Selective Laser Trabeculoplasty
What is Selective Laser Trabeculoplasty (SLT)?
It is a laser applied to the trabecular meshwork (i.e., internal drainage system of the eye) to lower intraocular pressure (IOP). It is thought to lower IOP by activating macrophages (i.e., vacuum- like immune cells) in the trabecular meshwork, so that they clean up the debris clogging it. Because of this, it can take up to six weeks to take full effect. It typically lowers IOP by 20-30%, and when successful, SLT can last 2-5 years. SLT works 80% to 85% of the time. The laser is extremely safe. The main risk is that it may not work (15-20% of the time). Once in a while the IOP goes up instead of going down (<1% of the time).
Who is a great candidate?
SLT works best in patients who have ocular hypertension (i.e., high IOP without opticnerve damage) to help prevent glaucoma and in patients with mild or moderate open-angle glaucoma with a history of elevated or borderline IOPs (> 18 mm Hg). It can be used favorably in patients as first-line therapy to avoid eye drops, in patients who wish to decrease eye drop burden or in patients who wish to delay more invasive interventions for their glaucoma.
How is it done?
Typically we'll ask you to come to the office 30-60 minutes before the procedure so that we can prepare your eye for the laser.
One of our skilled staff members will corroborate the eye being lasered (and mark the eye), make sure there is a consent form in place, and place eye drops in the eye.
When the eye surgeon walks in to do the laser, we'll perform a safety check one more time, place numbing drops in both eyes to minimize blinking, and place a lens with gel on the eye. SLT takes 5-10 minutes.
After the laser, one of our staff members will clean your eye and place some extra drops in it. You will then be asked to wait for another 20-45 minutes, so we can make sure the IOP didn't elevate excessively.
What is the follow-up?
You'll typically return in 2-4 weeks to check the eye pressure and check the drainage system of the eye. At that point, if the other eye needs the laser, we can book the procedure for the other eye, if appropriate.
There are no restrictions associated with the laser. You can typically return to work immediately if you desire. Vision in the lasered eye may be a bit blurry for 1-3 days. Preservative-free tears help with the blurring.
Sometimes and depending on the circumstances, your eye surgeon may ask you to use anti-inflammatory eye drops for 1-2 weeks after the laser.
- It's extremely safe
- It can lower IOP for 2-5 years
- It can help decrease or eliminate the medication burden
- If successful or partially successful the first time, it can be repeated up to 3 times (keep in mind the duration of effectiveness gets typically cut in half with each repetition)
Remember that as of today there is no cure for glaucoma, so you will still need monitoring after the laser, and our team of talented optometrists will help the eye surgeon monitor your eyes.