2 hours ago

epkathleen • 10

@_885

Doctor just told me my eye pressures are not low enough (average 16). He wants them 12-13 range. I have to take more eye drops. Or, he suggested DSLT procedure. I would like to know how pros and cons.

2 hours ago

david 4.4k

@david_fe

Direct selective laser trabeculoplasty (DSLT) represents a newer technological advancement over SLT. (In technical terms, it eliminates the need for gonioscopy by delivering laser energy to the trabecular meshwork using automated, image-guided technology.2, 3)

I'll compare DSLT to SLT for you.

SLT

The American Academy of Ophthalmology describes selective laser trabeculoplasty (SLT) as an effective option for lowering intraocular pressure that can be used as either initial or adjunctive therapy in primary open-angle glaucoma.1

Advantages of SLT include:

• Comparable efficacy to medications: SLT demonstrates similar IOP-lowering effectiveness to prostaglandin analog medications, particularly when 360 degrees of the trabecular meshwork is treated1

• Better cost-effectiveness: The LiGHT Study found SLT was more cost-effective than medical therapy over 3 years, with similar IOP lowering and quality of life scores1

• Potentially better disease control: Rapid visual field progression occurred in more eyes treated with medications compared to SLT in the LiGHT Study1

• Favorable safety profile: SLT produces less thermal damage than argon laser trabeculoplasty (ALT) because it uses lower energy selectively absorbed by pigmented trabecular meshwork cells. It causes only mild anterior chamber inflammation and less ocular discomfort compared to ALT1

• Repeatability: Some studies suggest SLT may have greater success with repeated treatments compared to ALT, though evidence is mixed1

Disadvantages and risks of SLT include:

• IOP spikes: Post-procedure IOP elevations occur in 4.5% to 27% of eyes, with more heavily pigmented trabecular meshwork being more prone to this complication1

• Variable repeat success: Retrospective studies report varying success rates with repeat SLT compared to initial treatment1

• Need for monitoring: IOP checks are required within 30 minutes to 2 hours after the procedure, with follow-up within 6 weeks1

DSLT

Advantages of DSLT include:

• Simplified procedure: DSLT is a non-contact, gonioscopy-free approach that enhances procedural efficiency and patient comfort compared to conventional SLT 2, 3

• Effective IOP reduction: DSLT reduces IOP by 18-27% and demonstrates sustained effectiveness over 12 months, with mean IOP reductions of 3.2 mmHg from screening at one year 2, 3

• Comparable safety profile: The GLAUrious trial found that ocular adverse events were generally mild and resolved without intervention, with a safety profile similar to conventional SLT2

• Potential for medication reduction: DSLT often enables reduction in or discontinuation of hypotensive topical medications3

• Expanded access: The automated, non-contact nature may make laser therapy more accessible across diverse clinical settings where gonioscopy expertise is limited3

Disadvantages and limitations of DSLT include:

• Did not achieve statistical noninferiority: This means it was not quite as good as SLT in lowering IOP. In the GLAUrious trial, DSLT failed to meet the primary endpoint of noninferiority to conventional SLT at 6 months, with a between-group difference of -0.7 mmHg (95% CI, -2.2 to 0.8 mmHg)2

• Subconjunctival hemorrhage: Clinically nonsignificant punctate subconjunctival hemorrhage occurred more frequently with DSLT compared to conventional SLT2

• Limited long-term data: As a newer technology, DSLT lacks the extensive long-term durability and repeatability data available for conventional SLT3

• Appropriate patient selection: DSLT remains most suitable when conventional SLT is not readily accessible or as part of early treatment paradigms, though failure to demonstrate noninferiority does not prove inferiority2

References

1. Primary Open-Angle Glaucoma Preferred Practice Pattern®. Gedde SJ, Vinod K, Wright MM, et al. Ophthalmology. 2021;128(1):P71-P150. doi:10.1016/j.ophtha.2020.10.022. 2. Randomized Noninferiority Trial of Direct Selective Laser Trabeculoplasty in Open-Angle Glaucoma and Ocular Hypertension: GLAUrious Study. Gazzard G, Congdon N, Azuara-Blanco A, et al. Ophthalmology. 2025;:S0161-6420(25)00299-4. doi:10.1016/j.ophtha.2025.05.004. 3. Non-Contact Laser Therapy for Glaucoma: A Review of Direct Selective Laser Trabeculoplasty. Koziorowska AM, Opala A, Grabska-Liberek I. Journal of Clinical Medicine. 2025;14(19):6884. doi:10.3390/jcm14196884.