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Surgeon: SLT a reasonable, effective initial glaucoma treatment option
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 Steven D. Vold |
SAN DIEGO — Selective laser trabeculoplasty is an effective initial treatment option for glaucoma, a "kind[er], gentler procedure" than argon laser trabeculoplasty, without the cost and compliance issues associated with first-line medical treatment.
"Obviously, there's the issue of medical compliance due to forgetfulness, side effects and cost of medications is becoming more and more of an issue," Steven D. Vold, MD, said here. "There's a whole host of reasons why people might do it — also, the efficacy and potentially improving [the] quality of life."
Dr. Vold gave an overview of his initial treatment approach at Glaucoma Day held preceding the American Society of Cataract and Refractive Surgery meeting. Laser surgery options include argon laser trabeculoplasty (ALT), selective laser trabeculoplasty (SLT) and micropulse diode laser trabeculoplasty (MDLT).
SLT and MDLT have the advantage over ALT of causing less tissue damage with apparent repeatability, Dr. Vold said. In addition, while most patients who undergo laser treatment will need additional therapy to maintain lowered pressure, the lack of compliance issues renders it a reasonable initial treatment choice, he said.
- Disclosure: Dr. Vold has no direct financial interest in the products discussed in this article.
I strongly feel that this technology and procedure may someday be recognized as the single greatest step forward that we have available as clinicians for the treatment of patients with glaucoma, similar in scope and impact as Ridley’s IOL and Kelman’s phacoemulsification were for the treatment of patients with cataracts.
After having performed almost 4,000 SLTs, I agree with Dr. Vold that as a surgical procedure, SLT is a gentle treatment, well suited as primary (initial) therapy of glaucoma. Our data since 2001 have consistently shown more than 30% reduction in IOP when SLT is used as primary therapy. At ASCRS, our data showed when SLT is used as primary treatment, there is a 35% greater reduction in IOP than when SLT is used as secondary (adjunctive) treatment after use of prostaglandin medications. I agree with Dr. Vold that the issues of medical compliance, systemic and local side effects, and cost of glaucoma medications are indeed real issues for all patients, especially for pensioners living on a fixed income. In summary, SLT is unique as an effective primary therapy of glaucoma, which assists us as physicians in preserving long-term visual function and improving the quality of life of our patients.
– Lawrence F. Jindra, MD
Winthrop
University Hospital and Columbia University, New York
Disclosure: Dr.
Jindra has independently conducted and financed the clinical research studies
discussed herein and has received honoraria from Ellex Corp. in the last year.