Managing Glaucoma With SLT

Mitch Ibach, OD, FAAO, made the case for SLT, DSLT, and patient quality of life at SECO 2026.

By: Sarah Fackler, managing editor, Optometric Management

Optometric Management February 28, 2026 Vol 61, Issue January-February 2026

Managing Glaucoma With Selective Laser Trabeculoplasty (SLT) and DSLT

Overview

Selective laser trabeculoplasty (SLT) remains a valuable treatment for open-angle and secondary glaucomas, effectively lowering intraocular pressure (IOP) while preserving visual function and quality of life. Emerging direct SLT (DSLT) offers a rapid, noncontact alternative with comparable efficacy and increased efficiency, expanding treatment options in glaucoma care.

Background

Glaucoma management centers on lowering IOP to preserve visual acuity, visual fields, and patient quality of life. SLT is established as a first-line or adjunctive therapy for open-angle glaucoma and secondary glaucomas such as pseudoexfoliation and pigmentary dispersion glaucoma. Recent trials, including LiGHT and COAST, support SLT's efficacy and safety. DSLT, a newer noncontact laser modality, delivers automated shots quickly and may be performed by optometrists in some regions, potentially increasing access to laser treatment.

Data Highlights

Study	Finding
Los Angeles Latino Eye Study	Vision-related quality of life worsens with monocular and binocular visual field loss; severe VF loss linked to mental health concerns
LiGHT Trial	SLT effective as first-line treatment for ocular hypertension and glaucoma
GLAUrious Trial	Minimal difference in mean IOP reduction between SLT and DSLT
Glaucoma Treatment Preferences Study	55% patients prefer drops; 6.3% prefer intraocular surgery over medications
Market Scope Q4 2024	Increasing optometric confidence in SLT utilization

Key Findings

SLT effectively lowers IOP and can be used as first-line treatment in phakic and pseudophakic patients without cataract or corneal edema.
Postoperative management has evolved to omit routine use of postlaser brimonidine, steroids, or NSAIDs, with IOP checks recommended at 8-12 weeks and new visual field/OCT baselines at 3-6 months.
DSLT is a noncontact, rapid procedure delivering 120 automated shots in under 3.5 seconds per eye, with efficacy comparable to conventional SLT but slightly less potent.
DSLT can be performed undilated and by optometrists in several states, potentially improving patient access and clinic efficiency.
Patient preferences show a majority favoring drops over drug delivery systems, but a minority prefer surgical options; optometric confidence in SLT is rising.
SLT may reduce the need for topical glaucoma medications postoperatively, lowering treatment burden.

Clinical Implications

Clinicians should consider SLT as an effective and patient-friendly first-line or adjunctive therapy for open-angle and secondary glaucomas, especially in patients without contraindications such as cataract or corneal edema. DSLT offers a promising, efficient alternative that may expand access to laser treatment, particularly in optometric settings. Postoperative protocols can be simplified, focusing on scheduled IOP monitoring and imaging to optimize outcomes while minimizing medication burden.

Conclusion

SLT remains a cornerstone in glaucoma management, balancing efficacy with quality of life benefits. The advent of DSLT enhances treatment efficiency and accessibility, supporting a more interventional approach that may reduce reliance on medications and improve patient care.

PentaVision

Optometric Management