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Medical Forum / General / Vision / September 2007SLT for Glaucoma
My doc is suggesting that the SLT treatment might be helpful for my glaucoma - it is pretty well controlled with just Timolol. What experience with this is out there? > My doc is suggesting that the SLT treatment might be helpful for my > glaucoma - it is pretty well controlled with just Timolol. > What experience with this is out there? Not a direct negative experience by me, but I had met a person who was talked into a SLT treatment for his eyes. He was doing well with drops, I had presumed. One eye was to be done at time. After the operation, there was a problem with the corneal flap healing correctly, so his eyelid hung up at that point. (A mechanical problem, would you believe). As a consequence he had to use dry eye drops in addition to the glaucoma drops. Other eye was just on glaucoma drops. I too would be interested with what the professional here say about this. Good luck, Don W. > Not a direct negative experience by me, but I had met a person who was > talked into a SLT treatment for his eyes. He was doing well with > drops, I had presumed. One eye was to be done at time. After the > operation, there was a problem with the corneal flap healing > correctly, so his eyelid hung up at that point. (A mechanical i'm not sure exactly what type of surgery you are describing but it sounds like a form of filtering surgery or perhaps implanting a drain. Regardless, it is not SLT. SLT (Selective Laser Trabeculoplasty) is a type of laser procedure using optimized wavelengths power levels. There are no flaps involved since there isn't actually any surgical cutting that occurs during the procedure. SLT is relatively new, but it seems like a promising technique. It is proven to be as effective as the best 1st line glaucoma medication available (e.g. prostaglandins @ ~25 - 35% reduction in IOP). There are fewer side-effects compared to ALT, a related procedure. Read more about it at http://www.glaucoma.org/treating/surgery.html. Unfortunately, I cannot re-question the person that described that condition and the procedure used. And reviewing the links provided, it does not appear that it was a SLT, but it was a glaucoma operation (if I can use that word) specifically to reduce the need for drops and to reduce pressure. In the link that Irv Arons provided, in the "Review of Ophthalmology", there is one paragraph that caught my eye describing the SLT: "Lack of reversability. Dr. Heuer notes that medical therapy appears to be completely reversable, which SLT is not". And that medical therapy is of course, drops. But if I were to make this decision, with the drops working well, I would choose the drops. I like the word "reversable". Don W. > Unfortunately, I cannot re-question the person that described that > condition and the procedure used. And reviewing the links provided, [quoted text clipped - 12 lines] > > Don W. While I suppose you could say SLT is not reversible, if I understand the process correctly, targeting the melanin-containing cells stimulates a healing response. Since the effect of SLT wears off, it is my understanding that the trabecular meshwork eventually rebuilds these cells, so in time you are back to where you started. ALT, on the other hand, does produce irreversible scarring. I'm sure some of the doctors here can explain this if I have misunderstood. -Gudrun > While I suppose you could say SLT is not reversible, if I understand > the process correctly, targeting the melanin-containing cells [quoted text clipped - 3 lines] > other hand, does produce irreversible scarring. I'm sure some of the > doctors here can explain this if I have misunderstood. That's pretty much how I understand it, too, Gudrun. The chief question appears to be how many times can SLT be repeated, and what is the effect after each retreatment. It seems as though there are still some questions about the long-term. > My doc is suggesting that the SLT treatment might be helpful for my > glaucoma - it is pretty well controlled with just Timolol. > What experience with this is out there? Jim, over on the Glaucoma board, I posted about SLT becoming a front line treatment for glaucoma. the link to my web Journal article about this is: http://irvaronsjournal.blogspot.com/2006/11/update-on-use-of-slt-for-treating.html Also, the June 2007 issue of Review of Ophthalmology has a "cover focus" article on this subject, titled: "Laser First: SLT as Primary Therapy". I'll try and get a link to the article and post it here if I can find it. Irv Arons > My doc is suggesting that the SLT treatment might be helpful for my > glaucoma - it is pretty well controlled with just Timolol. > What experience with this is out there? Jim, I found the reference, here it is: http://www.revophth.com/index.asp?page=1_13396.htm Irv Arons > My doc is suggesting that the SLT treatment might be helpful for my > glaucoma - it is pretty well controlled with just Timolol. > What experience with this is out there? SLT is a laser procedure designed to increase the outflow area of the eye so that the fluid will drain out more efficiently and thereby reduce the pressure in the eye. There is constantly fluid being produced in the eye & fluid draining from the eye. When you have glaucoma you usually have a problem either with too much fluid being produced or not enough draining or not draining quickly enough to keep up with the production. All treatments whether drops, laser (ALT or SLT), or surgery (filter, trabeculectomy, trabeculoplasty, etc.) are designed to work on one or both of these areas. Until relatively recently ALT was the laser procedure of choice, now SLT is most preferred as it causes less structural damage to the eye than ALT and it can be repeated. When to have SLT or surgery depends on the status of your glaucoma and your doctor's preferences. The more advanced your glaucoma is (the more damage you have), the lower your pressure needs to be. Many doctors will recommend 2 or 3 different drops to control the pressure before recommending laser. Laser is usually recommended before the surgical procedures. If your pressure has been controlled with only 1 medication and your doctor is recommending SLT it is possible that if the SLT works, you may not need to continue with the medication-at least for a period of time. |
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