Eyeworld

FEBRUARY 2025 | EYEWORLD BONUS ISSUE | 15 G by Ellen Stodola Editorial Co-Director About the physicians Gus Gazzard, MD, MBBChir, FRCOphth Consultant Ophthalmic Surgeon and Director of Surgery Moorfields Eye Hospital NHS Foundation Trust London, U.K. Arsham Sheybani, MD Associate Professor of Ophthalmology and Visual Sciences Washington University School of Medicine in St. Louis St. Louis, Missouri competitive to SLT but may be used before and after incisional glaucoma surgery. How these new options fit in with SLT and other glaucoma procedures will depend on how the technolo- gies develop and are proven through clinical results. Gus Gazzard, MD, MBBChir, FRCOphth, was the chief investigator of the LiGHT trial. 1 Looking at 3-year results comparing prima- ry SLT as the first choice, he said it has been shown that laser treatment seems to work better than eye drops at controlling eye pressure and preserving visual field loss. "I would say that ev- eryone should try laser, if the angle is open and there are no contraindications," he said. Prof. Gazzard said that using laser as a first-line treatment is now mandated by clini- cal guidance in the U.K., and he thinks this is a treatment that should be implemented. "In addition, for the many people who have already been diagnosed and are on eye drops, in mild to moderate or even severe glaucoma, laser W hen discussing the use of lasers in glaucoma, Arsham Sheybani, MD, said you first want to sep- arate the options based on inci- sionless lasers versus lasers that require an incision because those are two very different things. The incisionless lasers include those that perform SLT and direct SLT (DSLT, Alcon) and the femtosecond laser (ViaLase). These, Dr. Sheybani said, shouldn't be confused with things like ELT or excimer-based lasers that require an incision. "People generally try to lump all these lasers together, but that's not how it works. Each has its own place." Dr. Sheybani thinks that several new tech- nologies will find their place in the glaucoma treatment paradigm as time goes on and more research is done. Awareness of the benefits of SLT for early glaucoma is growing, with in- creased data to show its efficacy. Dr. Sheybani thinks that something like ELT might be more competitive with goniotomies and stents, while using the femtosecond laser might be somewhat Lasers: available and upcoming options for glaucoma continued on page 18 SLT is the standard of care in the U.K., according to Prof. Gazzard, and he thinks it should be offered to all glaucoma patients. Source: Gus Gazzard, MD, MBBChir, FRCOphth

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