Selective Laser Trabeculoplasty as additional line of management for Glaucoma, 2010 and 2015 - study by Dr Fatima Hamroush
Dr Fatima Hamroush has been treating glaucoma with SLT since 2008.
The following 2010 study and its follow up in 2015 showed results that preceded the LiGHT trial with an identical outcome in a smaller cohort of patients.
Ten Years’ Experience in SLT for Glaucoma
(January 2020)
Dr. Fatima Hamroush, FRCS, FRCOphth, DO, MBBS.
Consultant Medical Ophthalmologist,
DMEC (Drogheda Medical Eye Clinic),
Republic of Ireland
Presented at the ICO (Irish College of Ophthalmologists) Meeting, 28-30 April 2010:
Selective Laser Trabeculoplasty, as an additional Line of management for Open Angle Glaucoma (Fatima Hamroush)
A retrospective study of 89 eyes that received treatment with SLT
Effective laser response was defined as:
• a reduction of IOP up to 20 – 35% from the initial reading without additional therapy,
• a reduction equivalent to that obtained by efficient medical therapy, single or combined, eliminating the need for the use of anti-glaucoma medications.
Results:
Eyes with previous anti-glaucoma medications: Total response rate: 93% (excluding the 3 with part-response).
Eyes with no previous anti-glaucoma medications: Total percentage of response rate was 87%.
Five years follow up - ICO presentation in 2015:
• 1/3 of eyes that had SLT remained on target Pressure.
• 2/3 required additional SLT to bring IOP back to target.
• Ten years on (2019): 90% (estimate) required more than one top up, average: 8m to 2 years.
• 5-10% had to use drops drops (poor compliance with appointments, cessation of response, personal preference of the patient).
• 1%: referred for MIGs or Trabeculoplasty.
CONCLUSION:
• SLT is a painless, safe OPD procedure that can be repeated with minimal complications and an average overall success rate of 85% to 90%, eliminating the compliance issues and improving the quality of life of the patients, provided that they are aware of the fact that follow up is mandatory despite the cessation of medications.
• IOP lowering effect of SLT ranges from 10-50% in responsive cases, an IOP lowering that is comparable with the currently available pressure lowering medications.
• SLT is indicated as a first line management at the diagnosis of CSG, PXF, PG, NTG.
• A narrow angle does not necessarily mean that SLT treatment is not indicated. SLT can be performed as long as the trabeculum can be observed during gonioscopy.
• SLT is ideal for patients with poor compliance, allergies to topical medications and those who are on maximum therapy or those who are on multiple other medications.
• SLT has an additive effect to the topical anti-glaucoma medication in cases whose IOP control is achieved only by adjunctive therapy. This reduces the need for filtration surgery when these individuals reach the maximum therapy with topical medications. This reduces the need for filtration surgery when these individuals reach the maximum therapy with topical medications.
• It is also ideal for patients with poor perception of the seriousness of their condition, or those on multiple other medications and patients who find difficulty in instilling the drops (arthritis or need others to help them). SLT is also ideal for patients with poor perception of the seriousness of their condition.
• SLT is cost effective, both for the patients and the Health Board, as the long term cost of glaucoma medications exceeds the cost of the procedure. This is beneficial for both the Medical Card Scheme and the Drug Payment Scheme, as well as for those who neither of those schemes applies to.
Recommendations:
• Patient selection is very important for higher success rates.
• Patient education is valuable both for expectations and follow up, as it provides the best care for the patient without risking further deterioration due to non-attendance after the cessation of medical therapy.