Eyeworld

FALL 2026 | EYEWORLD | 71 G REWIND. REFRESH. REFINE. by Ellen Stodola Editorial Co-Director About the physicians Charles Frank, MD Clinical Assistant Professor Kellogg Eye Center University of Michigan Ann Arbor, Michigan Ariana Levin, MD Assistant Professor Department of Ophthalmology NYU Grossman School of Medicine Associate Program Director Glaucoma Fellowship Program NYU Langone New York, New York James Murphy, MD Adjunct Clinical Instructor Yale New Haven Hospital New Haven, Connecticut Lorraine Provencher, MD Advanced Cataract Surgeon and Glaucoma Specialist Vance Thompson Vision Omaha, Nebraska Douglas Rhee, MD James and Dolores Kleinman Chair in Ophthalmology Professor and Chair Department of Ophthalmology and Visual Sciences Director University Hospitals Eye Institute Case Western Reserve University School of Medicine Cleveland, Ohio Brian Shafer, MD Adjunct Assistant Professor of Ophthalmology University of Pennsylvania Clinical Instructor Wills Eye Hospital Shafer Vision Institute Philadelphia, Pennsylvania Dr. Murphy said that we know almost noth- ing about SLT. We don't know a lot about power, bubbles, distribution, how often, frequency, etc. He pointed to the COAST (Clarifying the Optimal Application of SLT Therapy) Trial, which is looking at low-power scheduled annual SLT, which is how Dr. Murphy has been doing it. We know that SLT is more effective than using topical medications as primary therapy, and it's also effective as a secondary treatment. It's also more cost-effective for practices, patients, and society, he said. Always strive for SLT OU; it's going to save your practice administrative costs. You can batch even one SLT, and he always batches dou- ble the amount he can do in a week. Standard- ize everything, he said. Dr. Murphy also uses indexing plus rotating SLT lens, which makes it faster. Dr. Levin said that data clearly supports lasers for primary glaucoma, and she added that lasers are great for some secondary glaucoma. But what about uveitic glaucoma? Lasers can work well in these cases, too. She shared sever- al cases examples before offering these pearls: • Collaborate with the uveitis specialist. • Control inflammation in advance. • Perform gonioscopy. • Treat the etiology of elevated IOP. • Control inflammation after laser. Consider steroids post-SLT. I n a fast-paced session at the 2026 ASCRS Annual Meeting, presenters shared videos and case-based content on a variety of glau- coma topics, competing for audience votes in this Survivor-themed symposium. The symposium featured Douglas Rhee, MD, Charles Frank, MD, James Murphy, MD, Ariana Levin, MD, Brian Shafer, MD, and Lorraine Provencher, MD. The six "contestants" gave presentations in different categories, with audience members voting off one speaker per round, who had to extinguish their "torch" and be "exiled" until there was one remaining survivor on "Temporal Island." Lasers The first set of presentations focused on lasers, with many of the contestants mentioning SLT. Dr. Rhee shared three main points relating to SLT. The first was SLT as first-line therapy. The standard of care now is to start a treat- ment-naïve POAG patient with SLT. He noted the LiGHT (Laser in Glaucoma and Ocular Hypertension) Trial but also shared a study he participated in on the morphologic and cellular changed induced by SLT. He said that the repopulation of trabecular meshwork cells coming from Schwalbe's line is part of the mechanism of action, leading to his second point to leave space between your shots. Dr. Rhee's last point was if you have what you are looking for at 2 weeks, you can skip a visit. If you get what you are looking for at 2 weeks, there is a 98.2% chance it will last at least 3 months. However, the full effect of the laser can take up to 6 weeks. Dr. Frank questioned who is using anti-in- flammatories after SLT, saying that he was surprised looking at research that there wasn't a consensus. "For me, it's a given that you should be using anti-inflammatory drops routinely after SLT," he said. The SALT (Steroids After Laser Trabecu- loplasty) Trial showed that there was no sig- nificant difference between NSAID and steroid as far and IOP lowering effect, but both were significantly lower than placebo. If you're doing the laser, you might as well put the patient on drops for 5–7 days, Dr. Frank said. Glaucoma symposium features competition for the survivor of 'Temporal Island' continued on page 72 In Dr. Provencher's cyclopexy technique, a long-curved CTC needle with 10-0 Prolene is passed directly through sclera to reappose the ciliary body in the area of the cleft (demarcated by violet marking pen). Source: Lorraine Provencher, MD

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