Patient Information on:
Selective Laser Trabeculoplasty
Glaucoma is a chronic disease with, mostly, raised intraocular pressure and is also potentially blinding if left untreated or if treatment is delayed. Glaucoma could be managed by various means, including eye drops, tablets, lasers and various drainage surgeries. This information is designed to help you not only to decide about this laser procedure but also make you aware what to expect.
Clinical indications of SLT
The current options available to treat ocular hypertension & open angle glaucoma are limited to methods of lowering IOP which include medical, laser and surgical treatments. If medications are not effective, laser and other surgical procedures could be of value in controlling the pressure and preventing further loss of vision. Various management options of glaucoma are designed to do one of two things:
• Decrease the amount of fluid production in the eye
• Improve the fluid outflow out of the eye
This procedure is not aimed at increasing your vision but to better manage the eye pressure and your glaucoma.
Vision once lost from glaucoma can not be regained. All treatment/operation for glaucoma is aimed at slowing down the rate of progression of glaucoma so that the risk of complete blindness in one's lifetime may be reduced.
SLT is one option for lowering intraocular pressure (IOP) for patients who have open-angles on gonioscopy, glaucoma in the early stages or with raised pressure in the eye and with high risk of developing glaucoma (Ocular Hypertension), and also in combination with drug therapy or as an alternative therapy when drugs fail. It is a flexible treatment option and can be repeated if necessary, depending on the individual patient's response.
Selective Laser Trabeculoplasty (SLT): How it works
The trabecular meshwork is around the periphery of the iris and is where fluid made in the eye drains out of the eye. This meshwork is treated directly with the laser to improve drainage through it. SLT does not rely on medicines, instead, uses an advanced laser system with short pulses of relatively low energy to target only the melanin-rich cells in the drainage channel of the eye. This allows for only these cells to be affected, leaving surrounding tissue intact. This gentle laser treatment induces a response from the body in which white cells are released to clear the affected cells and rebuild the meshwork so that it again functions effectively. Essentially, your body’s own healing response (activated by SLT) helps lower the pressure in your eye.
SLT effectively lowers raised pressure in the eye without the side effects or difficulty of taking eye drops. The treatment is particularly suitable for patients who cannot correctly use, or are intolerant to, glaucoma medications, and can also be used alongside medication to enhance the overall IOP-lowering effect. SLT is a newer form of a long-established treatment that has the advantage of not causing any damage to the tissue treated.
Stopping certain eye drops before SLT laser treatment
If you are taking certain anti-glaucoma drops, they may interfere with the effectiveness and success of the SLT laser. Therefore, you will be asked to stop them for at least 4 weeks prior to the SLT laser treatment and not to use them after the laser treatment. The drops you will be asked to stop are: Latanoprost 0.005% (Xalatan); Bimatoprost 0.01% 0r 0.03% (Lumigan); Tafluprost (Saflutan) or Travaprost 0.004% (Travatan). Some of these might be in combination with other drops; you will be advised to modify them appropriately as well.
The SLT treatment procedure
Treatment takes place in the outpatient department. A nurse will check your vision and you will be seen by an eye doctor who will put some drops into your eye to make your pupil small and to prevent and blunt the pressure spiking effect of the laser. These drops might take up to half an hour to work and may cause temporary brow ache and headache. The doctor will also take your written consent and explain further if you have any questions.
Once seated in front of the laser machine, which looks similar to the slit lamp microscope you will have been examined on in clinic, you will have anaesthetic drops put in to numb the front of your eye.
It is very important for you to be seated comfortably with your chin on the chin rest and forehead pressed against the forehead band of the machine (Similar looking to the top photograph) and also to stay relaxed and still during the laser procedure. Any movement might defocus the laser and it may not work as well as it should.
A special lens will then be placed against the front surface of your eye. This is not painful, but it might feel a little strange and rarely in some cases may cause some redness or irritation. During the laser treatment, you might see some flashes of light and hear clicking noises. Most patients tolerate the laser treatment well, but some might feel slight discomfort. The procedure takes between 10 and 15 minutes.
The doctor will put some more pressure lowering drops at the end of the laser procedure and will recheck your eye pressure one hour later. We will make an appointment for you to come back to the clinic usually 2-4 weeks later. This follow-up appointment is to check your eye pressure and that your eye is settling.
Potential side effects
SLT laser has a safety track record for over two decades; however, there may be uncommon side effects.
Your vision may be blurred for a few hours but the chance of your vision being permanently affected from SLT is extremely small. If you are concerned that your vision is not returning to normal, please contact the eye casualty. You are also advised not to drive yourself to the hospital, as you may be unable to drive home. It is possible for the pressure in your eye to increase immediately after the treatment but this is well anticipated and managed with specific eye drops. Unlike some glaucoma medications, there are no incidences of allergy or systemic side-effects with SLT. Complications are minimal but may include inflammation, temporary increase in eye pressure, blurred vision, headache, iritis, corneal oedema, conjunctivitis, or eye pain.
Studies show about 80% (4 out of 5) success rate for SLT, with most patients responding well to the treatment, but others not responding at all. Usually, we cannot predict how well the laser will work as your response is determined by the type and severity of glaucoma you have and the basic make-up of your eye. It might take from few weeks to few months to see the response of the SLT laser. You might require additional laser treatment ≥ 6 months later to lower the pressure if it is not sufficiently low after your first laser treatment.
There is a ‘loss of effect’ of the laser treatment. That is, the effects of the laser treatment might wear off in time – about half of all treatments stop working after five years, but the treatment can be repeated as required. You might still need to take some pressure lowering drops.
If you have any of the following after a tube implant surgery:
· Sudden loss of vision
· Severe and unrelenting pain
· Any abnormal and increasing discharges
Please contact your local emergency eye service.
Further information on SLT:
SLT Patient testimonials:http://www.ophthalmic.lumenis.com/testimonials
Various Glaucoma treatment video: http://www.youtube.com/watch?
SLT: How & why it works:http://www.ophthalmic.lumenis.com/slt_how
For private patients & referrals
Mr Akash Raj
Consultant Ophthalmologist, Glaucoma specialist & Cataract surgeon
(Alternate Thursday AM)
01384 632 640
Private Secretary: Liz Carter : 01384 632 636
Fax: 01384 632702
FAO Liz Carter
Mr Akash Raj
Consultant Ophthalmologist, Glaucoma & Cataract specialist
For NHS Referrals through GP/Opticians
Mr Akash Raj
Consultant Ophthalmologist (Glaucoma Lead)
Extn. 5815 (NHS Secretary: Lyn Eaton)
FAO Lyn Eaton