Since their development nearly 50 years ago, lasers have revolutionized many fields, particularly medicine. Lasers allow us to easily and safely perform procedures which were once much more invasive, or not possible at all.
A laser is basically a very focused beam of light energy. The color of light emitted by a laser is determined by the type of material used to produce it. This material can be a gas, a liquid, a solid, or a semiconductor such as a diode. When the material inside the laser tube is energized, it produces light of a very specific wavelength, or color. In ophthalmology, lasers range in wavelength from infrared to ultraviolet. The wavelength determines how the laser will affect different cells and tissues within the body. The ability to control the exact amount of energy delivered by the laser makes it the perfect tool to perform precise, delicate surgery within the eye.
Trabeculoplasty is a laser procedure performed for the treatment of open angle glaucoma. It is often recommended as an option when intraocular pressure (IOP) is not adequately controlled by medications alone, however can be performed as an initial means of lowering IOP in appropriate patients. The procedure tends to reduce pressure by about 20 to 30 percent, or roughly the equivalent of one glaucoma medication. Trabeculoplasty demonstrates up to 80% success in lowering IOP, depending on certain characteristics of the patient being treated, such as number of glaucoma medications used, amount of pigment within the eye’s drainage canal, and type of glaucoma. The effects of this procedure are not permanent, and tend to wear off after three to five years. Trabeculoplasty can be repeated when the treatment effect begins to fade, often with good pressure-lowering results.
Two forms of trabeculoplasty are commonly performed today. The original procedure, described in 1979, was performed using an argon laser, though currently a solid-state diode laser is often employed. These lasers produce light in the visible spectrum with a blue-green color. This type of treatment is often called “argon laser trabeculoplasty,” or ALT. ALT is a time-tested procedure which has been performed for nearly 30 years. The greatest drawback to ALT is that it can only be performed two to three times on an eye, as further treatments can cause injury.
A newer version of the procedure, known as “selective laser trabeculoplasty,” or SLT, achieves the same goal using a frequency-doubled neodymium:YAG laser, producing light in the blue-green spectrum. Because the amount of energy delivered by this laser is less than that in ALT, the procedure can theoretically be repeated as many times as desired without risk of injury to the eye. However, SLT has not yet been available long enough to know the results of multiply repeated treatments.
Presently, we perform both the ALT and SLT procedures, choosing that which we feel is most appropriate for each patient’s particular condition.
Trabeculplasty will not cure glaucoma. Damage to the optic nerve cannot be reversed. The goal of trabeculoplasty, as with all treatments for glaucoma, is to lower intraocular pressure and prevent the further loss of vision. In some cases glaucoma medications may be eliminated, however many patients will need to continue all pre-treatment eye drops to maintain adequately low IOP.
Trabeculoplasty is not 100% effective at lowering intraocular pressure. Results often vary depending upon the type of glaucoma, number and type of eye drops being taken, and other conditions affecting the eye. Your surgeon will discuss your specfic situation and will provide appropriate guidance.
The Laser Trabeculoplasty Procedure
Laser trabeculoplasty is a short, usually painless in-office procedure. Most patients are able to drive to and from their appointment alone. The actual procedure is described below:
- You are seated at a slit-lamp microscope, identical to the type used to examine your eyes during a regular appointment.
- Anesthetic eye drops are given.
- A special lens is placed on the treated eye. This lens helps to keep the eye open and still, as well as to focus the laser. Your eye is numb; you will not feel any discomfort from this.
- As the procedure begins, you will be asked to simply look straight ahead, or at a provided fixation target.
- During the procedure, which lasts about 2 to 3 minutes, you will see flashing lights and may hear a clicking or beeping sound as the laser operates. In most cases there is no pain, though a slight burning sensation may be noted. Rarely, more discomfort may be felt and the procedure can be adjusted to avoid this.
- Once the treatment is complete, the lens is removed and your eye is rinsed with saline. Eye drops are given for comfort.
- A prescription may be given for additional eye drops to be used for a few days, as desired by your surgeon.
- During the few days following the treatment you may experience slight blurred vision, discomfort, light sensitivity, and redness in the treated eye. These symptoms should all be very mild and should not limit your activities in any way.
- In general, all pre-treatment glaucoma medications will be continued until the long-term effect of the laser procedure is known. A follow up appointment will usually be made within 2 to 4 weeks of the treatment.
Risks of Trabeculoplasty
All laser procedures have some risk. Risks of trabeculoplasty are few, including inflammation, rise in intraocular pressure (usually brief and medically controlled) and, in extremely rare cases, vision loss. Serious complications from trabeculoplasty are quite rare, making this one of the safest ocular surgical procedures available.
If you have any questions about this or any other procedure, please feel free to contact us for more information.