Selective Laser Trabeculoplasty (SLT) for glaucoma

SLT is a non-invasive treatment for glaucoma. This video explains the SLT procedure and how it lowers intraocular pressure (IOP). Dr Nick Andrew is an Australian eye surgeon (ophthalmologist) with subspecialist qualifications in advanced cataract, laser eye surgery, and micro-invasive glaucoma surgery (MIGS). He was fellowship trained by world-renowned leaders in the field including Dr Ike Ahmed in Toronto, Canada, and Prof Tony Wells in Wellington, New Zealand. Learn more at www.drnickandrew.com.au and "Ophthalmology Against The Rule" podcast. Video transcript: The purpose of SLT is to increase the permeability of the eye's natural drainage channel. This allows aqueous humour to drain from the eye more easily and intraocular pressure to fall. During SLT, ultra-short pulses of light energy, just 3 nanoseconds long, are applied to the trabecular meshwork, which is the internal drainage channel of the eye. The light energy stimulates a metabolic response in pigmented cells living in the trabecular meshwork. Immune cells migrate into the tissue, and these work to clear away debris from the drainage channel. The gentle light pulses do not cause any permanent structural damage, even at a microscopic level. The result is that the eye's drainage channel is rejuvenated, to become more permeable. Fluid is able to drain more easily and intraocular pressure falls. Here is a video of SLT being performed in a patient. The iris is on the left side of screen. The red light is the aiming beam, which is precisely focussed on the trabecular meshwork, the drainage channel of the eye. The SLT laser pulses are too short to be seen, but as each pulse of laser is delivered you can see tiny microbubbles released from the tissue. This is a good sign that the laser is stimulating the cells. In most individuals the pressure falls over the following 4-6 weeks and the typical duration of effect is 1-3 years. SLT can therefore significantly reduce a patients need for glaucoma eye drops. The procedure is done sitting up in a chair, is entirely painless, and can be repeated as necessary.