GLAUCOMA


Early diagnosis of glaucoma and the ability to assess risk of developing glaucoma in patients with ocular hypertension is of utmost importance to preserve vision.

The following investigations are performed as part of glaucoma assessment:

    Humphrey's Visual Field Analyser
  1. Humphrey Visual Field
  2. OCT scan of the macula and the optic nerves
  3. Optic nerve coloured photgoraphy
  4. Pachymetry (corneal thickness measurement)

SELECTIVE LASER TRABECLUOPLASTY


Who Could Benefit from SLT?

SLT can be used as a primary therapy instead of drops. Also, it can be used If medications are not effective, or to reduce the number of drops required to control the intraocular pressure. SLT is one option for lowering intraocular pressure (IOP) for patients who have open-angle glaucoma in the early stages. It can also be used in combination with drug therapy or as an alternative therapy when drugs fail. 

It is a flexible treatment option and can be repeated if necessary, depending on the individual patient's response.

How it works?

The trabecular meshwork is around the periphery of the iris and is where fluid formed in the eye drains out of the eye. This meshwork is treated directly with the laser to improve drainage through it.

SLT uses short pulses of relatively low energy light to target only the melanin rich cells in the drainage channel of the eye. The laser pulses affect only these melanin containing cells, with the surrounding structure remaining unaffected. This gentle laser treatment induces a response from the body in which white cells are released to clear the affected cells and rebuild the meshwork so that it functions effectively again, reducing the IOP.

Benefits SLT

It effectively lowers raised IOP without the side effects or difficulty of taking eye drops. The treatment is particularly suitable for patients who cannot correctly use or are intolerant to glaucoma medications, and can also be used alongside medication to enhance the overall IOP-lowering effect. 

The Treatment Procedure

Treatment takes place in the outpatient department. Some drops will be instilled in your eye to prevent the pressure rising and to make your pupil small. These drops might cause a temporary headache and can take up to one hour to work. Once seated in front of the laser machine, which looks similar to the microscope you will have anaesthetic drops put in to numb the front of your eye. A special lens will then be placed against the front surface of your eye. This is not painful, but it might feel a little strange. During the laser treatment, you might see some flashes of light and hear clicking noises. Most patients tolerate the laser treatment well, but some might feel slight discomfort. The procedure takes between 10 and 15 minutes. About an half an hour to an hour after your treatment, the pressure in your eye will be checked. You will then be given a prescription for drops to take at home for five days. We will make an appointment for you to come back to the clinic, usually 6-8 weeks later. 

Potential side effects 

Your vision will be blurred for a few hours following your laser treatment, but this will settle. The chance of your vision being permanently affected from SLT is extremely small. It is possible for the pressure in your eye to increase immediately after the treatment and for there to be inflammation. In order to prevent this, we prescribe special drops. Rarely, the pressure in the eye rises to a very high pressure and does not come down. If this happens, you might require surgery to lower the pressure. However, please be assured that this is a very unusual occurrence.

Success Rate

Studies show around 80% success rate for SLT, with some patients responding well to the treatment, but others not responding at all. Usually, we cannot predict how well the laser will work. This is because your response is determined by the type of glaucoma you have and the basic make-up of your eye. If you take eye drops, you will usually need to continue these to lower the pressure after laser trabeculoplasty. It will take up to eight weeks after the laser treatment for the pressure to be reduced. You might require additional laser surgery to lower the pressure if it is not at a sufficiently low level after your first laser treatment. The effects of the laser treatment might wear off in time – about half of all treatments stop working after five years. However, the treatment can be repeated

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