Medical and Laser Treatment
Selective Laser Trabeculoplasty (SLT)
Selective Laser Trabeculoplasty (SLT)
Selective Laser Trabeculoplasty (SLT) is laser procedure in which a low energy laser beam is precisely aimed at the trabecular meshwork inside the eye. The trabecular meshwork is the “drain” inside the eye that has stopped working well in patients with open angle glaucoma, resulting in high pressure in the eye. The laser energy causes a very low-grade inflammation in the trabecular meshwork, attracting immune cells to the area to clean up and improve the functioning of the trabecular meshwork. As a result, the outflow through the trabecular meshwork increases and the pressure of the eye goes down.
SLT does not improve the clarity of your vision. However, by lowering the eye pressure in patients with glaucoma, it can prevent vision loss. It may also decrease your reliance on pressure lowering eye drops. The treatment typically takes 5-10 minutes to complete but the entire visit may last 2-3 hours. The pressure lowering effect usually last one to two years. It can be repeated once or twice, however subsequent treatments are usually less effective than the first treatment.
Laser iridotomy is a treatment for narrow-angle glaucoma. In laser iridotomy, a small hole is placed in the iris to create a hole for fluid to drain from the back of the eye to the front of the eye. Without this new channel through the iris, intra-ocular pressure can build rapidly causing damage to the delicate optic nerve, and permanent loss of vision. In most patients, the iridotomy is placed in the upper portion of the iris, under the upper eyelid, where it cannot be seen. The purpose of an iridotomy is to preserve vision, not to improve it.
Laser iridotomy is for those;
- who have been diagnosed with narrow-angle glaucoma.
- whose doctor has determined that laser iridotomy is the appropriate treatment for their condition.
What to Expect on Procedure Day
Your treatment will be performed in a specially equipped laser room. It does not require a surgery center. Once you have been checked in and settled comfortably, drops will be used to numb your eye; no injections or needles are used.
First, your ophthalmologist will place a drop in your eye to make your pupil smaller. This stretches and thins your iris, which makes it easier for the laser to make the pinhole sized puncture. Next your doctor will place a special contact lens on your eye to focus the laser light upon the iris. This lens keeps your eyelids separated so you won’t blink during treatment. It also reduces small eye movements so that you don’t have to worry about your eye moving during the treatment. To ensure that the contact lens doesn’t scratch your eye, a special jelly will be placed on the surface of your eye. This jelly may remain on your eye for about 30 minutes, leading to blurred vision or a feeling of heaviness.
During the laser treatment, you may see a bright light, like a photographer’s flash from a close distance. Also, you may feel a pinch-like sensation. Other than that, the treatment should be painless.
Your eye pressure will be checked shortly after your procedure and drops may be prescribed to alleviate any soreness or swelling inside your eye. Follow-up visits are necessary to monitor your eye pressure.
Your doctor may ask you to continue using eye drops to make your pupil smaller for a few days following your laser treatment. These drops can temporarily cause blurred vision (especially at night) and may also give you a slight headache. Your doctor may use other drops, both before and after your treatment to control your eye pressure. Still other eye drops may be used to reduce inflammation.
Everyone heals differently, but most people resume normal activities immediately following treatment, although you’ll need to have someone drive you home after your procedure. For the next few days your eyes may be red, a little scratchy and sensitive to light.
Serious complications with laser iridotomy are extremely rare, but like any medical procedure, it does have some risks. The chance of losing vision following a laser procedure is extremely small. The main risks of a laser iridotomy are that your iris might be difficult to penetrate, requiring more than one treatment session. Another risk is that the hole in your iris will close. This happens in less than one-third of the cases.
Following your procedure, you may still require medications or other treatments to keep your eye pressure sufficiently low. This additional treatment will be necessary if there was damage to the trabecular meshwork prior to the iridotomy or if you also have another type of glaucoma in addition to the closed-angle type.
If you and your doctor decide that laser iridotomy is an option for you, you will be given additional information about the procedure that will allow you to make an informed decision about whether to proceed. Be sure you have all your questions answered to your satisfaction.
Argon Laser Trabeculoplasty (ALT)
Laser surgery has become increasingly popular as an intermediate step between drugs and traditional glaucoma surgery. The most common type of laser surgery performed for open-angle glaucoma is called Argon Laser Trabeculoplasty (ALT). The objective of the surgery is to help fluids drain out of the eye, reducing intra-ocular pressure that can cause damage to the optic nerve and loss of vision.
Although your eye care professional may suggest ALT surgery at any time, it is often performed after trying to control intra-ocular pressure with medicines. In many cases, you will need to keep taking glaucoma medications even after ALT surgery.
ALT is for those;
- who have been diagnosed with glaucoma
- whose doctor has determined that ALT is appropriate for controlling their intra-ocular pressure
What to Expect on Procedure Day
Your treatment will be performed in a specially equipped laser room. It does not require a surgery center. Once you have been checked in and settled comfortably, drops will be used to numb your eye; no injections or needles are used. When your eye is completely numb, an eyelid holder will be placed between your eyelids to keep you from blinking during the procedure.
Your doctor will hold up a special lens to your eye as a high-energy beam of light is aimed at the lens and reflected onto the trabecular meshwork inside your eye. You may see flashes of bright green or red light. Your doctor will make 50-100 evenly-paced laser applications in 10-15 minutes. This will be done in one or two treatment sessions. The laser beam will cause some areas of your eye’s drain to shrink, resulting in adjacent areas stretching open to permit the fluid to drain faster. You will not feel any pain during the procedure.
Your eye pressure will be checked shortly after your procedure and drops may be prescribed to alleviate any soreness or swelling inside your eye. You should relax for the rest of the day. Follow-up visits are necessary to monitor your eye pressure. While it may take a few weeks to see the full pressure-lowering effect of this procedure, during which time you may have to continue taking your medication, many patients are eventually able to discontinue some of their medications. Most patients resume normal activities within a few days.
The effect of the surgery may wear off over time. Two years after ALT surgery, the pressure from glaucoma increases again in more than half of all patients. Serious complications with ALT are extremely rare, but like any surgical procedure, it does have some risks. You will be given additional information about the procedure that will allow you to make an informed decision about whether to proceed. Be sure you have all your questions answered to your satisfaction.