47
EW FEATURE
November 2015 • Glaucoma medical treatment
and fine tuning and adjusting
that happens," he said. "It's about
listening to the patient and remem-
bering to ask about side effects. The
decision is never final; it's 'let's try
this and see how it goes.'"
Where does laser
trabeculoplasty fit in?
As with second- and third-line medi-
cal treatments, there is no consensus
among physicians on where laser
trabeculoplasty (LTP) fits into the
treatment paradigm.
"In our current healthcare
system, I do not think it is appro-
priate to perform LTP on a newly
diagnosed glaucoma patient without
attempting a glaucoma drop first,"
Dr. Grover said. "Starting a patient
on drops, even for a few months,
gives them exposure to the challeng-
es of using glaucoma medications
and the adverse side effects. During
this time, the doctor is also able to
establish a relationship with the
patient that will set the stage for LTP
in the future."
Dr. Grover has found in his
experience that too often, patients
who choose LTP early in the treat-
ment process without a solid under-
standing of the disease feel that after
laser treatment, their glaucoma is
"fixed." This can alter their com-
pliance with follow-up and often
adversely affects their care, he said.
"I, therefore, will only perform LTP
once I have been able to establish a
solid relationship with the patient
and I think they have a good under-
standing of what to expect."
Dr. Parekh, on the other hand,
gives his patients the option of SLT
as a first-line treatment. With newly
diagnosed glaucoma, he'll typically
offer patients a choice between SLT
and a PGA; about half of his patients
choose the laser. He thinks it's im-
portant for the doctor to spend time
discussing the pros and cons of both
LTP and drops with each patient.
"Compliance and adherence
are big problems in glaucoma, and
I like the idea of SLT because the
patient doesn't have to remember
to do it every day," he said. "I think
glaucoma doctors in general hugely
underestimate how hard it is for
patients to take their drops, to afford
their drops, to remember to go to
the pharmacy every month. There
are so many obstacles and hurdles
that a patient has to go through
from the moment the doctor writes
the script to the drop actually
getting in the eyeball. I think SLT
is so nice because it skips all that. If
it doesn't work, you can always do
drops then." EW
Contact information
Grover: dgrover@glaucomaassociates.com
Parekh: parag2020@gmail.com
Wallace: danajwallace@gmail.com
Editors' note: Drs. Grover and Wallace
have financial interests with Allergan.
Dr. Parekh has financial interests with
Alcon, Allergan, and Bausch + Lomb
(Bridgewater, N.J.).
