Selective laser trabeculoplasty (SLT) was introduced as a safe, effective treatment for primary open-angle glaucoma (POAG) more than 20 years ago, and researchers have since touted it as not just a tool to stave off glaucomatous damage, but as a first-line therapy, even before drops, for many patients. Despite research into its safety and efficacy, though, it is still not the front-line therapy of choice for many physicians.1 Recently, a Philadelphia-based research team sought to understand why the procedure suffers from lack of adoption, and offer their suggestions for boosting SLT’s acceptance in the field.

Glaucoma is likely to affect more than 3 million Americans this year alone.2 Reducing intraocular pressure (IOP) is the only modifiable risk factor known to manage the disease, whether that’s accomplished via pharmacological treatment, laser therapy, or surgical interventions.2 SLT’s efficacy as an initial and adjunctive therapy has been confirmed through peer-reviewed research.2 Its predecessor, argon laser trabeculoplasty (ALT), could damage the trabecular meshwork, saw more reported adverse events, and had worse repeatability than SLT.1 Additionally, SLT can reduce or, in some cases, eliminate the need for topical medications.1 This makes it a viable treatment option for patients who cannot tolerate medications due to side effects, have trouble applying drops, or who are unable to undergo surgery. For many, the procedure is simply a more economical option than eye drops or surgery.1,3 

A 2019 study shows that a lower percentage of patients treated with SLT first experienced disease progression than patients treated with medicine first.4 In a post-hoc analysis of that study, 74.6% of eyes (400 eyes) treated with primary SLT achieved drop-free disease-control at 3 years follow-up, of which 58.2% (312 eyes) required only one SLT treatment.1

A Closer Look at Beliefs and Attitudes About SLT

In a study published in Glaucoma, researchers hypothesized that the disconnect between SLT’s documented efficacy and its rate of adoption may be related to a lack of understanding and a misconceived belief that eye drops are a less invasive initial treatment option.


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To test this, the investigators, including Lucas Bonafede, MD, and L. Jay Katz, MD, developed an educational video designed to clear up any confusion with regards to prescribing SLT for patients earlier in the treatment continuum. A group of 53 ophthalmologists, ophthalmology residents, and glaucoma specialists were asked to complete a questionnaire regarding their beliefs and attitudes about SLT before and after watching the video.

This article originally appeared on Ophthalmology Advisor