In today’s world of value-based care and the trending patient-driven care models, it is more important than ever that optometrists embrace their roles as clinicians in healthcare teams. Optometry’s success in the 21st century will depend on advanced clinical outcome support in areas including refractions, contact lens services, medical management of anterior segment disease, retinal disorders, neuro-ophthalmic conditions, glaucoma and other ocular conditions.
The use of topical anti-inflammatories post operatively has been debated in the past; however, the recent Steroids after Laser Trabeculoplasty (SALT) trial suggests the use of steroids or non-steroidal agents (NSAID) is beneficial in the effectiveness of the procedure.
The SALT trial was a multi-centered randomized control study comparing three study arms. The first group was given 1% prednisolone acetate, the second group was given 0.5% ketorolac (Acular, Allergan Pharmaceuticals) and the placebo group was given saline artificial tears. All groups were dosed four times per day for five days.
Patients were evaluated by a masked examiner for cells and flare on Day 1 and between five and seven days. IOP was measured by a masked technician, and IOP outcomes at six and 12 weeks showed a statistically significant lower eye pressure in those that were treated with either the steroid or NSAID compared to placebo.3
Another interesting technological development being studied is applying the SLT laser directly onto the limbus versus the traditional method of applying the laser to the trabecular meshwork via a gonioscopic lens.3
From a technical standpoint, applying the gonio lens requires a topical anesthetic, dexterity, patient cooperation, and visualization of the trabecular meshwork.
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3. Gazzard G, Konstantakopoulou E, Garway-Heath D, Garg A, Vickerstaff V, Hunter R, Ambler G, Bunce C, Wormald R, Nathwani N, Barton K, Rubin G, Buszewicz M. LiGHT Trial Study Group. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. The Lancet. 2019 Apr 13;393(10180):1505-1516.
4. Hong Y, Song SJ, Liu B, Hassanpour K, Zhang C, Loewen N. Efficacy and safety of micropulse laser trabeculoplasty for primary open angle glaucoma. International Journal of Ophthalmology. 2019 May 18;12(5):784-788.
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6. Groth SL, Albeiruti E, Nunez M, Fajardo R, Sharpsten L, Loewen N, Schuman JS, Goldberg JL. SALT Trial: Steroids after Laser Trabeculoplasty: Impact of Short-Term Antiinflammatory Treatment on Selective Laser Trabeculoplasty Efficacy. Ophthalmology. 2019 Nov;126(11):1511-1516.
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