Eyeworld

FALL 2025 | EYEWORLD | 65 G seconds," Dr. An said. "An irregular iris or high corneal astigmatism may also affect limbal de- tection. For those with arcus, pigmented limbus, or very light irises, shining a muscle light from the temporal side with external room lights off and LED ring light set to 7–8 can significantly improve limbal detection. For patients with PAS, I prefer traditional SLT to better target the open trabecular meshwork and avoid treating scarred areas." Dr. An stressed that accurate limbal detec- tion is critical. "Misfiring on the iris or ciliary body can lead to complications such as irido- plasty or cyclophotocoagulation, resulting in inflammation, pain, or IOP spikes," she said. "I recommend avoiding manual adjustment of the limbal detection until you've gained more experience with the procedure." She also recommends checking IOP 30–60 minutes post-procedure and offering NSAIDs or a short course of steroids for photophobia or discomfort. In addition, it's important to set expectations, especially in advanced cases; have a clear plan B, including escalation to urgent surgery, if the patient's baseline IOP is high or poorly controlled on maximal medical therapy, Dr. An said. She noted that there may be a learning curve with DSLT. "Although the procedure itself is straightforward to perform, integrating it into clinic flow required some trial and error," she said. "Patient coaching is critical, ensuring they understand the need to stay still and look straight during treatment. We also found that pre-treating with tetracaine 10 minutes before followed by proparacaine immediately prior to the procedure significantly improved comfort." She also said that optimizing technician support and setup logistics is key for seamless integration. "The Alcon representatives provided outstanding support in training our technicians and surgeons, ensuring we were confident adopting novel technology that differs signifi- cantly from conventional tools in glaucoma management." Dr. Bafna also mentioned one limitation with DSLT is that it has to be able to identify the limbus of the patient. If there's something going across the limbus, it won't be able to find the limbus or perform the procedure, he said, noting the example of a patient having a pte- rygium or if there's some type of a corneal scar that's peripherally located and it's hard for the machine to identify that. "There's nothing from a medical perspective that's a contraindication," he said. "Now, I line up all these procedures one after the other, and it's almost like performing a YAG capsulotomy." Dr. Bafna said the "main drawback" is the fact that you receive the same reimbursement as with manual SLT, and every time you do the procedure, there's a click fee. However, he thinks it's worth it because of the efficiency. He said it's important for physicians to know the capital cost to purchase this technol- ogy. It becomes an easier discussion if some- one has an SLT device that they're looking to replace. But if you have a perfectly working SLT machine, you wonder if it makes sense to put forth the capital expense and click fee. "In our clinic setting, I would do it hands down. It's a much nicer procedure than what we had before. continued on page 66 Dr. An performs DSLT with the technique of shining a muscle light from the temporal side to improve the limbal detection. "We find it really makes a difference for better and safer energy delivery," she said. Source: Jella An, MD

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