Since the results of the Laser in Glaucoma and Ocular Hypertension Trial (LiGHT) were published in 2023, selective laser trabeculoplasty (SLT) has been a major topic in the glaucoma community, Eileen Choudhury Bowden, MD, noted in her presentation Friday morning as part of the Practical Tips in Glaucoma Management session.
“I think it's created a paradigm shift in the way that people practice,” said Dr. Bowden, of University of Texas at Austin, Dell Medical School. “Especially for early glaucoma. And there are a lot of questions on how best to use selective laser trabeculoplasty practically.”
To address the demand, Dr. Bowden presented “Practical Tips in Selective Laser Trabeculoplasty” during glaucoma subspecialty day at the American Academy of Ophthalmology's 2025 annual meeting in Orlando, Florida.
Tip 1: Consider It Sooner
Her number 1 tip, she said, is to offer SLT as first-line therapy in newly diagnosed patients with primary open-angle glaucoma and ocular hypertension. “We have really great evidence to support doing that,” she told the audience.
Tip 2: Longer Duration Likely
Another finding Dr. Bowden discussed is that effects of SLT may last longer than originally thought. “When I was in training, I was taught to counsel patients that SLT lasts on average 2 to 3 years, maybe 5 years at best. The LiGHT trial, the West Indies glaucoma laser study, both prospective trials have showed that the median time to SLT needing to be repeated is greater than 6 years. That's a great thing and something that may help in counseling patients.”
Tip 3: It’s Safe to Repeat
Yet another reason to embrace SLT: Dr. Bowden notes that research indicate the procedure can be safely repeated. Moreover, “It can be effective when repeated,” she said. “The COAST [Clarifying the Ophthalmic Application of SLT Therapy] trial being run by Tony Realini may give us some answers on how best to repeat SLT, whether for example, it's something that should be provided as an annual booster, kind of like we do with vaccines.”
Dr. Bowden said she repeats SLT when the first procedure did not achieve as significant IOP lowering as she had hoped. In that circumstance, she has repeated SLT as soon as 2 to 3 months after the first attempt.
“I’ve repeated up to 3 times in patients. And I think again, that's something that the COAST trial will give us more answers on. Can we repeat it more, perhaps as a kind of annual lower energy booster before it's officially needed? Will we maybe be able to extend that repeatability even 5-6 years down the road?”
COAST will hopefully provide some answers in the next few years, Dr. Bowden said. But in the meantime, “the LiGHT trial and other studies have demonstrated that repeat SLT is safe and effective.” GP