Glaucoma Treatment Options

What is Selective Laser Trabeculoplasty (SLT)?

Selective Laser Trabeculoplasty (SLT) is a laser treatment used to lower intraocular pressure (IOP) in patients with open-angle glaucoma or ocular hypertension. It helps improve drainage of fluid from the eye, reducing pressure and preventing further damage to the optic nerve.

Why is SLT Recommended?

SLT may be recommended if:

• Eye pressure remains high despite using eye drops or other treatments.

• You have difficulty tolerating glaucoma medications.

• Additional pressure reduction is needed to prevent glaucoma progression.

How Does SLT Work?

SLT uses a low-energy laser to target specific cells in the eye’s drainage system (the trabecular meshwork). This stimulates natural healing responses, improving fluid outflow and lowering eye pressure. The laser treatment is selective and does not damage surrounding tissues, making it a safe and repeatable procedure.

What to Expect During the Procedure

• Before Treatment: Numbing eye drops will be applied to ensure comfort. 

• During Treatment: A special contact lens is placed on the eye, and short laser pulses are applied to the trabecular meshwork. The procedure is painless and typically takes 5-10 minutes.

• After Treatment: Normally no extra eye drops are needed. You can resume normal activities immediately, but follow-up visits will be scheduled to monitor your eye pressure.

Benefits of SLT

• Non-invasive: No incisions or injections are needed.

• Quick and Safe: A short outpatient procedure with minimal discomfort.

• Long-Lasting Effects: Can lower eye pressure for months to years.

• Repeatable: Can be repeated if needed, unlike some other laser treatments.

• Reduces Dependence on Medication: May decrease the need for glaucoma eye drops.

What is the evidence?

The LIGHT (Laser in Glaucoma and Ocular Hypertension) study was a large clinical trial that compared SLT with traditional eye drop treatments as an initial treatment. The results showed that:

• 74.2% of patients treated with SLT did not require eye drops for at least three years after the procedure.

• SLT was as effective as eye drops in controlling eye pressure.

• Patients who underwent SLT were more likely to maintain a good eye pressure without additional treatment compared to those on eye drops.

• SLT had fewer side effects and reduced dependence on daily medications.

• SLT was a cost-effective alternative for long-term glaucoma management.

The LIGHT study showed SLT is a safe and effective first-line treatment for glaucoma and ocular hypertension and  SLT is now recommended by the The National Institute for Health and Care Excellence (NICE). 

Possible Side Effects and Risks

SLT is generally safe, but some potential side effects include:

• Temporary eye redness or discomfort.

• Mild inflammation (usually controlled with eye drops).

• A slight increase in eye pressure (rare and usually temporary).

• The effect may wear off over time, requiring repeat treatment or additional therapy.

Follow-Up and Aftercare

• You will need a follow-up appointment within 5-6 weeks to assess your eye pressure.

• Continue using any prescribed medications unless advised otherwise.

What is the PRESERFLO™ MicroShunt?

The PRESERFLO™ MicroShunt is a small, flexible tube measuring approximately 8.5 millimeters in length. It is implanted into the eye to help lower intraocular pressure (IOP) in patients with glaucoma. The device is made from a synthetic material called SIBS (styrene-block-isobutylene-block-styrene), which is biocompatible and designed to remain stable over time. It is non-metallic, so it will not trigger airport scanners and is safe for MRI or CT scans. 

How does it work?

In glaucoma, increased IOP can damage the optic nerve, leading to vision loss. The PRESERFLO™ MicroShunt creates a new drainage pathway for the aqueous humor (the fluid inside the eye), allowing it to flow out of the eye and thereby reducing IOP. This helps prevent further damage to the optic nerve. 

Who is it for?

The PRESERFLO™ MicroShunt is intended for patients with primary open-angle glaucoma where IOP remains uncontrollable despite maximum tolerated medical therapy, or where glaucoma progression warrants surgical intervention. 

Benefits

• Effective IOP Reduction: Studies have shown that the PRESERFLO™ MicroShunt can significantly lower IOP. 

• Reduced Medication Dependence: Many patients experience a decrease in the need for glaucoma medications after the procedure. 

• Minimally Invasive: The procedure is less invasive compared to traditional glaucoma surgeries, potentially resulting in fewer complications and a quicker recovery. 

Risks and Complications

As with any surgical procedure, there are potential risks, including:

• Vision Changes: Temporary or, in rare cases, permanent vision loss.

• Infection: Risk of infection inside the eye.

• Bleeding: Bleeding inside the eye during or after surgery.

• Hypotony: Excessively low IOP.

• Device Exposure: Exposure or movement of the implant.

Alternatives

Alternative treatments include medications (eye drops), laser therapy, or other surgical procedures like trabeculectomy. 

Before the Procedure

• Medications: Continue using your prescribed eye drops unless advised otherwise. 

After the Procedure

• Medications: Use prescribed eye drops to prevent infection and control inflammation.

• Activities: Avoid rubbing your eye and refrain from strenuous activities until your doctor advises otherwise.

• Follow-Up: Attend all follow-up appointments to monitor your recovery and IOP levels.

What is the Hydrus® Microstent?

The Hydrus Microstent is a small, flexible device designed to help reduce eye pressure in patients with mild to moderate open-angle glaucoma. It is made from a biocompatible alloy (nitinol) and is implanted into the eye’s Schlemm’s canal to improve fluid drainage and lower intraocular pressure (IOP).

Who is it for?

The Hydrus Microstent is typically recommended for patients who:

• Have mild to moderate open-angle glaucoma

• Need additional pressure reduction despite using glaucoma medications

• Are undergoing cataract surgery, as the stent is often implanted during the same procedure

How Does It Work?

Glaucoma is caused by a buildup of fluid in the eye, leading to increased intraocular pressure (IOP). The Hydrus Microstent enhances the eye’s natural drainage system by:

1. Expanding the Schlemm’s canal to increase fluid outflow

2. Bypassing resistance in the eye’s drainage pathway

3. Reducing dependency on glaucoma medications

Procedure: What to Expect

• The stent is implanted during cataract surgery or as a standalone procedure

• It is inserted through a tiny incision in the cornea

• The procedure is quick, typically taking 10-15 minutes

• Recovery is usually fast, with minimal discomfort

Benefits of the Hydrus Microstent

✔ Reduces eye pressure and slows glaucoma progression
✔ Minimally invasive with a quick recovery time
✔ May reduce or eliminate the need for glaucoma eye drops
✔ Implanted during cataract surgery, avoiding additional surgeries

Risks and Possible Side Effects

While the procedure is generally safe, some risks include:

• Temporary eye irritation or redness

• Mild inflammation or discomfort

• Increased eye pressure (rare and usually temporary)

• Possible need for additional glaucoma treatments

Your doctor will monitor your progress and address any complications if they arise.

Aftercare and Follow-Up

• Use prescribed eye drops to aid healing and reduce inflammation

• Avoid rubbing your eyes and follow post-operative care instructions

• Attend all scheduled follow-up appointments to monitor eye pressure

• Contact your doctor if you experience severe pain, vision changes, or swelling

Frequently Asked Questions (FAQs)

1. Will I still need glaucoma medications after the procedure?

• Some patients may reduce or stop using medications, but others might still require them.

2. How long does the stent last?

• The stent is designed to remain in place permanently and continue working indefinitely.

3. Can the Hydrus Microstent be removed?

• It is not usually removed, as it is designed to be a permanent implant.

4. How soon can I resume normal activities?

• Most patients can return to normal activities within 3 weeks.

An aqueous shunt is a device which drains aqueous humour out of the eye to a small blister (called a bleb) under the surface of the eye (the conjunctiva). It bypasses the normal drainage channels in the eye, and drainage of the aqueous out of the eye is improved, reducing IOP.

Different types of shunt are available. The two most common types are the Ahmed Glaucoma Valve or the Baerveldt Glaucoma Implant. Other common names for this type of device are tube implant, glaucoma drainage implant or glaucoma tube shunts.

The shunt has two parts: a small silicon tube and a plate. The aqueous drains down the tube to the plate, which sits in the conjunctiva.

How will it help with my glaucoma?

By improving the flow of aqueous out of the eye, the IOP will decrease. This reduces pressure on the optic nerve, which means vision loss is less likely. However, any vision already lost to glaucoma can’t be recovered, and the glaucoma is not cured.

This type of treatment is for people with moderate to advanced glaucoma, particularly where eye drops aren’t working very well.

What does the surgery involve?

The surgery is usually done under local anaesthetic, which means you will be awake but the eye will be numb. It usually lasts one to two hours, and you will probably be able to go home the same day or the next day.

What happens after surgery?

The shunt will not normally be permanently visible after surgery. While the eye is healing from the surgery, it will probably be red and swollen.

You will be seen by your ophthalmologist the day after the surgery, and will be given antibiotic and steroid eye drops to improve recovery. You must continue to take all eye drops as directed, including for your other eye if you have glaucoma in both eyes. You’ll be asked to attend several follow-up appointments after the surgery to check the eye is healing well and the device is working. It is very important to attend all these appointments.

It will take your eye several weeks to recover from the surgery, so you’ll need to take some time off work and avoid some types of physical activity.