Effectiveness of Selective Laser Trabeculoplasty in Open Angle Glaucoma

IOP Reduction Efficacy

The American Academy of Ophthalmology recommends selective laser trabeculoplasty (SLT) as a treatment for open angle glaucoma, achieving IOP reduction comparable to prostaglandin analog medications and superior to older beta-blocker therapy, with a better safety profile and potential repeatability compared to argon laser trabeculoplasty 1, 2
SLT achieves comparable IOP reduction to prostaglandin analogs, though one prospective study found SLT was only equivalent to latanoprost when 360 degrees of trabecular meshwork was treated, with latanoprost showing better IOP-lowering effect at 90 and 180 degrees of treatment 1, 2
A multicenter randomized trial comparing SLT to medical therapy as initial treatment showed similar IOP reduction after 1 year of follow-up 1, 2
Meta-analysis of 5 studies with 366 participants confirmed that SLT and topical medication demonstrate similar success rates and effectiveness in lowering IOP 3, 4, 5, 6

Multiple prospective and retrospective studies indicate SLT appears comparable to but not better than ALT in lowering IOP 1, 2, 7, 8
Meta-analysis of randomized controlled trials confirms SLT is non-inferior to ALT in IOP reduction and achieving treatment success 3, 4, 5, 6
SLT produces less thermal damage to the trabecular meshwork compared to ALT due to selective absorption by pigmented cells using lower energy 1, 2, 7, 8
SLT has a better safety profile with less ocular discomfort compared to ALT 1, 2, 7, 8

While controlled randomized trials have not definitively demonstrated superior success with repeated SLT treatments, retrospective studies show similar IOP reduction and success rates with repeat SLT compared to initial SLT 1, 2, 7, 8
This contrasts with repeat ALT, which has low long-term success rates with failure occurring in nearly 90% of eyes by 2 years 1, 2, 7

Mild anterior chamber inflammation after treatment is the most common side effect 1, 2, 7, 8
IOP spikes occur in 4.5% to 27% of eyes, similar to rates observed with ALT 1, 2, 7, 8
Eyes with more heavily pigmented trabecular meshwork are more prone to IOP spikes 1, 2, 7, 8
Overall perioperative treatment is well tolerated and safe 3, 4, 5, 6

Laser trabeculoplasty can be considered as initial therapy in selected patients or as an alternative for patients at high risk for nonadherence to medical therapy 1, 2
Specific indications include patients who cannot or will not use medications reliably due to cost, memory problems, difficulty with instillation, or intolerance to medication 1, 2

360-degree treatment appears more effective than partial treatment when comparing to prostaglandin analogs 1, 2
Treatment can be performed to 180 degrees or 360 degrees depending on clinical scenario 1, 2

While effective, 30% to more than 50% of eyes may require additional surgical treatment within 5 years, based on historical laser trabeculoplasty data 1, 2
Perioperative medications (brimonidine, apraclonidine) are superior to placebo in preventing IOP spikes during the first 24 hours after laser trabeculoplasty 3, 4, 5, 6