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Steven D. Vold
SAN DIEGO —
Selective laser trabeculoplasty is an effective initial
treatment option for glaucoma, a "kind[er], gentler procedure" than argon laser
trabeculoplasty, without the cost and compliance issues associated with
first-line medical treatment.
"Obviously, there's the issue of medical compliance due to
forgetfulness, side effects and cost of medications is becoming more and more
of an issue," Steven D. Vold, MD, said here. "There's a whole host of reasons
why people might do it — also, the efficacy and potentially improving
[the] quality of life."
Dr. Vold gave an overview of his initial treatment approach at Glaucoma
Day held preceding the
American Society of Cataract and Refractive Surgery meeting.
Laser surgery options include
argon laser trabeculoplasty (ALT), selective laser
trabeculoplasty (SLT) and micropulse diode laser trabeculoplasty (MDLT).
SLT and MDLT have the advantage over ALT of causing less tissue damage
with apparent repeatability, Dr. Vold said. In addition, while most patients
who undergo laser treatment will need additional therapy to maintain lowered
pressure, the lack of
compliance issues renders it a reasonable initial treatment
choice, he said.
- Disclosure: Dr. Vold has no direct financial interest in the products
discussed in this article.
I strongly feel that this technology and procedure may someday be
recognized as the single greatest step forward that we have available as
clinicians for the treatment of patients with glaucoma, similar in scope and
impact as Ridleys IOL and Kelmans phacoemulsification were for the
treatment of patients with cataracts.
After having performed almost 4,000 SLTs, I agree with Dr. Vold that as
a surgical procedure, SLT is a gentle treatment, well suited as primary
(initial) therapy of glaucoma. Our data since 2001 have consistently shown more
than 30% reduction in IOP when SLT is used as primary therapy. At ASCRS, our
data showed when SLT is used as primary treatment, there is a 35% greater
reduction in IOP than when SLT is used as secondary (adjunctive) treatment
after use of prostaglandin medications. I agree with Dr. Vold that the issues
of medical compliance, systemic and local side effects, and cost of glaucoma
medications are indeed real issues for all patients, especially for pensioners
living on a fixed income. In summary, SLT is unique as an effective primary
therapy of glaucoma, which assists us as physicians in preserving long-term
visual function and improving the quality of life of our patients.
Lawrence F. Jindra, MD
University Hospital and Columbia University, New York
Jindra has independently conducted and financed the clinical research studies
discussed herein and has received honoraria from Ellex Corp. in the last year.