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.
This means the procedure is easier to perform because the surgeon simply needs to aim for the TM as opposed to find the small junction between non-pigmented and pigmented TM demanded by the small, 50-μm spot size of ALT.
More importantly, SLT has non-thermal effects selective for pigmented tissue; it does not burn the TM. This makes it a safer procedure than ALT—and a repeatable one—while its effectiveness was found to be equivalent to ALT.
In MLT the laser is pulsed in 300-μsec bursts, resulting in “cooling off” periods between pulses. As such, similar to SLT, no thermal damage to tissue results from the procedure.2
MLT has been demonstrated to be as efficacious at lowering IOP as SLT with a similar safety profile and improved patient comfort. The procedure came about in the mid 2000s, though has not yet gained the same traction that SLT enjoyed, likely because the gains in MLT compared to SLT are not as large as those in SLT compared to ALT.
Still, it is likely that MLT will become more mainstream. MLT is being introduced and utilized in retinal disease as well.3
Pre-operative management for laser trabeculoplasty involves instillation of apraclonidine to prophylactically treat IOP spikes and pilocarpine to open the angle. It often includes the use of prednisolone acetate (Pred Forte, Allergan Pharmaceuticals) 1% for five to seven days.
1. Nouri-Mahdavi K, Hoffman D, Coleman AL, Liu G, Li G, Gaasterland D, Caprioli J. Predictive factors for glaucomatous visual field progression in the Advanced Glaucoma Intervention Study. Ophthalmology. 2004 Sep 111(9): 1627–1635.
2. 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. British Journal of Ophthalmology. 2019 Apr 13;393(10180):1505-1516.
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.
5. Abramowitz B, Chadha N, Kouchouk A, Alhabshan R, Belyea DA, Lamba T. Selective laser trabeculoplasty vs micropulse laser trabeculoplasty in open-angle glaucoma. Clinical Ophthalmology. 2018 Aug 30;12:1599-1604.
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.
7. Geffen N, Ofir S, Belkin A, Segev F, Barkana Y, Kaplan Messas A, Assia EI, Belkin M. Transscleral Selective Laser
Trabeculoplasty Without a Gonioscopy Lens. J Glaucoma. 2017 Mar;26(3):201-207.
8. Geffen N, Ofir S, Belkin A, Segev F, Barkana Y, Kaplan Messas A, Assia EI, Belkin M. Transscleral Selective Laser Trabeculoplasty Without a Gonioscopy Lens. Journal of Glaucoma. 2017 Mar;26(3):201-207.
9. Lavia C, Dallorto L, Maule M, Ceccarelli M, Fea AM. Minimally invasive glaucoma surgeries (MIGS) for open angle glaucoma: A systematic review and meta-analysis. PLoS One. 2017 Aug 29;12(8):e0183142.
10. Sun W, Yu CY, Tong JP. A review of combined phacoemulsification and endoscopic cyclophotocoagulation: efficacy and safety. International Journal of Ophthalmology.
2018 Aug 18;11(8):1396-1402.
11. Dorairaj SK, Seibold LK, Radcliffe NM, Aref AA, Jimenez-Román J, Lazcano-Gomez GS, Darlington JK, Mansouri K, Berdahl JP. 12-Month Outcomes of Goniotomy Performed Using the Kahook Dual Blade Combined with Cataract Surgery in Eyes with Medically Treated Glaucoma. Advances in Therapy. 2018 Sep;35(9):1460-1469.