Treatment of Open Angle Glaucoma

OAG treatment concentrates on lowering the pressure inside the eye to prevent damage to the optic nerve. The most common treatments for glaucoma have been the use of medications in the form of eye drops, pills, and laser treatments. Laser treatments and some medications allow for faster drainage, while other medications reduce the production of aqueous humor. If these methods fail to decrease fluid pressure, conventional surgery may be required to create a new drainage channel.

Traditional Laser Treatment

Since medications and eye drops can cause undesirable effects or simply fail to control glaucoma, and because patients frequently fail to take their medications, laser surgery may be a better alternative.

With traditional argon laser trabeculoplasty (ALT), tiny, evenly spaced burns are made in the trabecular meshwork with an argon laser. These laser burns stimulate the drainage of aqueous humor. However, scarring of the trabecular meshwork occurs as a result of ALT burns, and may limit its success and the ability to retreat the eye should the procedure need to be repeated in the future.

Selective Laser Trabeculoplasty

Selective Laser Trabeculoplasty (SLT) is an advanced type of laser surgery and approach to managing patients with an open-angle glaucoma. Instead of generally burning tissue as in ALT, SLT selectively targets pigmented cells in the trabecular meshwork. Both SLT and ALT produce equivalent drops in IOP, however the more sophisticated SLT procedure does not have the associated damage to other tissues and adverse scarring effects. For this reason, where ALT is limited, SLT may potentially be repeated many times. SLT has also been found to be effective when ALT and other forms of treatment have failed.

Benefits of SLT

• SLT results in a biological response that increases aqueous drainage, and reduces IOP.
• No adverse reactions from medications
• No adverse scarring of trabecular meshwork
• May reduce the need for lifelong use of expensive eye drops and other medications
• May reduce or eliminate the trouble of always having to take glaucoma medications

How is SLT performed?

SLT is usually performed in the office and only takes about 15-20 minutes. Prior to the procedure, eye drops will be given for anesthesia and to prepare the eye for treatment. The laser applications are made through a slit lamp microscope, similar to the one used for eye examinations. About one hour of office time should be planned so the IOP can be checked after the eye is treated.

What should be expected after SLT treatment?

The IOP should drop significantly within a day of having the SLT performed. The doctor may treat the eye with anti-inflammatory eye drops that will be continued for four to seven days after the procedure. Most patients will have to return for follow-up visits to recheck the treated eye.

Unlike some glaucoma medications, there are no incidences of allergy or systemic side effects with SLT. Complications are minimal but may include inflammation, transitory IOP spike, conjunctivitis, or eye pain. For more information about SLT and its benefits and possible adverse effects ask the doctor.

Prevention is the best medicine

Vision loss from glaucoma is permanent but can usually be prevented with early detection and treatment. Glaucoma management is usually a lifelong process that requires frequent monitoring and constant treatment. Since there is no way to determine if glaucoma is under control based on how a person feels or their vision, a person with glaucoma generally should be examined every three to four months for the rest of their lives.