Glaucoma Laser Therapy Is Getting Smarter: What’s New With SLT and More
In recent years, the glaucoma world has shifted in a pretty exciting direction — especially when it comes to laser therapy. If you’re managing patients with ocular hypertension (OHT) or open-angle glaucoma (OAG), there’s a growing body of evidence saying: maybe we should laser first.That’s right. Selective Laser Trabeculoplasty (SLT) isn’t just for when drops fail anymore. Thanks to newer research, we now have solid reasons to consider SLT as a first-line treatment. Let’s break it down.
Where SLT Fits In
SLT has carved out a valuable place in glaucoma management — not just as an alternative to meds, but sometimes as the preferred starting point. Here’s when it shines:
1. Initiating treatment in newly diagnosed OHT/OAG patients.
2. Escalating care when a patient’s already maxed out on meds or isn’t responding well.
3. Solving compliance problems, whether it’s forgetfulness or side effects.
4. Dealing with cost or insurance headaches, like prior authorizations.
Instead of adding yet another med, SLT gives you a way to intervene early — and maybe even delay or avoid drops altogether.
The LiGHT Trial: A Real-World Game Changer
The LiGHT trial (2023) gave us the most convincing SLT data to date. Here’s what stood out:
– Progression rates were significantly lower in patients who received SLT first (just 19% over six years) compared to those who started with drops (27%).
– 70% of SLT-first patients maintained IOP control six years later — without needing drops.
– 18% of drop-first patients eventually stopped using their meds by year six — and in 80% of those cases, it was because they had later transitioned to SLT.
– Trabeculectomies were less than half as likely in the SLT group (2.4% vs. 5.8%).
– And importantly, no sight-threatening complications or significant corneal issues were reported in the SLT group.
So if you’re on the fence about lasering first, these numbers are hard to ignore.
What About Repeating SLT? The COAST Study Is Asking Smart Questions
The COAST Study (Clarifying the Optimal Application of SLT Therapy) is currently looking at whether we can get even better results by repeating SLT annually — but with lower energy settings.
Here’s the interesting part: A 2018 case series found that the 10-year rate of being medication-free was nearly double in patients who received annual low-energy SLT compared to the standard PRN (as-needed) approach.
So instead of waiting for IOP to creep back up, what if we proactively keep it down with routine laser tune-ups? The study’s Phase III results are still pending, but it could reshape how we time SLT treatments moving forward.
DSLT: The New Laser on the Block
Another new player worth watching is Direct Selective Laser Trabeculoplasty (DSLT). Think of it like a contactless version of SLT:
– No gonio lens required
– Treatment takes just a few seconds
– Doesn’t require eye positioning or coupling gel
For patients who struggle with positioning or have corneal issues, this might become a more comfortable and accessible laser option. It’s still gaining traction in the U.S., but the concept of “no-contact SLT” is definitely something to keep an eye on.
Bottom Line
Lasers aren’t just a backup plan anymore — they’re a front-line strategy. SLT is safer, more effective, and more sustainable than we once gave it credit for. With newer technologies like DSLT and the ongoing COAST study rethinking how we apply laser energy, we’re entering an era where glaucoma therapy is smarter, more personalized, and maybe even a little simpler.
If you haven’t been offering SLT early or often, now might be the time to rethink your approach.
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