Understanding Glaucoma Treatments: Eye Drops and Selective Laser Trabeculoplasty

Hello, I’m Dr. Erin Lally, a board-certified ophthalmologist specializing in cataract surgery, glaucoma, and retinal diseases. In this post, I aim to clarify some common queries about the treatment options for glaucoma, focusing specifically on Selective Laser Trabeculoplasty (SLT). Whether you’re newly diagnosed with glaucoma or seeking more effective treatment options, understanding these therapies can help you make informed decisions about your eye health.

Eye Drops vs. Selective Laser Trabeculoplasty (SLT)

Glaucoma is a complex eye condition that requires careful management to prevent vision loss. The primary goal is to lower the intraocular pressure (IOP) which, if left untreated, can lead to damage to the optic nerve and irreversible blindness. The initial approach often involves the use of medicated eye drops, which help lower IOP by either reducing the amount of fluid the eye produces or improving its flow out of the eye. However, for some patients, eye drops may not be sufficient or ideal due to side effects, allergies, or difficulties with adherence to the treatment regimen.

Selective Laser Trabeculoplasty, or SLT, is a laser treatment that targets the trabecular meshwork — the eye’s drainage system — to improve the outflow of fluid from the eye and effectively reduce IOP. One of the main benefits of SLT is that it can decrease the dependence on eye drops and, in some cases, replace them entirely.

Common Questions About Selective Laser Trabeculoplasty (SLT)

 Who is a candidate for SLT?

SLT is particularly suited for patients who have been diagnosed with open-angle glaucoma, the most common form of the condition. It is an excellent option for individuals who struggle with compliance to a daily medication regimen or experience significant side effects from eye drops. Additionally, SLT can be used as a primary treatment for those seeking a non-invasive option or as an adjunct therapy for patients who need additional IOP reduction.

How does SLT work?

SLT uses an advanced laser system to deliver low-energy light pulses to specific cells in the trabecular meshwork. The procedure stimulates the body’s natural healing mechanisms to enhance fluid drainage, lowering intraocular pressure. The entire process is quick, typically taking about five minutes per eye, and is performed in my office.

Why is it called Selective?

The term ‘selective’ comes from the laser’s ability to selectively target specific cells within the trabecular meshwork without causing thermal damage to surrounding tissues. This selectivity is crucial for preserving the structure of the drainage angle, which is vital for long-term eye health.

What are the risks of Selective Laser Trabeculoplasty?

SLT is generally safe with a low risk of complications. Some patients may experience temporary increased eye pressure, inflammation, or mild pain immediately following the procedure. However, these side effects are typically transient and can be effectively managed with anti-inflammatory eye drops.

How effective is SLT and how long does it last?

The effectiveness of SLT can vary, but it typically reduces eye pressure by about 20-30%. The results can last from 1 to 5 years, depending on individual factors such as the underlying health of the eye’s drainage system and the patient’s overall eye health. For some, a repeat procedure might be necessary to maintain optimal IOP levels.

What happens if it wears off?

If the effects of SLT wear off, the procedure can often be repeated. Many patients experience similar IOP reduction with subsequent treatments. Your ophthalmologist will monitor your eye pressure and recommend when a repeat SLT might be beneficial.

What happens if the SLT treatment doesn’t work?

While SLT is effective for many, it does not work for everyone. If there is inadequate reduction in IOP or if the treatment is not effective, additional glaucoma treatments, including alternative medications or surgical options, may be considered. Each patient’s treatment plan is tailored to their specific needs.

What is the cost of Selective Laser Trabeculoplasty (SLT)?

The cost of SLT can vary depending on geographical location and the healthcare facility. It is generally covered by most health insurance plans as it is recognized as a standard treatment for glaucoma. However, patients should check with their insurance provider for specific coverage details.

Will I still need to use glaucoma medications if I have the SLT treatment?

The term ‘selective’ comes from the laser’s ability to selectively target specific cells within the trabecular meshwork without causing thermal damage to surrounding tissues. This selectivity is crucial for preserving the structure of the drainage angle, which is vital for long-term eye health.

What are the alternative laser treatments for glaucoma?

Apart from SLT, other laser treatments for glaucoma include Argon Laser Trabeculoplasty (ALT) and Micropulse Laser Trabeculoplasty (MLT). Each has its advantages and suitability depending on the patient’s specific condition and history. Discussing these options with an ophthalmologist can help determine the most appropriate treatment.


In conclusion, both medicated eye drops and SLT offer valuable options for managing glaucoma. The choice between these treatments depends on a variety of factors, including the severity of the condition, patient preferences, and medical history. As your ophthalmologist, I am here to provide personalized advice and support, helping you to achieve the best possible outcome for your eye health. Remember, early detection and treatment are key to managing glaucoma and preserving your vision.

Dr. Erin Lally, MD
Board Certified Ophthalmologist
Specialist in Anterior Segment and Retina

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