Inder Paul Singh, MD, a glaucoma surgeon and the president of The Eye Centers of Racine and Kenosha in Wisconsin, was eager to try Alcon’s new Voyager Direct Selective Laser Trabeculoplasty (DSLT) system at his practice, because data indicate that SLT is a better first-line treatment for most glaucoma patients than topical drops.
He maintains that DSLT is a win-win for patients and physicians. “SLT can’t be used on some patients who have angles that are difficult to view,” he says. “The Voyager DSLT provides an opportunity to treat a variety of difficult angles, allowing me to help a larger population of patients.”
From a personal perspective, Dr. Singh—like many of his colleagues—was having physical difficulty performing traditional SLT surgeries due to shoulder, neck, and head strain. Because DSLT is performed without the need for a slit lamp or manual gonio lens, he is no longer forced to work in uncomfortable positions, he said.
How Voyager Works
Figure 1. Voyager DSLT is fully automated, efficiently delivering 120 laser pulses without the need for a gonio lens as with manual SLT.
The Voyager device can be used to treat ocular hypertension, primary open-angle glaucoma, and secondary open-angle glaucoma, if the patient does not have any contraindications to laser. The Voyager DSLT is fully automated, delivering 120 laser pulses directly through the limbus to the trabecular meshwork and stimulating the eye’s natural healing response to improve aqueous outflow and reduce intraocular pressure (IOP).1 This technology eliminates the need for a gonio lens or manual identification of the angle structures, and results in an intuitive, streamlined workflow and noncontact delivery.
The Voyager DSLT is controlled through an intuitive touchscreen. It uses an eye-tracking technology called SureTrac, which enables an accurate, automated treatment delivery through the limbus. Voyager autofocuses and autoaligns, then it delivers the full treatment in about 3 seconds. The laser includes safety functions to ensure that the sclera, cornea, or other important nearby structures are not damaged.
Practitioners have reported that some patients can’t tolerate a gonio lens on their eye for an extended period or can’t sit still while manual SLT is applied. “By eliminating the slit lamp and manual approach, we remove these potential barriers and improve the patient experience,” says Jim Di Filippo, vice president and general manager for US Surgical at Alcon in Fort Worth, Texas.
Benefits Abound
Evidence has shown that SLT treatments, including DSLT, are effective in reducing medication burdens because they address the pathology that causes high IOP in many patients by reducing outflow resistance. “This makes SLT or DSLT an ideal first-line treatment,” Dr. Singh maintains.
Data from the LiGHT trial demonstrated that SLT is a better first-line treatment than topical latanoprost, resulting in less progression of visual field loss, fewer incisional surgeries being needed, and greater cost savings to health systems over a 6-year follow-up.2 “There are more reasons to use SLT than not to use it,” Dr. Singh says.
Studies have also found that DSLT offers similar efficacy to traditional SLT in treating glaucoma. The GLAUrious study, a randomized, controlled trial, demonstrated that after 12 months, 62% of all DSLT patients were medication free. The same study showed that 70% of DSLT patients who entered the study medication free remained medication free at 12 months. The study also compared direct SLT vs standard SLT, and at every time point showed comparable IOP with either technique.3
Because DSLT offers precise delivery in a few seconds, it optimizes workflows and brings greater efficiency to a practice as well.
Educating patients is key, because some will be hesitant to have a laser procedure, Dr. Singh says. He tells patients that DSLT involves using a beam of light to help the body heal itself and rejuvenate the eye’s drains by opening them up naturally. “When I explain the procedure like this, less than 5 percent of patients prefer treatment alternatives,” he says.
According to Alcon’s data,4 6 months after having a DSLT procedure, nearly all DSLT patients indicated that they would recommend Voyager DSLT to a friend with glaucoma, says Di Filippo.
Conclusion
As glaucoma care continues to evolve, technologies like Alcon’s Voyager DSLT device are helping surgeons expand access to effective first-line treatment while improving both patient comfort and clinical workflow. By offering a noncontact, automated alternative to traditional SLT, Voyager addresses many of the limitations associated with manual laser delivery, including patient tolerance and provider ergonomics. Dr. Singh says Voyager represents a practical and impactful advancement that enables broader treatment eligibility, supports long-term medication reduction, and enhances overall practice efficiency. GP
References
1. Voyager DSLT User Guide; 2024.
2. Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Laser in glaucoma and ocular hypertension (LiGHT) trial: six-year results of primary selective laser trabeculoplasty versus eye drops for the treatment of glaucoma and ocular hypertension. Ophthalmology. 2023;130(2):139-151. doi: 10.1016/j.ophtha.2022.09.009.
3. Belkin M. GLAUrious, a multicentre, randomised, controlled study of direct selective laser trabeculoplasty in open angle glaucoma. Invest Ophthalmol Vis Sci. 2023;64(6):5393.