Introduction

Selective Laser Trabeculoplasty (SLT) is a laser treatment that is used to lower the intraocular pressure of the eye. Laser energy is delivered to the drainage tissue of the eye (called the trabecular meshwork). This leads to increased drainage of fluid from the eye and a lowering of the eye pressure. The full effects of the laser treatment may not be apparent until 1-2 months after the laser treatment.

Indications

Patients with open-angle glaucoma who are in need of lowering eye pressure. This can be in addition to medical therapy with eye drops or as a first-line treatment.

Benefits

When used as initial therapy, SLT can lower the eye pressure by up to 30% in the majority of patients. The effect may be reduced in patients who are already on medical treatment with eye drops. The laser is effective in lowering eye pressure in 75-80% of eyes and the effect of the laser can last up to 1-5 years. The procedure is non-invasive with minimal discomfort, and is performed in an outpatient clinic or office. Treatment of each eye is approximately 5-10 minutes and there are no restrictions of activities afterward. The laser treatment can be repeated, though second treatments may not be as effective or last as long. Laser treatment does not affect the success rates of other medical or surgical treatments.

Risks

Compared to the other treatments for glaucoma, including topical eye drops, other laser treatments and surgery, SLT has a very favorable side effects profile. Post-laser inflammation is common and is often self-resolved. In about 5% of procedures, there can be a temporary elevation of eye pressure immediately following the laser treatment that is managed with glaucoma medications and generally goes away within 24 hours. Some patients also report a mild temporary eye discomfort from the lens used during the procedure that can be treated with over-the-counter artificial tears.

What to expect on the day of selective laser trabeculoplasty (SLT)

Check into a clinic as you typically would for a routine clinic appointment. A technician will then check your vision and your eye pressure and review any medications and eye drops you might be taking. They will then review a consent form for the SLT procedure with you. Drops will then be instilled to prevent elevations in intraocular pressure following laser treatment.

The doctor will then review your exam findings and confirm that an SLT procedure is still the appropriate treatment. You will then be escorted to the laser room where the physician will administer a drop of anesthetic to the eye(s) that are to have the SLT. The doctor will then position you in the laser machine and place a special contact lens on the surface of the eye. The lens is coated with a special jelly to help focus the light properly into the eye. You will then hear a series of clicks and may see flashes of red light as the laser treats the drainage tissue of the eye (called the trabecular meshwork). There is virtually no pain with the procedure. You will feel the lens slowly rotating on the surface of the eye as the doctor treats various areas within the eye. The procedure generally takes 5-10 minutes per eye. At the conclusion of the laser treatment, the lens will be removed from the eye. Because of the jelly used on the lens, it is normal for the vision to be temporarily blurred, but this will improve over several hours.

After the laser treatment, you will be asked to wait in the waiting area and your eye pressure will be checked after 30-60 minutes. If the eye pressure is stable, you will be released home. You will continue all your pre-laser eye drops, if any, and the doctor will then reassess your treatment plan at your follow up appointment. Followup will take place in 1-4 weeks, depending on your status and doctor.

There are typically no restrictions in activities following laser treatment. You may return to your normal daily routine. You may want to avoid driving right away if both eyes have been treated in the same session because of the temporary blurring from the jelly used during the laser treatment. While side effects of SLT are very rare, should you experience any decrease in vision, worsening pain or worsening redness in the eye following your laser treatment, please contact Charlotte Eye Ear Nose & Throat Associates, P.A. at (704) 295-3000 for further instructions.

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