Eyeworld

EW GLAUCOMA 81 response is confined around the ab- sorbing melanosomes. The mechanism of action for laser trabeculoplasty is the same for all lasers, Dr. Dorin thinks. He pointed out that all have compara- ble IOP reduction in the 20-25% range. Dr. Dorin believes that the real contribution in trabeculoplasty is cellular renovation that can actu- ally transport ocular fluid inside the cell and regulate this in such a way that the pressure in the eye de- creases. "This type of cellular renovation occurs in every type of trabeculoplasty—it's a stress re- sponse," Dr. Dorin said. "You induce stress and then you have a response." He pointed out that Mother Nature is pretty good at repairing when there is something that could be repaired. With laser trabeculoplasty, scarring is the watchword, Dr. Lish thinks. "Just like any laser trabeculo- plasty, the thing that you have to re- alize about laser trabeculoplasty is as long as you're not causing scarring, it doesn't matter what laser you use," he said. "It doesn't matter if it lowers pressure." When it comes to repeatability of laser trabeculectomy, he stressed that it's important to make sure that you're comparing apples to apples. He pointed out that with ALT the standard was to do 180 degrees and then come back later and do the rest. "The jury is still out on MLT as to what's best, 180 degrees or 360 degrees, and what constitutes one treatment," Dr. Lish said. At this point, he stressed that there is not one data set that can show repeata- bility for any of the laser trabeculo- plasty procedures beyond the initial 360 degrees. Overall, Dr. Krawitz finds that his patients are thrilled with the SLT option. "Patients who had never complained about the irritation, the cost, the pigmentation, and the red- ness that they were getting on drops would come back 4-6 weeks after their SLT and be giddy with happi- ness at being off the drops," he said. "For us that has solidified our choice to heartily recommend SLT." Meanwhile, Dr. Lish urged practi- tioners to ask critical questions when choosing a laser trabeculoplasty ap- February 2011 September 2011 proach. "There is not one right an- swer for every practice, but for my practice, MLT was a good answer that I'm pleased with," he said. EW Editors' note: Drs. Dorin and Lish have financial interests with Iridex. Dr. Krawitz has no financial interests related to his comments. Contact information Dolin: gdorin@iridex.com Krawitz: krawitzmail-2@yahoo.com Lish: ajlishmd@gmail.com

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