Selective Laser Trabeculoplasty (SLT)

Selective Laser Trabeculoplasty (SLT) is a relatively straightforward laser treatment that can help reduce eye pressure. It’s often used as an alternative to, or in addition to, eye drops. SLT works for around 7 out of 10 patients and can keep eye pressure lower for up to 5 years. It tends to work best in patients with high pressures who have not already been treated with multiple eye drops. For this reason, it is often recommended as an initial treatment. If needed, it can be repeated.

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SLT uses short pulses of low-energy light to target melanin-containing cells in the trabecular meshwork, which is the part of your eye responsible for fluid drainage. This laser treatment activates cells called macrophages, which help remodel the trabecular meshwork and improve fluid outflow.

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On the day of your SLT treatment, your eyes will be numbed with anaesthetic drops, which may cause temporary blurring and a mild headache. The laser procedure is quick, taking about 5-10 minutes per eye, and is performed on a machine similar to the one used in routine eye exams. After the procedure, you might need to wait for an hour to have your eye pressure re-checked, and you’ll be given drops to use for up to a week.

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The laser may take up to 6 weeks to fully take effect, so you’ll have a follow-up appointment around that time to check your eye pressure. Although SLT is generally safe, it’s still surgery, so there’s a small risk of complications such as temporary blurred vision, mild headaches, or a slight rise in eye pressure. In rare cases, inflammation or persistent blurred vision may occur, but these are usually manageable.

Yag Laser Peripheral Iridotomy (PI)

Yag Laser Peripheral Iridotomy (PI) is a laser treatment primarily used for patients with angle-closure glaucoma or those at risk of developing it due to a narrow drainage angle in the eye. This procedure involves creating a tiny hole in the iris (the coloured part of the eye) to open up the drainage angle and reduce the risk of pupil block, which can lead to increased eye pressure.

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Yag PI helps lower the risk of developing or worsening angle-closure glaucoma, though it doesn’t eliminate the risk entirely. In some cases, cataract surgery may be a better option, particularly for patients over 50, as it provides more space for fluid to drain and can be more effective than Yag PI. However, younger patients might want to avoid cataract surgery due to the loss of near-focus ability and higher complication risks compared to Yag PI.

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The procedure itself is quick and usually requires one or two visits to the laser room. You’ll receive anaesthetic drops and a contact lens will be placed on your eye to help focus the laser. Some patients might feel slight pressure or mild pain during the procedure, and temporary blurring is common afterwards, usually clearing by the next day.

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Yag PI is a very safe procedure, but like any surgery, there are potential risks. These include a temporary rise in eye pressure, slight blurring or ghosting of images, and very rarely, inflammation, bleeding, or damage to the retina. Your doctor will discuss whether Yag PI is right for you based on your specific risk factors.

Cyclodiode Laser Treatment

Cyclodiode is a laser treatment used primarily for reducing eye pressure in advanced or end-stage glaucoma, particularly when other treatments haven’t been successful. It’s performed in an operating theatre, and a strong local anaesthetic injection is given around the eye before the laser is applied over the sclera (the white part of the eye).

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Cyclodiode works by damaging the ciliary body, the part of the eye that produces aqueous fluid. By reducing fluid production, this treatment lowers eye pressure. Traditionally, Cyclodiode was reserved for end-stage glaucoma because of the potential for severe damage to the ciliary body and the eye itself. However, newer techniques, using lower doses or micropulse diode, have made it possible to use Cyclodiode earlier in the disease process with a lower risk of complications.

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While Cyclodiode can be an effective treatment, it’s still primarily used for patients with significant vision loss or those whose glaucoma hasn’t responded to other surgeries.