Direct Selective Laser Trabeculoplasty – The Innovative First-Line Glaucoma Treatment

Worldwide there are more than 79 million glaucoma patients. The regular use of antiglaucomatosa may limit the quality of life of these glaucoma patients. Many glaucoma patients want to be independent of their eye drops and most of these patients do not want to undergo a real surgery in an early stage.

Selective Laser Trabeculoplasty (SLT) has been implemented successfully in treatment of early forms of glaucoma since several years. In conventional SLT treatment, a contact glass has to be applied on the ocular surface and multiple, separate laser shots have to be applied. This can be a prolonged and quite unpleasant procedure for patients.

Ruhr University Eye Hospital, Bochum, Germany

Direct selective laser trabeculoplasty (DSLT) is an automated device that employs a Nd: YAG laser of 532 nm wavelength. It directs the 400 μm diameter laser beam to the eye limbus region without any contact with the patient's eye. An image-processing algorithm automatically locates the target area on the limbus. An eye-tracking algorithm tracks eye movement, so that the laser shots are delivered to the accurate location on the limbus.

With DSLT we are able to treat a full 360° circle with 120 laser shots, then laser emission is automatically completed in approximately 2,4 seconds. Optionally, you can also treat only 180 degrees or, for example, skip pre-operated areas.

DSLT is a new possibility in first-line glaucoma treatment. A large number of glaucoma patients qualify for DSLT treatment. We can treat naive eyes as first-line therapy, but also eyes with a progressive disease as well as eyes after glaucoma surgery. This is a significant advantage of DSLT.

The DSLT treatment can be easily integrated into the daily routine of an ophthalmologist. The treatment time is very short. Usually, a DSLT treatment can be performed on an outpatient basis as an in office procedure and needs no longer than 5 minutes. Patients have no downtime after this smooth procedure.

Very first results show, that there is an effective reduction of intraocular pressure (IOP) with DSLT.

DSLT is suitable for the majority of glaucoma patients - as first-line therapy, but also after glaucoma surgery. Thus, DSLT opens up a very large patient clientele. Long-term randomized controlled studies are needed, to optimize the treatment regime and to analyze the long-term stability of this innovative procedure.