Laser Trabeculoplasty for Glaucoma Treatment

What Is Laser Trabeculoplasty?

Laser trabeculoplasty is a specialised glaucoma laser treatment designed to lower eye pressure in patients with open-angle glaucoma. During this trabeculoplasty surgery, a focused laser beam is applied to the trabecular meshwork, the eye’s natural drainage system. 

This helps improve the outflow of aqueous fluid, reducing the pressure inside the eye. The laser does not create a hole or cut. Instead, it stimulates biological changes that enhance drainage and maintain healthy eye pressure levels.

Types of Laser Trabeculoplasty

Argon Laser Trabeculoplasty (ALT)

Argon laser trabeculoplasty (ALT) uses a thermal laser to create tiny, precise burns on the trabecular meshwork. These small burns cause the tissue to contract, opening nearby drainage channels and allowing fluid to flow out more efficiently. 

ALT is highly effective in lowering eye pressure during ALT glaucoma treatment. This is particularly the case in patients with primary open-angle glaucoma or secondary forms such as pseudoexfoliation or pigmentary glaucoma.

Selective Laser Trabeculoplasty (SLT)

Selective laser trabeculoplasty (SLT) is a more advanced technique that uses low-energy laser pulses to target only pigmented cells in the trabecular meshwork. The surrounding tissue remains unaffected, making the SLT glaucoma procedure gentler and repeatable if needed.  Because it causes minimal thermal damage, SLT is often preferred for its safety profile and long-term effectiveness. It is widely considered a first-line glaucoma treatment for patients who do not tolerate or respond well to eye drops.

How Does Laser Trabeculoplasty Work for Glaucoma?

In laser trabeculoplasty glaucoma procedures, the laser energy interacts with the trabecular meshwork to improve the outflow of aqueous fluid. Enhancing the eye’s natural drainage system helps lower intraocular pressure, the leading risk factor for glaucoma-related vision loss. 

This improved outflow prevents further optic nerve damage and maintains stable vision. Unlike traditional glaucoma surgery options, the procedure is quick, requires no incisions, and can be done in a clinic setting.

Benefits of Laser Trabeculoplasty Over Other Treatments

The benefits of laser trabeculoplasty are numerous, making it a preferred option for many patients.

• It is a non-invasive procedure performed under topical anaesthesia, eliminating the need for surgical cuts.

• Patients experience minimal discomfort and a quick recovery.

• It can reduce dependency on glaucoma drops, improving treatment compliance.

• In some cases, it delays or prevents the need for more invasive glaucoma surgeries.

Both ALT and SLT have excellent safety profiles, but ALT vs SLT studies show that SLT offers better repeatability and lower risk of tissue damage.

Who Is a Candidate for Laser Trabeculoplasty?

Candidates for laser trabeculoplasty include individuals diagnosed with open-angle glaucoma, pseudoexfoliation glaucoma, or pigmentary glaucoma. It is also recommended for patients whose intraocular pressure remains high despite using medications or for those who wish to reduce their dependence on multiple eye drops. 

Patients with narrow or closed angles are typically not suitable candidates. An ophthalmologist will perform a detailed assessment to determine eligibility and choose between ALT or SLT based on the individual’s eye condition.

What to Expect During a Laser Trabeculoplasty Procedure

Pre-Procedure Preparation

Before the laser trabeculoplasty procedure, the doctor performs a thorough glaucoma exam to measure intraocular pressure and examine the angle of the eye using gonioscopy. Medications may be reviewed to ensure they are compatible with the laser treatment. Some patients are given pressure-lowering drops before the procedure to minimise temporary spikes after treatment.

During the Procedure

During laser trabeculoplasty steps, the eye is numbed with anaesthetic drops, and a special contact lens is placed to help focus the laser. The ophthalmologist applies laser pulses to the trabecular meshwork, typically 50 to 100 spots in total. 

The ALT procedure or SLT procedure usually takes 10-20 minutes. Patients may feel mild pressure or light flashes, but no significant pain.

Recovery and Aftercare Following Laser Trabeculoplasty

Post-Surgery Care and Instructions

During laser trabeculoplasty aftercare, patients may receive anti-inflammatory eye drops to reduce swelling and irritation. Vision may appear slightly blurred or hazy for a few hours after the procedure. It is essential to attend follow-up visits to monitor intraocular pressure and assess treatment success.

Returning to Normal Activities

The laser trabeculoplasty recovery time is typically short. Most patients resume their normal routines within one to two days. Heavy exercise and eye rubbing should be avoided immediately after treatment.

Potential Risks and Complications of Laser Trabeculoplasty

Though generally safe, laser trabeculoplasty risks include mild inflammation, temporary increases in intraocular pressure, or light sensitivity. Rarely, the procedure may need to be repeated if eye pressure rises again. The risk of serious complications is significantly lower compared to surgical glaucoma procedures, making it a safe first-line or adjunctive treatment option.

Argon vs. Selective Laser Trabeculoplasty: Which Is Right for You?

When comparing argon vs selective laser trabeculoplasty, both techniques aim to lower eye pressure, but they differ in mechanism and long-term outcomes. ALT uses heat to create small burns, whereas SLT selectively targets pigmented cells. 

SLT is generally preferred due to its reduced tissue damage, fewer side effects, and ability to be repeated safely. However, ALT may still be effective for specific patients or in settings where SLT is unavailable. Your ophthalmologist will decide based on eye type, previous treatments, and overall glaucoma status.

Conclusion: Is Laser Trabeculoplasty the Right Choice?

Laser trabeculoplasty glaucoma treatment offers a safe, quick, and effective way to control intraocular pressure and prevent vision loss. 

Whether through argon laser trabeculoplasty or selective laser trabeculoplasty, the procedure helps maintain long-term eye health without surgery. It’s ideal for patients seeking a non-invasive solution with minimal downtime. Consulting an experienced ophthalmologist is essential to determine if ALT or SLT suits your specific needs and to establish an appropriate follow-up plan for sustained results.