Selective laser trabeculoplasty – SLT
Selective laser trabeculoplasty (SLT) is an in-office laser procedure to reduce intraocular pressure. A remodeling laser is used to widen the trabecular meshwork, the membrane responsible for draining aqueous humor. By widening this meshwork, intraocular pressure can decrease by 3 to 5 mmHg, the effect of a single drop of eye drops. The laser can be used as a first-line treatment for mild glaucoma without eye drops, or in conjunction with eye drops to reduce discomfort or avoid surgery. The procedure takes approximately 3 minutes, is painless, and has an effect lasting an average of 2 to 5 years. It can be repeated.
What is SLT laser?
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The SLT laser is a laser used in glaucoma specialists' offices. The laser reshapes the trabecular meshwork, increasing its capacity to drain aqueous humor.
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The excess aqueous humor, responsible for the increase in intraocular pressure, is thus better drained. Intraocular pressure decreases.
How does the SLT laser work?
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Laser energy is applied to the trabecular membrane. The impacts separate the trabecular meshwork, increasing its permeability.
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It can sometimes take up to two months for the laser to produce its full effects.
When to perform the laser treatment?
SLT laser treatment is indicated only for patients with open-angle glaucoma. The laser may be indicated:
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During glaucoma diagnosis, to avoid treatment with eye drops.
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In case of poor tolerance or contraindications to eye drops.
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In addition to eye drops, to avoid surgery.
How is laser trabeculoplasty performed?
SLT laser treatment takes place in the office, in a dedicated room. The laser is placed on a table. The machine resembles a classic slit lamp to which a laser module is connected.
Before the laser
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No special precautions need to be taken before the laser treatment.
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Do not wear your contact lenses on the day of the laser treatment, or remove them upon arrival at the clinic.
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Pilocarpine drops are sometimes instilled 30 minutes before the procedure to constrict the pupil and better see the trabecular meshwork.
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3 to 5 minutes before the laser, an anesthetic will be instilled so that a lens can be placed on your eye.
The laser
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Your ophthalmologist will place a special lens on your eye to help focus the laser on the trabecular meshwork. This lens also prevents your eye from blinking and keeps it still during the treatment. A clear gel is placed between the eye and the lens to protect the eye's surface.
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You will then hear a series of clicks and may see some bright flashes when the laser is in operation.
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The procedure is virtually painless. You will feel the lens slowly rotate on the surface of the eye while the doctor treats the different parts of your eye.
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The procedure takes approximately 3 minutes.
Aftercare and treatment following laser surgery
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At the end of the laser treatment, the lens will be removed from the eye. The gel may remain on your eye for up to an hour and blur your vision. Your vision will gradually return.
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The eye was not pierced, so no post-laser hygiene precautions are necessary.
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You can resume your usual activities 1 to 2 hours after the procedure, including sports and screen time.
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Start treatments 1 to 2 hours after the procedure to limit inflammation.
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A follow-up appointment is usually scheduled one month after the laser procedure to assess its effectiveness. If necessary, the procedure can be repeated.
Risks of complications following trabeculoplasty
Laser trabeculoplasty is a well-established and relatively benign procedure. However, some complications are sometimes observed:
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Lack of effectiveness.
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A transient peak in intraocular pressure.
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Inflammation of the trabecular meshwork with conversion to angle-closure glaucoma.
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Trabecular bleeding (rare).
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Corneal decompensation with edema (exceptional).
Frequently Asked Questions
Can I stop using my glaucoma eye drops after laser surgery?
Will my vision improve after the laser procedure?
The laser is used to reduce eye pressure and will not improve your vision.
What are the advantages of SLT lasers?
On average, SLT reduces intraocular pressure by 3 to 5 mmHg, the same effect as a single drop of eye drops. The laser is effective in reducing intraocular pressure in approximately 80% of patients.
Can the laser treatment be done multiple times?
Yes! The laser's effect fades after several years (2 to 5 on average), but the trabecular meshwork can be stimulated again with a new laser treatment. Having had a previous laser treatment does not affect success rates or eligibility for other medical or surgical treatments.
- Your doctor will tell you which drops you should continue to use and how often after the laser procedure.
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Sometimes patients are able to reduce the number of eye drops they take or stop treatment altogether.
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Even if you take the same glaucoma medication after the procedure, laser treatment is successful if your blood pressure is lower or if you no longer experience blood pressure spikes.
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The need for long-term eye drops after this treatment varies greatly and depends on your type of glaucoma and how quickly it is progressing.