Laser Treatment for Glaucoma
Argon Laser Trabeculoplasty (ALT)
ALT was the first laser treatment that was used to lower eye pressure in open-angle glaucoma patients. It is not used very much as another laser has improved the results from laser trabeculoplasty. An argon wave length laser is used to open the fluid channels in the trabecular meshwork. This laser usually lowered the eye pressure in 75% of patients. Usually ½ of the meshwork is treated and the second half can be treated later if necessary. This laser can only be used one in treating glaucoma as more treatment may actually increase eye pressure.
Selective Laser Trabeculoplasty (SLT)
SLT selectively treats the trabecular meshwork. The laser stimulates the body’s own healing response to lower the eye pressure. SLT improve the outflow of fluid through the trabecular meshwork lowering the eye pressure.
The laser is attached to a slit lamp in the eye doctor’s office which the eye doctors use to examine the eye. A numbing eye drop is instilled into the eye for anesthesia. A contact lens is placed on the eye to visualize the trabecular meshwork. The laser is then applied around the inside of the eye in the trabecular meshwork. The procedure only takes a few minutes to perform. The treatment usually lasts for several years and may be repeated if necessary.
The eye doctor will have you use an anti-inflammatory eye drop medication for several days after the treatment. You should be able to drive home after the procedure is completed. The eye doctor will have you return for follow up visits to monitor the effectiveness of the treatment. It takes about 6 weeks for the final result of the laser treatment to be known.
There are very few side effects from SLT. Some patients may have some inflammation after the treatment, or may have a temporary increase in eye pressure. The eye pressure lowering affect is usually equivalent to the stronger eye drop medications.
Laser Iridotomy
Laser peripheral iridotomy is the treatment indicated for the treatment of angle-closure glaucoma and people with very narrow angles who are at risk of developing angle-closure glaucoma.
Angle-closure closed usually happens as a rapid rise in eye pressure that can severely and permanently damage the eye with loss of vision. The iris is too close to the cornea and totally blocks the flow of fluid out of the eye.
The laser is attached to a slit lamp. The pupil is constricted with eye drops to facilitate the laser procedure. A numbing eye drop is instilled into the eye for anesthesia. The small opening is made in the iris in the peripheral part of the iris. This opening allows the fluid direct access to the trabecular meshwork and letting the fluid out of the eye. It is like putting in a safety valve to stop the angle from closing.
After the procedure, there could be some minor bleeding and inflammation that are temporary. The iridotomy could close later and retreatment may be necessary. You will use anti-inflammatory eye drops for several days after the procedure.
JAMES E. CROLEY III, M.D.
Dr. James E. Croley III is a board-certified ophthalmologist and the founder of the Cataract & Refractive Institute of Florida. He graduated magna cum laude from Cumberland College before attending medical school at the University of Miami and completing his residency at the University of Alabama Eye Foundation Hospital. Additionally, he studied at Stanford University where he gained further education in advanced ophthalmology techniques. Dr. Croley is a member of the American Academy of Ophthalmology and the Florida Society of Ophthalmology.