Factors affecting response to laser trabeculoplasty in glaucoma

Given my interest in the anterior segment and myopia control, I will freely admit that I am not the best at treating glaucoma. I know my limits. That said, it has driven me to learn as much about it as humanly possible. This paper gives an excellent data set for why laser trabeculoplasty should be considered as first-line treatment in most forms of glaucoma.

“In eyes with trabeculoplasty response, those with lower baseline pressure, angle recession or uveitis had shorter survival. Eyes without medications before treatment remained medication-free for a median of 197 days.”

That’s about 200 days without having to use medication. In every aspect of chronic disease (not just the eyes) practitioners deal with non-compliance. Buying 6-7 months of time without having to use medication is huge.

The paper does state this effect is not universal in glaucoma. It tends to fail more quickly or not work at all in uveitic and angle recession glaucomas.

“The analysis of angle recession and uveitis failures following LTP treatment may imply different mechanisms of trabecular dysfunction in these diseases. At 6 months post-LTP, a larger proportion of angle recession eyes had failed compared with uveitic eyes (20.9% vs. 9.8%). However, by 18 months, the proportion of failures in both groups were comparable (47.5% angle recession vs. 48.3% uveitic). The mechanism behind the earlier failure in eyes with angle recession compared to uveitis remains uncertain, and may be attributed to the different ways the trabecular tissues are affected in angle recession (irreversible metaplasia) versus uveitis (partially reversible trabecular dysfunction).”

This study also underscores (at least in the way I read it) the importance of optometrists being able to perform SLT. The reasoning given for not allowing this is completely asinine and purely driven by money. I won’t get into that here. If you would like to engage on that subject, reach out to me on Twitter.