SLT Blog by Dr. Savak Teymoorian

03 September 2018

SLT: A Strategic Ally to Remember When Entering the New Glaucoma Frontier

The word “Glaucoma” packs a powerful punch the moment a doctor uses it in front a patient. There are only a few other words in medicine that are more jaw-dropping: cancer, stroke, and heart attack. But how can an eye condition even approach the same magnitude of consequence as those life-threatening ones? The truth is any medical condition that significantly alters a person’s quality-of-life creates similar fear and nervousness. Blindness represents the worst-case scenario when thinking about what could happen to someone’s vision.

“Hey, SLT! We Need You in the Game Right Now!”

The word “Glaucoma” packs a powerful punch the moment a doctor uses it in front a patient. There are only a few other words in medicine that are more jaw-dropping: cancer, stroke, and heart attack. But how can an eye condition even approach the same magnitude of consequence as those life-threatening ones? The truth is any medical condition that significantly alters a person’s quality-of-life creates similar fear and nervousness. Blindness represents the worst-case scenario when thinking about what could happen to someone’s vision. Unfortunately, not only does the general public associate glaucoma with loss of vision; but they also think it is an unavoidable result. Any eye care practitioner will confess that they have heard patients say “I wouldn’t want to live if I couldn’t see.” These are heavy words, and they strike the provider back with the same force as when he initially mentioned glaucoma to the patient.

But it doesn’t need to be this way. There is good news with which we can be joyful. What was once just a small ray of hope that attempted to prevent blindness in our glaucoma patients – eye drops, trabeculectomies, and tube shunts – is turning into a bright light of promise illuminating our lives. The introduction of new diagnosing technologies and surgical interventions is dramatically improving glaucoma management. Along with this change, our outcome goals are being elevated. The reactive approach of watching until there is nerve damage and then providing a high-risk therapy that may control, or possibly even worsen, the vision is becoming obsolete. A proactive strategy is the new and improved game plan to not allow vision loss in the first place. I am excited to say we are entering the next frontier in glaucoma.

This proactive philosophy goes hand-in-hand with an evolution of how practitioners view glaucoma. It is shifting from a medically managed disease to a procedural one. The introduction of MIGS (Micro-Invasive Glaucoma Surgery) has led the way. These interventions provide better options for care through more favorable benefit-to-risk ratios than what was offered before their time. Remember, a physician’s oath is “To do no harm.” Although they can effectively reduce IOP, the trouble with prior gold standard surgeries like trabs and tubes are their high risks. Simply put, MIGS offers a great ratio of pressure reduction to side-effect profile.

But we need to be honest with ourselves. MIGS has inherent limitations. The relative decrease in risk as compared to trabs and tubes also means that IOP reduction may not be as low as they need to be for patients. The natural reflex for practitioners is to combine eye drops with MIGS to provide the needed care. The unintended consequence of this thought process reverts us back to our reactive days of treatment. Why? Because we all know that the major limitation and hurdle to conservative management with eye drops is compliance. I challenge that we not return to and accept again options that passively allow optic nerve damage. The better answer to this predicament is a safe and efficient, yet low risk, procedural intervention. Guess what? We have one – Selective Laser Trabeculoplasty.

It is with this belief in mind that I am excited to share with you my thoughts about the many advantageous uses of SLT for glaucoma management. This blog, however, is not just intended for glaucoma specialists that perform SLT. The audience is much broader because the effects of glaucoma influence everyone. The entry topics will vary in scope and purpose to be applicable to all types of ophthalmologists; but this also includes an audience of optometrists, medical doctors, patients, friends and families of patients, and even those just interested in the technology. The discussion points will still remain relevant and valuable to all those that read them.

Also, the hope is to have more than just a platform for my ideas. This blog is meant for improvement by serving as a learning environment where I can interact with my readers. I ask that you comment and provide feedback along with questions and ideas that you would like to have answered. Please also share it with others that you feel may benefit from it. I truly believe that a united front from all of us will be a powerful force as we go through our journey to fight glaucoma. I look forward to partnering with you. Thank you and welcome!

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