Selective laser trabeculoplasty, or SLT, is an FDA-approved laser procedure for the treatment of open-angle glaucoma. SLT is an advanced treatment option that lowers eye pressure and increases fluid drainage. It is minimally-invasive and uses low levels of energy to selectively pinpoint the areas of the trabecular meshwork, relieving the symptoms of glaucoma. If needed, the procedure can be repeated several times without causing damage to surrounding tissue.
What is selective laser trabeculoplasty?
Selective laser trabeculoplasty (SLT) is a form of laser surgery used to lower the elevated intraocular pressure of glaucoma. It is typically used when eye drop medications are not lowering the eye pressure enough to preclude damage to the optic nerve, or if the patient is having significant side effects from glaucoma medication. But it can be the first course of treatment.
The name “selective” comes from the way the laser energy is only absorbed by selected pigmented tissue in the eye. The minimal heat energy involved creates less scar tissue and only minimal, if any, pain. Because of the lack of heat, the laser used for SLT is sometimes known as a “cold laser.”
When the laser energy is applied to the drainage tissue in the eye, the trabecular meshwork starts a chemical and biological change in the tissue that improves drainage out of the eye. It is the lack of drainage and accumulation of fluid that raises the intraocular pressure in glaucoma. As drainage improves the intraocular pressure lowers.
Who is a candidate for selective laser trabeculoplasty?
Patients who have primary or secondary open-angle glaucoma (the drainage system in the front part of the eye is open) and are in need of lowering their intraocular pressure are good candidates for this laser procedure. This procedure isn’t right for all patients, but Dr. Keverline or Dr. Uber will discuss your candidacy with you during your consultation.
These are criteria we look for in patients who would be right for selective laser trabeculoplasty:
- You have a primary open-angle, pseudoexfoliation, pigmentary or juvenile glaucoma.
- You are not tolerating the glaucoma medications used to lower your eye pressure.
- You are on glaucoma drug treatment but want to combine it with SLT.
- You cannot commit to regular follow-up treatments.
- You have a history of failed argon laser trabeculoplasty.
Advantages of SLT for Glaucoma
Performed as an in-office procedure, SLT takes just a few minutes yet provides long-term results. Other advantages of the SLT procedure include:
- Selective targeting of areas within the trabecular meshwork
- Minimal damage to surrounding tissue
- Reduction of intraocular pressure (IOP) by about 30 percent
- Minimal side effects
- The procedure can be repeated
SLT controls glaucoma symptoms for up to 5 years with no need for additional medication and relieves symptoms by promoting the body's natural healing response. There are no major risks or complications associated with SLT and the procedure is covered by most major insurance companies.
How is selective laser trabeculoplasty performed?
For SLT procedures, Dr. Keverline or Dr. Uber first numbs the eye with topical eye drops, ensuring you won’t feel anything. The laser energy is then applied to the drain of the eye, which has been clogged and has caused intraocular pressure to rise. This creates openings in the trabecular meshwork, opening exits for fluid and lowering the pressure inside the eye.
How long does selective laser trabeculoplasty take?
These FDA-approved treatments only take a few minutes to perform with Dr. Keverline or Dr. Uber. There is some additional time prior to the procedure for the anesthetic eye drops to fully take effect.
What can I expect after having selective laser trabeculoplasty?
Selective laser trabeculoplasty lowers the eye pressure in about three-quarters of patients, and this lowers their risk of vision loss from glaucoma. Although the results are not typically permanent, the procedure can be repeated in the future if the pressure begins to build again. Recovery is minimal after SLT, and any future use of eye drops will be less than before the SLT was performed.
Is selective laser trabeculoplasty painful?
These are not painful procedures. Prior to applying the laser, we place anesthetic eye drops to numb your eyes. Some patients say they can feel the laser pulses, but that it isn’t a feeling of pain. Others don’t feel anything. Post-surgical pain is easily treated with eye drops we provide and over-the-counter pain medication. You may not even need the eye drops, but they are necessary to help control swelling and to keep eye pressure down.
What are the risks involved with SLT surgery?
Complications with these laser surgeries are rare. The most common complication is an increase in the pressure in the eyes after this surgery. This rise usually occurs within 1 to 4 hours after the trabeculoplasty. To protect against this possibility, Dr. Keverline or Dr. Uber will place medicine in the patient’s eyes before or after the laser trabeculoplasty.
These are other possible complications of selective laser trabeculoplasty:
- A brief period of inflammation of the iris
- Cloudiness of the cornea, which usually quickly resolves
- Blockage of the drainage angle when the cornea and the iris stick together
- Decreased vision, which is usually temporary
How effective is selective laser trabeculoplasty? How long will my results last?
When used as the initial treatment for glaucoma, SLT lowers the patient’s intraocular pressure by about 30 percent. This is comparable to the use of the most powerful and commonly used class of glaucoma medication (prostaglandin analogs). This lowering of eye pressure lasts from 1-5 years in most patients, but it can last longer. At that point, if the pressure begins to increase again, SLT can be repeated. Sometimes, half of the meshwork may be treated in a first selective laser trabeculoplasty, with the other half treated in a second SLT.
Will I still need glaucoma eye drops after having SLT surgery?
Most patients still need to continue using glaucoma eye drops to keep their intraocular pressure down, but these laser procedures are likely to lessen the amount needed.
What will my recovery be like after having selective laser trabeculoplasty?
There can be variation among patients, but most people can resume normal activities immediately after their SLT. You need someone to drive you home. For the next few days, your eyes may be red, and they may feel a little scratchy and be sensitive to light if there is any inflammation (which isn’t unusual).
You may have blurred vision, but it quickly improves within hours. You don’t have any restrictions on using your eyes to watch TV, use a computer, and the like, but your eyes may tire more quickly.
Over-the-counter acetaminophen (Tylenol) is usually all that’s needed for the pain.