic nerve.
• The procedure is not meant to restore or improve vision, and SL’s full effects can take up to several months to manifest.

People who may be good candidates for SLT include those who:

• Have the following types of glaucoma:
  • Primary open-angle
  • Pigmentary, when pigment particles release from the iris and block fluid outflow
  • Pseudoexfoliation, when protein particles build up in the front of the eye and block fluid outflow
  • Juvenile glaucoma
• Cannot tolerate, or have difficulty taking, glaucoma medications as prescribed
• Want to combine SLT with their glaucoma medication regimen
• Have had no success with argon laser trabeculoplasty (ALT)
• Have difficulty committing to follow-up treatments

Your ophthalmologist will know your glaucoma type and whether or not you qualify for SLT.

The potential benefits of SLT are many.

• About 80% of glaucoma patients experience an average decrease in IOP of 20%-30%.
• Results are usually noticeable within three months of treatment.
• Eye pressure-lowering effects generally last for up to five years, and sometimes longer.
• Treatment can be repeated when the effect wears off.

Risks and complications are few, but they do exist. While SLT has “a strong safety record” and fewer side effects than eye drops, surgery, and other laser procedures, potential drawbacks can include:

• Post-op inflammation, which is easily treatable with non-steroidal anti-inflammatory drugs like ibuprofen, and
• A temporary spike in IOP just after the procedure.

According to the Glaucoma Research Foundation, SLT has an “excellent benefit-to-risk profile,” with fewer eye drops needed by those who may still require medication post-procedure.

Other glaucoma treatments that are similar to SLT include argon laser trabeculoplasty (ALT) and micropulse laser trabeculoplasty (MLT). 

• ALT, the first laser therapy used to treat glaucoma, involves a thermal (heat-inducing) laser that has the potential to leave more scarring than SLT does in the trabecular meshwork.
• MLT is designed to reduce needed energy to the eye. It emits tiny pulses of laser energy in small increments, and so has the potential for low scarring and inflammation like SLT, as well as repeatability.

The IOP-lowering capacities of ALT and MLT are similar to that of SLT.

Given the issues surrounding glaucoma eye drop use (cost, adherence, side effects, allergies), and SLT’s high success rate and low risk, MyVision states, “there is a strong case for SLT to be applied as primary therapy for new glaucoma patients.”

Sources:

• MyVison.org. (2022, April 27). SLT Laser Treatment for Glaucoma: How It Works, Pros and Cons. https://myvision.org/eye-surgery/slt-laser-for-glaucoma