SLT Becomes First-Line Treatment for Glaucoma

Discussion in 'Optometry Archives' started by Irv Arons, Nov 23, 2006.

  1. Irv Arons

    Irv Arons Guest

    In addition to the information about Avastin/Lucentis, I have also
    posted information about the use of the Selecta laser to treat glaucoma
    using "Selective Laser Trabuculoplasty" or SLT. It appears that the use
    of SLT is becoming a first-line treatment for glaucoma, in place of
    drug therapy.

    The article is entitled: An Update on the Use of SLT for Treating
    Glaucoma

    and the web reference is:
    http://irvaronsjournal.blogspot.com/2006/11/update-on-use-of-slt-for-treating.html

    This update is also from Michael Lachman's EyeQ Report No. 9, from the
    recent AAO meeting held in Las Vegas. There is a link to this report in
    my web posting.

    Irv Arons
     
    Irv Arons, Nov 23, 2006
    #1
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  2. Irv Arons

    Dr. Leukoma Guest

    Of course it is, Irv, because optometry is now using topical meds to
    treat glaucoma. We also know that SLT needs to be repeated. But, is
    it repeatable forever, or just until filtering surgery is required?
    Aren't you the same person who promotes refractive surgery?

    DrG
     
    Dr. Leukoma, Nov 24, 2006
    #2
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  3. Irv Arons

    Irv Arons Guest

    DrG,

    I don't promote anything -- am/was an ophthalmic journalist for over 20
    years and just report on what I learn.

    In my original article on SLT (published in Ocular Surgery News in
    2001), I interviewed the inventor of the laser procedure and based on
    what I learned from him, thought that SLT would eventually become a
    first-line treatment, which now appears to be the case.

    I also have written extensively on new developments in refractive
    surgery, again based on what I learned from attending both ASCRS and
    AAO meetings and writing the Technology Update column for Ocular
    Surgery News for about 10 years.

    Regards,

    Irv Arons
     
    Irv Arons, Nov 24, 2006
    #3
  4. Irv Arons

    p.clarkii Guest

    actually laser treatment already IS pretty much the first line
    treatment in europe (ALT). in the US we seem to prefer using medical
    therapy first. when they work, laser treatments have advantages over
    medical treatment-- better patient compliance, reduced cost (over the
    long haul), etc.

    i think it might be overly cynical to suggest that SLT might become
    first line as a way to shut optometry out of treating glaucoma.
    controlled studies will define the treatment of choice
    ===========
     
    p.clarkii, Nov 24, 2006
    #4
  5. Irv Arons

    Dr. Leukoma Guest

    Am I being overly cynical? I don't think so. I'm merely calling into
    question the long term efficacy of this as a first line defense. It
    has nothing to do with shutting optometry out of treating glaucoma,
    which is an absurd suggestion. Can you tell us this, Irv?

    By the way, do you treat glaucoma?

    DrG
     
    Dr. Leukoma, Nov 24, 2006
    #5
  6. Irv Arons

    Dr. Leukoma Guest

    the ridiculous assertion that LASIK is safer than contact lenses?

    DrG
     
    Dr. Leukoma, Nov 24, 2006
    #6
  7. Irv Arons

    serebel Guest


    Leukoma's jealousy rides on. You read Irv's post stating he's a
    JOURNALIST. Why would you ask if he treats eyes?
     
    serebel, Nov 24, 2006
    #7
  8. Irv Arons

    Dr. Leukoma Guest

    I'm not directing my question at Irv. I directed it at the other
    person who posted.

    Do you have something useful to add to this discussion? If so, I would
    like to see it.

    DrG
     
    Dr. Leukoma, Nov 24, 2006
    #8
  9. Irv Arons

    serebel Guest


    I'll add as I see fit, I don't see a hall monitor's badge on you.
     
    serebel, Nov 24, 2006
    #9
  10. Irv Arons

    Irv Arons Guest

    Hey guys, cool the rhetoric. I didn't mean to start a street fight,
    just wanted to pass along what I thought was some useful information
    for those seeking treatment for glaucoma.

    Irv Arons
     
    Irv Arons, Nov 24, 2006
    #10
  11. Irv Arons

    LarryDoc Guest

    And this, I think, is an issue that warrants further discussion. In
    many parts of the civilized world ALT is indeed the first line treatment
    while here in the good 'ole USA, it's try one med, then another, then
    perhaps add a second med, then another and then when that doesn't work
    (because drug therapy simply fails or the patient can not or will not be
    complaint) only then do we go for the laser.

    One would think that a larger patient base undergoing laser surgery and
    filtering surgeries for glaucoma would ultimately yield better
    techniques, not to mention a good statistical analysis of the efficacy
    of doing so.

    Considering that we went for what----20-30 years with no real change in
    pharmaceutical therapy before the "new wave" of meds hit the market,
    while on the other side of the pond ALT became the standard of care, it
    looks to me that if we want to look at conspiracy theory, that's a good
    place to start.

    LB, O.D.
     
    LarryDoc, Nov 24, 2006
    #11
  12. Irv Arons

    Dr. Leukoma Guest

    I treat glaucoma in my practice, and I understand first-hand the
    problem with medical compliance. In fact, I am about to refer an
    elderly patient for SLT.

    If you want to know what the stink is about, here is one glaucoma
    specialist's opinion from the glaucoma newsgroup:

    http://makeashorterlink.com/?I1223514E

    Also, the first abstract I came across when doing a Medline search is a
    recent study from the Journal of Glaucoma:
    ________________________________________________________________
    High failure rate associated with 180 degrees selective laser
    trabeculoplasty.

    J Glaucoma. 2005; 14(5):400-8 (ISSN: 1057-0829)
    Song J; Lee PP; Epstein DL; Stinnett SS; Herndon LW; Asrani SG;
    Allingham RR; Challa P
    Department of Ophthalmology, Duke University Medical Center, Durham,
    North Carolina NC 27710, USA.

    PURPOSE: To determine the efficacy of selective laser trabeculoplasty
    (SLT) in a tertiary care referral center. (SNIP)

    By survival/life-table analysis, mean time to failure was 6 months and
    5.5 months, by definitions one and two, respectively. By the end of the
    study (14.5 months), the failure rates were 86% and 92% by definitions
    one and two, respectively. By each definition, in both univariable and
    multivariable analysis, only lower baseline IOP was a significant
    predictor of failure.

    CONCLUSIONS: Selective laser trabeculoplasty had an overall low success
    rate in our tertiary clinic population, with overall failure rates of
    68% to 74% in those who underwent 180 degrees selective laser
    trabeculoplasty
    _____________________________________________________________

    DrG
     
    Dr. Leukoma, Nov 24, 2006
    #12
  13. Irv Arons

    Dr. Leukoma Guest

    Are patients really in a position to properly evaluate the various
    treatment options for glaucoma? With regard to SLT, when I see my
    local glaucoma specialists using it as a first line treatment, and then
    if I see that medical therapy is still effective once SLT has
    permanently lost its effect, then I'll jump on that bandwagon. If SLT
    loses its effectiveness and has destroyed the trabecular meshwork to
    the point where medical therapy is no longer effective, then the only
    remaining option is filtering surgery, which is not a walk in the park
    for the patient.

    DrG
     
    Dr. Leukoma, Nov 24, 2006
    #13
  14. Irv Arons

    Dr. Leukoma Guest

    Stopping Glaucoma with a Stick in the Eye

    Incubator spin-off Transcend Medical wants to change the way glaucoma
    is treated.
    November 10, 2006

    On Friday, ophthalmic incubator ForSight Labs hatched its first
    company. Meet Transcend Medical, a company focused on stopping glaucoma
    before it can seriously impair sight.



    The Menlo Park, California-based company is out to replace current
    surgical approaches for treating glaucoma with a less invasive
    procedure. "And what's unique is that it can be performed right
    there in the (doctor's) office," said Transcend's CEO Mitchell
    Campbell, as opposed to a surgical setting.



    Transcend has developed a synthetic tube that is implanted to help
    ensure the eye's fluid flow to maintain a healthy level of pressure
    within the eye.



    When fluid, called aqueous fluid, becomes blocked, pressure builds
    within the eye causing damage to the optic nerve, which can eventually
    lead to blindness.



    But the potential breakthrough that Transcend offers is the ability to
    place the device with a needle stick delivery, rather than having to
    make an incision.
     
    Dr. Leukoma, Nov 24, 2006
    #14
  15. Irv Arons

    Dr. Leukoma Guest

    Glaucoma is a lifetime disease, therefore you are buying time with the
    treatment.

    Electing ALT as the first line treatment will leave you with no other
    option but filtration surgery when ALT fails, and it will fail. It
    simply destroys the trabecular meshwork.

    Certainly SLT causes less destruction because the laser produces less
    energy, and so the end game is prolonged over ALT.

    When medical management fails, you've got two more options: SLT and
    filtration surgery.

    Should ALT be the first line treatment when medical management is
    available? Probably not. With SLT, the answer is not as clear at
    least in some cases.

    DrG
     
    Dr. Leukoma, Nov 24, 2006
    #15
  16. Irv Arons

    Dr. Leukoma Guest

    ALT loses effectiveness, and after about two treatments the patient is
    left with a trabecular meshwork that is refractory to medical therapy.
    Maybe this won't happen with SLT, but maybe it's just a bit premature
    to be touting it as a first-line treatment in patients who are
    compliant and can tolerate prostaglandin analogues. It does alter the
    meshwork, it just doesn't fry it like the ALT.

    Everyone's entitled to their opinion, and it appears that Irv got his
    money's worth out of his news release.

    DrG
     
    Dr. Leukoma, Nov 25, 2006
    #16
  17. Irv Arons

    Irv Arons Guest

    Dr. G,

    My post was not based on a news release, but rather the reporting of
    Michael Lachman, an industry consultant, based on his interviews of
    glaucoma specialists and a scientific poster presented at the AAO
    meeting. For all the details please take a look at his EyeQ Report No.
    9, which is linked in my web site.

    Regards,

    Irv Arons
     
    Irv Arons, Nov 25, 2006
    #17
  18. Irv Arons

    serebel Guest


    Doesn't matter how or what you post, leukoma will spin it anyway.
     
    serebel, Nov 26, 2006
    #18
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