Clinical Scorecard: Managing Glaucoma With SLT

At a Glance

Key Highlights

• SLT is effective as a first-line or adjunctive treatment to lower IOP and preserve visual function and quality of life
• Direct SLT (DSLT) is a noncontact, rapid automated laser procedure with similar efficacy but slightly less than conventional SLT
• Postoperative management no longer routinely requires steroids, NSAIDs, or in-office brimonidine; follow-up IOP checks at 8-12 weeks and new visual field/OCT baselines at 3-6 months

Guideline-Based Recommendations

Diagnosis

• Perform standard visual acuity and intraocular pressure exams
• Conduct gonioscopy to assess angle structure and pigmentation before SLT

Management

• Schedule SLT same-day or 2 to 4 weeks after glaucoma evaluation
• Prefer undilated 360º treatment in one or both eyes
• Avoid SLT in patients with cataract, corneal edema, or low IOP
• Consider discontinuing one topical glaucoma medication post-SLT if appropriate

Monitoring & Follow-up

• Check intraocular pressure at 8 to 12 weeks post-procedure
• Obtain new visual field and OCT baselines at 3 to 6 months after surgery

Risks

• Avoid SLT in eyes with cataract, corneal edema, or low intraocular pressure

Patient & Prescribing Data

Patients with open-angle and secondary glaucomas, both phakic and pseudophakic

SLT reduces treatment burden by potentially decreasing topical medication use; patient preferences vary with majority favoring drops but some preferring surgery

Clinical Best Practices

• Use SLT to enhance natural aqueous outflow via the trabecular meshwork
• Optometrists can perform DSLT and improve patient experience by explaining the procedure and stabilizing the head
• DSLT can be performed undilated with follow-up extended to 8-12 weeks
• Postoperative steroids, NSAIDs, and in-office brimonidine are not routinely necessary

References

• Los Angeles Latino Eye Study
• LiGHT Trial
• COAST Trial Abstract
• Melamed et al. SLT as primary treatment
• GLAUrious Trial Protocol
• Glaucoma Patient Treatment Preferences
• Market Scope Ophthalmic Market Trends US Glaucoma Edition Q4 2024