Eyeworld

FALL 2025 | EYEWORLD | 63 G BEYOND THE ROUTINE by Ellen Stodola Editorial Co-Director About the physicians Jella An, MD Storm Eye Institute MUSC Health Charleston, South Carolina Shamik Bafna, MD Cleveland Eye Clinic Brecksville, Ohio Christine Funke, MD Barnet Dulaney Perkins Eye Center Phoenix, Arizona T he DSLT laser (Voyager, Alcon) became commercially available in the U.S. earlier this year, and many surgeons are beginning to incorporate this into their glaucoma treatment paradigm. Several physicians discussed this new technology, how it compares to SLT, and how they're using it in their practices. Christine Funke, MD, is already using DSLT frequently in her high-volume practice. "I start- ed using DSLT in clinical practice right after it was launched," she said, adding that she's been using it for about a year. "The reason I was excited about it is be- cause I do such a high volume of laser that I am always looking for a way to increase efficiency and maximize my time in the operating room," she said. "When I sit down to do laser proce- dures, I'll do 70–80 patients in a half day. It used to be I would do 40–45. [With] the adop- tion of DSLT, as I got used to the device and my staff got better at the flow, I've been able to increase the volume of patients that I can take care of." Given that there is the LiGHT trial 1 and evidence to support that SLT should be first line, we know the volume will increase, she said. "Pa- tient volume is rising, and we need to be able to accommodate that volume. I think this is a good way to increase access of care when it comes to SLT technology." Shamik Bafna, MD, also cited the LiGHT trial, which demonstrated that SLT as a first-line therapy is better than drops. "The SLT group had less progression on visual fields, less need for additional glaucoma surgery, and tended to have better pressure compared to drops," he said. But even with this data, he said the ques- tion is, "Why haven't we as doctors been advocating SLT as first line?" Dr. Bafna thinks the reason is that the "manual" SLT procedure is a bit cumbersome. "Traditional SLT is a proce- dure that's been around for 25 years, but if you talk to most ophthalmologists, they don't enjoy doing it," he said. "This is where I think DSLT has made a huge impact and has been revolutionary in terms of being able to offer something that we initially did not enjoy doing, but it's more intuitive to do," he said. Overall results in his hands with DSLT and traditional SLT are similar, but the main difference is it's better accepted by both patients and surgeons. Jella An, MD, said she works at one of the few academic centers in the U.S. that adopt- ed DSLT early this year. "One of my longtime glaucoma patients, who had a great response to traditional SLT, was so enthusiastic about the technology that he generously donated the DSLT device to our clinic after learning about its potential to improve treatment delivery," she said. "The early experience has been promising; patients appreciate the speed and comfort of the procedure. That said, it's still relatively new and not yet widely available in most practices." Dr. An noted that her institution is working on a randomized clinical trial to directly compare the efficacy, safety, and patient-reported experiences among DSLT and traditional SLT. Dr. An said DSLT is especially helpful for patients who have difficulty being positioned at Incorporating DSLT: a new routine in glaucoma treatment continued on page 64 The DSLT laser in action Source: Christine Funke, MD

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