SLT: Laser Treatment for Glaucoma Patients
Primary open-angle glaucoma is a secondary optic neuropathy characterized by an acquired, progressive loss of retinal ganglion cells, decreased function of the optic nerve, and slow, insidious vision loss. Affecting more than five million people in the United States, glaucoma is a leading cause of blindness worldwide.
In a clinical series report, selective laser trabeculoplasty (SLT) proved to be an effective first-line (primary) treatment in patients with glaucoma. With this treatment, the overall mean reduction in intraocular pressure (IOP) was more than 30 percent after a single office-based procedure. SLT was also effective as adjunctive (secondary) therapy, in place of adding additional topical medication when further reduction in IOP was required. One of the major benefits of using SLT for such secondary treatment was that, post-operatively, SLT appeared to reduce significantly the number of medications required to control IOP, by a factor of nearly two. It appeared that, due to its unique method of action, SLT could be repeated without any significant decrease in its effectiveness, although usually a higher energy setting was used for repeat therapy in eyes which had seemingly under-responded to their initial SLT treatment. While the mean reduction in IOP was similar between the secondary and repeat groups, the effectiveness of SLT in reducing the need for medications appeared to be acceptable, although somewhat decreased, when it was used as a repeat treatment.
Given the results of this study, it seems that treatment with SLT will become widely used and accepted as the first-line treatment of choice for newly diagnosed glaucoma patients. To date, there has been no evidence in the scientific literature to suggest that this type of treatment will not work at least as well as, if not better than, medication as first-line therapy; nor has there been any evidence that initial treatment with SLT leads to more complications in these patients. The incidence of complications, such as post-operative IOP spike, was less than one-half percent in each group. In addition, there appears to be other benefits that SLT provides to patients, such as reduced local and systemic side effects caused by topical drops, decreased cost of therapy to patients on fixed incomes, and increased compliance relative to the use of medications. On balance, SLT appears to be an effective primary, secondary, and repeat treatment for patients with glaucoma.
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