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Surgeon: 'Think before you shoot' when considering laser trabeculoplasty
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NEW YORK — Laser trabeculoplasty is a safe primary treatment option for open-angle glaucoma, but ophthalmologists should consider the potential drawbacks before making the decision to treat, according to a surgeon here.
"[Laser trabeculoplasty] certainly has a role in the management of adult open-angle glaucoma. It can be offered as a primary treatment, but think before you shoot. There are significant concerns — both real and theoretical," Douglas J. Rhee, MD, said during a presentation at the OSN New York Symposium.
Studies have shown that both argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) are at least as effective as glaucoma medications for reducing IOP, Dr. Rhee said. However, efficacy data alone may not be enough to warrant using ALT or SLT as primary treatments. Other factors, such as compliance, diurnal IOP fluctuation and cost, should be considered as well, he noted.
"[Laser trabeculoplasty] can be advantageous for patients who have issues with compliance; they do not have a boat full of medications they have to take," he said.
In addition, there is less fluctuation in diurnal IOP with laser trabeculoplasty compared to medications. Also, laser procedures may be less expensive compared to the costs for medications over roughly 2 years. However, this represents "a more theoretical argument," Dr. Rhee said.
"There are lots of 'ifs' that have to come through for SLT or ALT to be more cost-effective: If it is done as a primary treatment, if it works, and if IOP is lowered enough so you don't have to take other medications," he said.
Potential concerns regarding safety are minimal, but they include a roughly 1% risk of IOP spike after surgery. There is also a potential risk of failure if subsequent surgery is needed, Dr. Rhee said.