Selective laser trabeculoplasty for glaucoma: can it wear off?

Written by: Mr Vaughan Tanner
Published: | Updated: 19/03/2020
Edited by: Laura Burgess

Selective laser trabeculoplasty (SLT) is a laser surgery that is used to lower intraocular pressure in glaucoma and has been around for over 25 years. Thanks to recent advances in laser technology there has been greater use of laser treatment, which means that the need for more invasive eye surgery or extra glaucoma drops is avoided.

If you have been advised to have the procedure, you may have some questions, such as what happens if the effects of SLT wear off or if it does not work in your particular case. We’ve asked one of our top ophthalmologists, Mr Vaughan Tanner, for his expert advice.

Who is a good candidate for SLT?

SLT is suitable for patients who have primary or secondary open-angle glaucoma, which is when the drainage system in the front part of the eye is open, and therefore need to have lower intraocular pressure (IOP).


What happens if SLT wears off?

SLT is effective at lowering intraocular eye pressure but if it wears off after several years, the procedure can then be repeated. In fact, about half of patients will require repeat treatment after five years. Repeat treatments don’t always lower eye pressure as much and continued repeat laser will eventually not be effective.

In some patients, we may decide to treat half of the tissue on the first treatment, then treat the second half at a later date. If SLT is not initially successful then repeat treatment is not likely to be effective.

What happens if SLT does not work?

If SLT fails to lower your eye pressure, then you still have the option for medications or surgery as the laser does not affect the success of either of these options.

Are there any alternative laser treatments?

Other similar procedures are argon laser trabeculoplasty (ALT) and micropulse laser trabeculoplasty (MLT).

ALT was the first-ever laser trabeculoplasty procedure. It uses a thermal (heat) laser and may cause more scarring in the drainage angle than SLT.

MLT was designed to reduce the amount of energy delivered to ocular tissues by pulsing the energy in small increments. Therefore, it has similar potential benefits as SLT in terms of lower inflammation, tissue scarring and ability to repeat. The IOP lowering results of SLT, ALT and MLT are comparable.

Read more on what happens on the day of surgery for SLT

If you would like to find out if you are a suitable candidate for SLT for glaucoma, you can book an appointment to see Mr Tanner now via his Top Doctor’s profile here.


By Mr Vaughan Tanner

Mr Vaughan Tanner is a senior consultant ophthalmic surgeon at The Royal Berkshire Hospital, Reading and King Edward VII Hospital, Windsor. He leads the Berkshire wide Vitreo-Retinal surgical service, established a sub-specialist age-related macular degeneration service, provides a micro-incision cataract service and heads a general ophthalmic team providing care for acute and routine eye conditions.

His subspecialist interests and recent advances include the introduction of sub-2mm micro-incision cataract extraction with multifocal and toric lens implants designed to significantly reduce spectacle dependence following cataract surgery. He has also developed sutureless small-incision vitrectomy techniques for the repair of retinal detachment, macular hole and other vitreoretinal diseases.

Mr Tanner’s extensive surgical experience includes the performance or supervision of over 10,000 major intraocular cataract and retinal procedures. Mr Tanner has led on the introduction of many new retinal treatments including Lucentis and Eylea injections, Ozurdex steroid implants and Jetrea treatment. These innovations have significantly improved vision for many patients suffering from age-related macular degeneration, diabetic retinopathy, retinal vein occlusion and other retinal problems. Mr Tanner now carries out selective laser trabeculoplasty and YAG laser vitreolysis.

In the private sector, he has developed a comprehensive service aiming to provide the highest level of personal care using the latest surgical techniques available. His main practice covers Berkshire, Oxfordshire, Surrey, Buckinghamshire, Hampshire and London with many national and international referrals.

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