Eyeworld

66 | EYEWORLD | FALL 2025 G UCOMA Relevant disclosures An: Alcon Bafna: Alcon Funke: AbbVie, Alcon, Elios, Glaukos, New World Medical, Nova Eye Medical, Sight Sciences Contact An: anjel@musc.edu Bafna: sbafna@midwestvision.com Funke: christine.funke@bdpec.com It's completely revolutionized how we do SLT," Dr. Bafna said. Dr. Funke noted that there are some pa- tients where DSLT can be more challenging than manual. One is patients who have small open- ings to their eyes. You need to have a 360-de- gree view of the sclera. "If someone is very deep set and small eyed, sometimes you can't get the view you need," she said. "The more I've done this, the more I'm finding patients anatomically where it might be hard to get the entire view of the peripheral limbus." In terms of the interface, Dr. Funke said it's very user friendly. "Within a handful of patients, I felt comfortable," she said. "By the end of my first day, which I did a larger number than average, I was already changing how I wanted my flow to go." Updates and future implications Dr. Bafna said DSLT has changed his mindset in terms of interventional glaucoma. "I used to see patients who were on drops, and I had manual SLT available, but I wouldn't have much of a discussion with patients about it," he said. "Now that I have DSLT, I'm pushing to have patients do it." Dr. Funke said she's still using manual SLT if she wants to do 180 degrees instead of a whole 360-degree treatment. Those are more targeted toward pigment dispersion, she said. "In the U.S., we don't have the capability to change the treatment algorithm in the machine, but that's coming and it's already available in other coun- tries." In addition to that feature, Dr. Funke said she's looking forward to other updates like man- ual override, which she said could help if you know where the limbus is (even if the machine doesn't) and can automatically adjust. Dr. Funke is also interested in being able to treat either 180 degrees or 360 degrees or in being able to skip areas. In Europe, they can skip area of treatment zone, for example if the patient has a stent. She added that there's no known impact if you treat over that area, but it will be an option in the future to bypass this area. "It's wonderful to be in glaucoma right now because we have so many options," Dr. Funke said. "These options need to be done earlier. We all emphasize this because we know that the trabecular meshwork and beyond is best remodeled and rejuvenated if we touch it early. If we wait until we've inundated the eye with medication, especially all the problems we see with additives and preservatives associated with those medications and we give this disease time to ravage all that tissue, the potential for rejuvenation is going to be lower. If we can get in there earlier with laser, MIGS, or drug-eluting pharmaceuticals, we see these positive benefits earlier." Dr. Funke thinks DSLT is going to open the door for more patients. "Right now, there's a limited amount of people who want to do it. It does take time," she said. DSLT has the po- tential to cut down on the time for the proce- dure, improve access for patients, and offer an improved/more comfortable procedure for the surgeon as well. Dr. An said DSLT has the potential to in- crease access and efficiency while maintaining efficacy. "I see it playing a major role in reduc- ing medication dependence, improving adher- ence, and offering early intervention, especially for patients who might otherwise go undertreat- ed due to compliance issues or limited access to specialists," she said. continued from page 65 Mary Qiu, MD, EyeWorld Glaucoma Editorial Board member, shared how she goes "beyond the routine": "In eyes with quiescent NVG with open or partially open angles, I offer angle- based surgeries that incise the trabecular meshwork, such as goniotomy and GATT, to try to surgically restore the conventional outflow pathway instead of immediately implanting a tube shunt." B E Y O ND T H E R O U T I N E

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