The Laser Quest for a Happy Medium
In glaucoma, medical management is plagued with noncompliance, and filtration surgery can be complex and risky. Could laser-based treatments offer a happy medium?
At a Glance
- Topical glaucoma therapy is usually very effective at lowering IOP – so long as the patient follows the regimen, and self-administers the drops correctly.
- Even though eyedrop use can be associated with adverse events which reduce patients’ quality of life, filtration surgery is still viewed by some as risky, and an “option of last resort”
- Two glaucoma specialists review two laser-based techniques occupying the middle ground between drops and penetrating incisional techniques: SLT and CLASS
- Is there a happy medium? An approach that lowers IOP and reduces patients’ reliance on drops without requiring invasive surgery?
Few people under your care are “model patients.” Almost everyone misses a dose now and then, and it’s understandable. People have busy lives to lead, and some things get forgotten. The problem is, glaucoma is a progressive disease. Missed doses soon add up to progression, and unless the disease has been caught by screening measures (perhaps because of a family history), it’s likely that the disease is first diagnosed at a relatively advanced stage (and age) – as that’s when people start noticing vision loss. So this renders a predominantly elderly population, some of whom might be forgetful, with stiff fingers, and who need to take a considerable number of other medications to take each day (in addition to their eyedrops) just to get by – yet they are at a critical stage of their disease, where any progression equals vision loss.
Compared with only a decade ago, there are considerably more treatment options available today for glaucoma specialists to choose from. There’s no longer the simple dichotomy of eyedrops and filtration surgery: there’s a number of laser and micro-incisional, minimally invasive approaches that can be taken today – the challenge is to determine which approach is most suited to your patient. We asked two glaucoma surgeons to discuss the laser-based treatments that they offer, in order to understand which patients are most suitable for their procedure of choice: Dan Lindfield discusses his use of selective laser trabeculoplasty (SLT) in the clinic, and Noa Geffen reviews 5 year results of using the CO2-based CLASS laser.
I have an extensive academic background in the life sciences, having studied forensic biology and human medical genetics in my time at Strathclyde and Glasgow Universities. My research, data presentation and bioinformatics skills plus my ‘wet lab’ experience have been a superb grounding for my role as a deputy editor at Texere Publishing. The job allows me to utilize my hard-learned academic skills and experience in my current position within an exciting and contemporary publishing company.
