Laser Treatments - YAG PI, SLT, MLT, New Iridex Micro Pulse Laser

Glaucoma is an eye disease that involves damage to the optic nerve, which sends signals to the brain. No one knows exactly what causes this damage, but pressure buildup in the eye is one of the major risk factors associated with glaucoma. When the optic nerve is damaged by high intraocular pressure, some signals from the eye aren't transmitted to the brain. This can result in visual field loss and, if not managed, could eventually lead to blindness.

Glaucoma is the leading cause of preventable blindness in the U.S. However, most Americans may be unaware of it because glaucoma does not cause pain or have any noticeable symptoms. People who are at a greater risk for glaucoma usually have the following conditions:

At least 45 years old without regular eye exams
A family history of glaucoma
Abnormally high eye pressure
African descent
Previous eye injury
Regular, long-term use of cortisone/steroid products
Although glaucoma cannot be cured, it can be detected early and controlled. To detect glaucoma, your physician will test your visual acuity, visual field, dilate your pupils, and test the pressure in your eyes. Regular and complete eye exams help to monitor the changes in your eyesight and will help to determine whether you may develop glaucoma.

YAG Laser Peripheral Iridotomy

YAG Laser Iridotomy is a laser procedure used to treat and prevent Narrow or Closed Angle Glaucoma.
Laser Iridotomy can prevent future episodes of sudden (acute) closed angle glaucoma in people at risk.

A procedure called Selective Laser Trabeculoplasty (SLT) is one of the greatest advances in the surgical treatment of intraocular pressure (IOP) in patients with open-angle glaucoma. Prior to its introduction, medications and Argon Laser Trabeculoplasty (ALT) were the Ophthalmologist's primary tools.

SLT (selective laser trabeculoplasty) Better than Drops for Glaucoma

What do SLT and MIXTO have in common?  The answer may surprise you.  SLT (selective laser trabeculoplasty) is a laser procedure used to lower eye pressure within the eye for patients with glaucoma. MIXTO is a facial laser procedure to tighten and rejuvenate skin.  Both use laser light energy in specific areas to build collagen, making the target treatment areas look and act younger.

Glaucoma is often a disease of aging. Many things get stiffer as we age and our trabecular meshwork, or the drain within the eye, is one of them.  More resistance means that fluid inside the eye has more trouble crossing the drain and glaucoma can result when pressure builds inside the eye.

Years ago, we used another laser, ALT (argon laser trabeculoplasty) to lower eye pressure. It worked, but collateral damage scarred the eye so that patients could only be treated a few times before the procedure lost effectiveness.  The SLT however, is the next generation of ALT and I describe it as a “smart bomb.”  Because the SLT targets the drain of the eye, there is no scar tissue formation and the SLT can be repeated as often as needed to keep  eye pressure down over your lifetime.  Best of all, studies have shown us that every time we use the SLT, we can expect the same amount of pressure-lowering each time (about 4-8 points) without any loss of effectiveness over time.

SLT is also better than drops because drops wear off over time and people don’t always get the same amount of medication in their eyes each time. We know that even the most dedicated patients forget their drops, don’t get them in at the same time every day or go a few days before refilling.  Once performed, SLT lasts 1-4 years and works all day every day, eliminating the small gaps of time that pressure might sneak up.  This is why clinical studies consistently show that SLT preserves vision better than drops.

Most patients can eliminate at least one drop from their daily treatment after SLT. This saves money, time at the pharmacy and convenience. Reducing or eliminating glaucoma drops also improves vision and symptoms of dry eye by improving the ocular surface. Daily doses of glaucoma medication and the accompanying preservatives necessarily irritate the ocular surface causing dryness which people often describe as blurriness, scratchiness or grittiness.

The new smarter technology SLT has now become the first line glaucoma treatment in the US as well as Europe.  Patients undergo a simple, quick in-office procedure (covered by most insurances) and avoid or reduce the number of eye drops that they are taking for glaucoma. In addition to eye pressure lowering, patients experience many other benefits including reduced prescription cost, convenience and improved ocular surface With no downtime or restrictions, patients can drive themselves to and from the appointment.

New Non Invasive Glaucoma Laser Taking the Place of Surgery

You’ve heard of going from 0-60 in 6 seconds but what if I could take you from 50 to 18 in 160 seconds? I’m not talking about the latest automotive advance but instead about reducing the pressure in glaucoma patients with a new, in-office laser procedure that is light years from traditional glaucoma surgery.

We’ve been using the Iridex diode laser in retina surgery because it is the first and only retinal laser that is safe to use directly on the fovea, the most sensitive tissue in the eye.  Before the Iridex retinal laser, we could not treat the fovea directly and even had to be careful about the tissues near the fovea because of the collateral damage the other lasers caused. This laser, however, has revolutionized the way we are treating diabetes, macular swelling and even macular generation and studies are currently underway looking at the way this may change our treatment protocols for these diseases.

For glaucoma, we have long known that the MLT and SLT are less invasive but equally effective in improving pressure in glaucoma patients by increasing the way the eye gets rid of extra fluid.  It generates literally no inflammation or collateral damage compared to previous lasers.  The Iridex MicroPulse P3 system is the next step up.  Instead of working on the outflow, it works by slowing down the production of fluid inside the eye.

After just one treatment, patients eye pressures are reduced, on average by 40% and even in some cases 50% , and most patients were able to eliminate 2 drops from their regimen and avoid more invasive surgery.  This is important for anyone who finds drops inconvenient, is unable or unwilling to put drops in everyday, or can’t afford drops (some of them run into the hundreds of dollars – even generic brands).  Patients who suffer from dry eye are another group of patients that will benefit from this procedure as all glaucoma medications (and the preservatives that accompany them) are guaranteed to worsen dry eye.

The Iridex MicroPulse P3 procedure is a comfortable, in office procedure.  After the eye is numbed, the laser is applied for approximately 160 seconds and patients are ready to head home.  Results are seen as quickly as one week (my first patient went from 50 mm Hg to 18 in just 7 days) but may take as long as one month.  Patients can be re-treated to gain the desired results.  At this point, the pressures are staying stable for 18 months (and counting) and patients were able to stop, on average, at least 2 of their glaucoma medications after the procedure.  This procedure is covered by most major insurances.