Eyeworld

FEBRUARY 2025 | EYEWORLD BONUS ISSUE | 19 G Contact Gazzard: g.gazzard@nhs.net Sheybani: arsham.sheybani@gmail.com interno excimer laser (Elios Vision, acquired by Bausch + Lomb). Prof. Gazzard added that there are explo- rations being done for applications with the femtosecond laser, specifically the femtosecond laser image-guided high-precision trabeculoto- my (FLigHT) procedure from ViaLase. Dr. Sheybani is also looking forward to these products currently in development and further research in the glaucoma laser space. Hopefully DSLT does open up a portal for doc- tors to be able to offer this laser to patients who are newly diagnosed, he said. Dr. Sheybani thinks the ViaLase procedure shows promise. "If there's a chance to do a goniotomy-level procedure without opening up tissue, that's very exciting, but we have to wait and see what the data show." Having used the ELIOS laser, Dr. Sheybani noted the safety profile because if you're in the wrong spot, you can stop instead of continuing to slide and creating more damage. "From a teaching perspective, this might be the safest way to jump into MIGS or trabecular meshwork-based surgery," he said. All of these procedures require technical skills, and as far as being able to do gonioscopy, that's paramount, Dr. Sheybani said. He added that many of these available and upcoming glaucoma laser procedures are accessible to the comprehensive ophthalmolo- gist as well as the glaucoma specialist, and Dr. Sheybani thinks it will be valuable for a variety of surgeons to learn how to perform them. require a technical skill and decent amount of expense to own the laser." Dr. Sheybani thinks that at this time, drops are still the first-line treatment in the U.S. because the vast majority of patients are being treated for the first time by optometrists. He expects this to change slowly, but it will require making that initial referral where "you can start a drop but also get that patient over to someone who can do SLT, who can do gonio properly, and give the patient that chance." He said the evidence shows that patients who have laser treatment and repeat treatment do better than those who are just medicated. "I think a big push that we need to make is for those frontline providers, who are doing a huge chunk of the work; they need to make that referral to a comprehensive ophthalmologist or a glaucoma specialist for laser, and I think that's one of the bigger barriers," he said, adding that SLT might be first-line treatment for glaucoma specialists and ophthalmologists who are well versed in gonioscopy and who have the ma- chine, but they're not necessarily the first to see the patient. Most people are going in to get checked for glasses by the optometrist. Prof. Gazzard discussed other applications for lasers and new lasers being developed for glaucoma, adding that there are a few ways to address this. One way of thinking about it is that laser trabeculoplasty, treating the trabec- ular meshwork to increase drainage, used to be done with argon laser. It's now done with SLT and may work via stimulation of trabecular stem cells. Another area of interest is DSLT, which doesn't go through a contact lens; it goes di- rectly onto the surface of the eye. Prof. Gazzard said more data is needed on DSLT, but a recent randomized controlled trial was very promising. There are other forms of direct laser treat- ment to the trabecular meshwork. A laser from Carl Zeiss Meditec is a new type of SLT laser, which seems to be working well and is certainly of interest because it may be more reliable, he said. Prof. Gazzard added that more evidence is needed on this technology, but it may be more reproducible. There is a procedure where a hole is made with an excimer laser during surgery though the trabecular meshwork, which is more like MIGS, he said, specifically mentioning the ELIOS ab Relevant disclosures Gazzard: AbbVie, Alcon, Balance Ophthalmics, Bausch + Lomb, Belkin Vision, Carl Zeiss Meditec, Ciliatech, Essential Pharma, Eyetronic, Genentech, Glaukos, Haag-Streit, Iantrek, iStar Medical, Ivantis, Lumenis, McKinsey Consulting, Merck & Co., Nova Eye Medical, Oertli, Quantel/Ellex Lumibird, Rayner, Reichert, Ripple Therapeutics, Santen, Sight Sciences, Thea, Topcon, ViaLase, VISUfarma Sheybani: AbbVie, Alcon, Glaukos, Nova Eye Medical Lorraine Provencher, MD, EyeWorld Glaucoma Editorial Board member, shared her thoughts on interventional glaucoma: "SLT is the gateway to interventional glaucoma. It is a safe, effective, and comfortable way for patients to gain trust in their surgeon and to begin to appreciate the many benefits of a pro- cedural approach (vs. topical therapy)." INTERVENTIONAL GL AUCOMA

• Cover