Trabeculoplasty

What is Laser Trabeculoplasty?

Laser trabeculoplasty is a surgical procedure that treats open-angle glaucoma by lowering intraocular pressure. 

Glaucoma is a series of eye conditions caused by increased intraocular pressure. It permanently damages the optic nerve (communication pathway between the eye and brain), leading to vision loss and blindness. 

Open-angle glaucoma, the most common type of glaucoma, occurs when the eye's drainage angle is clogged. This results in a backup of aqueous humor (the clear fluid that gives eyes shape and nutrients) and causes increased eye pressure and damage to the optic nerve over time. 

Laser trabeculoplasty uses a laser to target the trabecular meshwork, which is a structure in the drainage angle. This allows eye fluid to flow at a normal rate and reduces intraocular pressure.

There are three types of laser trabeculoplasty:

1. Selective laser trabeculoplasty (SLT). Also called a cold laser, this device uses minimal heat compared to other lasers. 
2. Argon laser trabeculoplasty (ALT). Uses a thermal heat laser to target the tissue. 
3. Micropulse laser trabeculoplasty (MLT). Uses pulsing energy to target the tissue. 

Selective laser trabeculoplasty is the most popular form of laser trabeculoplasty due to less scarring. It can also be repeated as needed.

Who is a Candidate for Laser Trabeculoplasty?

Laser trabeculoplasty is recommended when glaucoma medications alone do not lower intraocular pressure. 

Selective laser trabeculoplasty may also be recommended as a first-line treatment for people who can’t tolerate or afford daily medicated glaucoma eye drops to reduce eye pressure.

Laser Trabeculoplasty Procedure

Laser trabeculoplasty is an outpatient procedure performed in an ophthalmologist's office.  The procedure takes 10 to 15 minutes and is painless.

Selective laser trabeculoplasty uses laser energy to target the trabecular meshwork (drainage tissue). This action opens up the trabecular meshwork while allowing better fluid drainage and lowering eye pressure. 

Before Surgery

To prepare for laser surgery, you should:

• Eat a good breakfast and take your glaucoma medication as prescribed
• Plan to be at the doctor’s office or clinic for several hours (you may want to bring a book or other entertainment)
• Wear comfortable clothing
• Avoid wearing makeup
• Bring dark glasses for the drive home

During Surgery

Before the procedure, the doctor will check your intraocular pressure. 

They will administer medicated eye drops to lower eye pressure and numb your eye. 

During the procedure, you will sit in a comfortable position, and the doctor will:

• Place a mirrored contact lens over your iris to guide the laser
• Use a slit lamp microscope to focus on the treatment area
• Administer a series of 50 to 100 laser applications, which may result in a clicking sound

The entire procedure lasts about 10 to 15 minutes.

After Surgery

The doctor will check your intraocular pressure about 45 minutes to 1 hour after surgery. If it is within a normal range, you can go home. 

After surgery, you:

• Will schedule a follow-up appointment for a week later
• Will administer anti-inflammatory eye drops daily for 3 to 7 days
• Have no restrictions on daily activities
• May experience blurry vision, which should clear up the next day
• May experience mild discomfort and soreness for a few days

It takes about 6 weeks to see results from laser trabeculoplasty. 

After 6 weeks, you will make another appointment to recheck eye pressure and see if the procedure was successful. 

The effects of selective laser trabeculoplasty tend to wear off 1 to 5 years after treatment. Because SLT uses minimal heat, you can repeat the procedure as needed.

Side Effects of Laser Trabeculoplasty

Side effects of laser trabeculoplasty are usually mild and include:

• Soreness
• Discomfort
• Redness
• Blurred vision 
• Light sensitivity

What are the Risks?

Complications from laser trabeculoplasty are rare. The most significant risks after the procedure include:

• Elevated eye pressure
• Swelling and inflammation 
• Peripheral anterior synechiae (iris sticks to the cornea)

Elevated eye pressure and inflammation are usually temporary and can be treated with glaucoma medication and anti-inflammatory eye drops. However, peripheral anterior synechiae can cause complications that may require surgery.

Contact your eye doctor immediately if you experience severe pain or changes in vision after the procedure.

Trabeculoplasty Outlook & Success Rates

Selective laser trabeculoplasty is both safe and effective at lowering eye pressure. It effectively lowers eye pressure by 20% for 60 to 70% of people who get the procedure.¹ 

However, laser trabeculoplasty does not work for everyone, and it is not a cure for glaucoma. The effects typically last 1 to 5 years, and then the procedure will need to be repeated.

Alternative Treatments

Alternative glaucoma treatments for selective laser trabeculoplasty include:

4. Argon laser trabeculoplasty (ALT). Uses a thermal heat laser to target the tissue. 
5. Micropulse laser trabeculoplasty (MLT). Uses pulsing energy to target the tissue. 
6. Laser iridotomy. Uses a laser to make a small hole in the iris.
7. Trabeculectomy. Surgically creates a new pathway for eye fluid to flow.

Summary

Laser trabeculoplasty is a safe and effective way to lower eye pressure for people with glaucoma. The procedure uses a laser beam to target drainage tissue and allow eye fluid to flow normally. This stabilizes eye pressure.

The procedure takes place in an eye doctor's office and takes 10 to 15 minutes. You can resume normal activities afterwards. 

You’ll see results in about 6 weeks. The effects wear off in 1 to 5 years.