Italian researchers took a closer look at selective laser trabeculoplasty (SLT) and argon laser trabeculoplasty (ALT) treatments for glaucoma, and came across some interesting results, to be presented this afternoon at the ARVO conference in Honolulu, Hawaii.

“Laser trabeculoplasty is a viable alternative to additional topical medication(s),” explains Joseph Shovlin, OD, of Scranton, PA. “It’s often added to the therapeutic regimen when a second or third medication is needed to control IOP.”

Although SLT on a PRN schedule, determined by uncontrolled intraocular pressure (IOP), is the conventional model of care for glaucoma laser treatment, this new data suggests another method may serve patients better.

Researchers studied 216 consecutive patients, with at least three years of follow up, and collected data on IOP, best-corrected visual acuity, timing of initiation of medical treatment, optic disc data and visual fields. They categorized the patients into three different groups based on their treatment regimen: 360° low power SLT repeated yearly, 360° SLT repeated PRN when IOP was considered out of control and 360° ALT performed once with no retreatments.

Ten years after treatment, they found 21 of 32 eyes in the yearly SLT group were still untreated, compared with only nine of 36 eyes in the SLT PRN group and seven of 31 eyes in the ALT group. Patients treated yearly with SLT also took nearly twice as long to require medication: 6.2 years before onset of medication compared with 3.2 years for the SLT PRN group and 2.8 years for those treated with ALT.          

“Low power, timed yearly SLT may soon be the standard when laser trabeculoplasty is employed,” says Dr. Shovlin. “In this cohort, yearly SLT performed better when compared with conventional PRN SLT or ALT in delaying the need for topical medication and, in some cases, what is required to control IOP in POAG.”

Gandolfi SA, Ungaro N, Varano L, Saccà S. Low power selective laser trabeculoplasty (SLT) repeated yearly as primary treatment in open angle glaucoma(s): long term comparison with conventional SLT and ALT. ARVO 2018. Abstract 3459.