TY - JOUR
T1 - A Proposal for the Use of a Fixed Low-Energy Selective Laser Trabeculoplasty for Open Angle Glaucoma
AU - Sacks, Zachary
AU - Katz, L. Jay
AU - Gazzard, Gus
AU - Van Tassel, Sarah H.
AU - Blumenthal, Eytan Z.
AU - Lerner, Fabian S.
AU - Azuara-Blanco, Augusto
AU - Spooner, Gregory John Roy
AU - Solberg, Yoram
AU - Samuelson, Thomas
AU - Belkin, Michael
N1 - Publisher Copyright:
© 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024/1/1
Y1 - 2024/1/1
N2 - Selective laser trabeculoplasty (SLT) has been in routine clinical use for over 20 years with millions of patients successfully treated and a low rate of clinically significant complications. The procedure requires the clinician to manually position the laser beam on the trabecular meshwork using a gonioscopy lens and to titrate the SLT laser energy based on the amount of pigmentation in the angle, as well as the observation of small bubbles produced by the laser effect. We propose that SLT energy titration is unnecessary either to achieve intraocular pressure (IOP) reduction or to minimize potential side effects. Ample evidence to support our proposal includes multiple clinical reports demonstrating comparable levels of IOP reduction resulting from different laser energies, a large variety of energy and other laser parameters used in commercially available SLT lasers, and the nature of the laser-induced changes in the trabecular meshwork tissue with respect to energy. Despite these variations in laser parameters, SLT consistently reduces IOP with a low complication rate. We propose that using low fixed energy for all patients will effectively and safely lower patients' IOP while reducing the complexity of the SLT procedure, potentially making SLT accessible to more patients.
AB - Selective laser trabeculoplasty (SLT) has been in routine clinical use for over 20 years with millions of patients successfully treated and a low rate of clinically significant complications. The procedure requires the clinician to manually position the laser beam on the trabecular meshwork using a gonioscopy lens and to titrate the SLT laser energy based on the amount of pigmentation in the angle, as well as the observation of small bubbles produced by the laser effect. We propose that SLT energy titration is unnecessary either to achieve intraocular pressure (IOP) reduction or to minimize potential side effects. Ample evidence to support our proposal includes multiple clinical reports demonstrating comparable levels of IOP reduction resulting from different laser energies, a large variety of energy and other laser parameters used in commercially available SLT lasers, and the nature of the laser-induced changes in the trabecular meshwork tissue with respect to energy. Despite these variations in laser parameters, SLT consistently reduces IOP with a low complication rate. We propose that using low fixed energy for all patients will effectively and safely lower patients' IOP while reducing the complexity of the SLT procedure, potentially making SLT accessible to more patients.
KW - fixed-dose
KW - glaucoma
KW - low-energy beam
KW - selective laser trabeculoplasty
UR - http://www.scopus.com/inward/record.url?scp=85180269750&partnerID=8YFLogxK
U2 - 10.1097/IJG.0000000000002306
DO - 10.1097/IJG.0000000000002306
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C2 - 37851966
AN - SCOPUS:85180269750
SN - 1057-0829
VL - 33
SP - 1
EP - 7
JO - Journal of Glaucoma
JF - Journal of Glaucoma
IS - 1
ER -