In this episode, Dr Damji and I discuss the use of Selective Laser Trabeculoplasty (SLT) in treating patients with open angle glaucoma. The conversation includes a comparison of this to Argon Laser Trabeculoplasty (ALT), the step-wise approach to treating patients with glaucoma and where the SLT might fit it. We also cover the burning question of the repeatability of this treatment modality as well as its contraindications.

Dr Damji is Professor, Department of Ophthalmology, University of Alberta. His recent research topics include Pseudoexfoliation Glaucoma, SLT vs medications as first line glaucoma therapy, and whether SLT treatment reduces diurnal variation of intraocular pressure (IOP.)

Karim Damji, MD, FRCSC, MBA

Professor

Department of Ophthalmology

University of Alberta

2317, 10240 Kingsway Avenue

Edmonton, AB T5H 3V9

Tel: 780.735.4200

Fax: 780.735.5242

This episode was recording using Skype on December 3, 2010 and mixed in January 2010. After much delay it ws finally posted on January 20, 2010. Opinions expressed in this podcast are those of the speakers and are not intended to be taken as the standard of care for glaucoma treatment. Please always weigh the complete clinical picture and involve patients with any decisions in their care.

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Selected references:

1. SLT as effective and safe as ALT:

Damji KF, Bovell AM, Hodge WG, et al. Selective laser trabeculoplasty versus argon laser trabeculoplasty: results from a 1-year randomised clinical trial. Br J Ophthalmol, 2006;90(12):1490-1494.

Pham H, Mansberger S, Brandt JD, Damji K, Ramulu PY, Parrish RK. Argon laser trabeculoplasty versus selective laser trabeculoplasty. Surv Ophthalmol. 2008 Nov-Dec;53(6):641-6.

Juzych MS, Chopra V, Banitt MR, et al. Comparison of long-term outcomes of selective laser trabeculoplasty versus argon laser trabeculoplasty in open-angle glaucoma. Ophthalmology, 2004;111(10):1853-1859.

2. 360 degree SLT as effective as Latanoprost when used as first line treatment:

Nagar M, Ogunyomade A, O'Brart DP, Howes F, Marshall J. A randomised, prospective study comparing selective laser trabeculoplasty with latanoprost for the control of intraocular pressure in ocular hypertension and open angle glaucoma. Br J Ophthalmol. 2005 Nov;89(11):1413-7.

3. Baseline IOP predicts SLT response:

Hodge WG, Damji KF, Rock W, Buhrmann R, Bovell AM, Pan Y. Baseline IOP predicts selective laser trabeculoplasty success at 1 year post-treatment: results from a randomised clinical trial. Br J Ophthalmol. 2005 Sep;89(9):1157-60.

4. Risk of irreversible IOP spike following SLT treatment of heavily pigmented trabecular meshwork:

Harasymowycz PJ, Papamatheakis DG, Latina M, De Leon M, Lesk MR, Damji KF. Selective laser trabeculoplasty (SLT) complicated by intraocular pressure elevation in eyes with heavily pigmented trabecular meshworks. Am J Ophthalmol. 2005 Jun;139(6):1110-3.

Repeat SLT less effective than initial treatment:

5. Hong BK, Winer JC, Martone JF, Wand M, Altman B, Shields B. Repeat selective laser trabeculoplasty. J Glaucoma. 2009 Mar;18(3):180-3.

6. SLT can be effective following ALT:

Birt CM. Selective laser trabeculoplasty retreatment after prior argon laser trabeculoplasty: 1 year results. Can J Ophthal, 2007;52(5):715-719.

7. Reduced visit to visit IOP fluctuation following 360 degree SLT:

Prasad N, Murthy S, Dagianis JJ, Latina MA. A comparison of the intervisit intraocular pressure fluctuation after 180 and 360 degrees of selective laser trabeculoplasty (SLT) as a primary therapy in primary open angle glaucoma and ocular hypertension. J Glaucoma. 2009 Feb;18(2):157-60.

Robert M Schertzer, MD, MEd, FRCSC
Clinical Associate Professor
Dept of Ophthalmology & Visual Sciences
University of British Columbia
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Talking About Glaucoma (TAG) AAC

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Ep 10 Talking About Glaucoma - Jan 19, 2010 w/ Karim Damji discussing SLT (AAC Enhanced)

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