Eyeworld

76 | EYEWORLD | FALL 2024 G UCOMA by Ellen Stodola Editorial Co-Director About the physicians Richard Lewis, MD Founder Sacramento Eye Consultants and Capital City Surgery Center Sacramento, California Inder Paul Singh, MD The Eye Centers of Racine and Kenosha Racine and Kenosha, Wisconsin S LT has gained popularity in the treat- ment of glaucoma, and there are several new laser technologies and procedures in various stages of devel- opment. Richard Lewis, MD, and Inder Paul Singh, MD, spoke with EyeWorld about a few of the newer options and what they're excited about. Dr. Lewis said that lasers in glaucoma have been utilized for his entire career for a variety of things including angle closure, YAG, and more. The most common use of laser has been for ALT or SLT, which is treating the trabecular mesh- work for open angle glaucoma, Dr. Lewis said, adding that this has been used for around 40 years, evolving from ALT to SLT. The LiGHT study 1 looked at SLT and showed that it could be better and safer than medications because there are no compliance problems and a reduced incidence of side effects compared with incisional procedures. The problem with SLT is that its effect tends to wane over time, Dr. Lewis said, adding that this is why it's important to follow patients to ensure the pressure is under control. On the surgical side, there have been efforts for years to do minimally invasive surgery and create a trabeculotomy. "That's what we're do- ing with newer laser applications—such as with the femtosecond—is creating a hole through an area of resistance into the canal," Dr. Lewis said. "SLT stimulates that tissue; it doesn't make a hole, but surgically, we do." Dr. Singh sees advancements in glaucoma laser procedures as having the potential to help a lot of patients. This can maintain high safety by not having to go into the eye, and providing access to more doctors who aren't as comfort- able doing procedures in glaucoma will allow us to intervene and help more patients early on, he said. "That's big for me as a glaucoma specialist. We never like to see people coming into our office who are so advanced that we can't do much. I wish every primary care ophthalmol- ogist was treating glaucoma and trying to get patients off drops. I think these new glaucoma technologies will allow that earlier intervention by non-glaucoma specialists." DSLT Discussing a new procedure called direct se- lective laser trabeculoplasty (DSLT), Dr. Singh said this is done with the Eagle laser (BELKIN Vision, acquired by Alcon). This laser allows the surgeon to perform SLT directly through the limbus, through the sclera, as there's no goni- oprism. The machine looks like an OCT, like a diagnostic machine, he said. The patient looks into the machine, which automatically recog- nizes the limbus and fires 120 shots externally without any pain in a few seconds. You can control which spots are being applied, he said, adding that it's fairly automated. One of the biggest barriers to SLT, Dr. Singh said, is likely due to efficiency and flow; it's not the data. The LiGHT trial was clear that SLT is New laser technology in glaucoma Gonioscopic image during FLigHT procedure Source: ViaLase

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