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| Clinical Tips by:
Prashant N. Vasa, MD, Kutch Netramani Clinic & Eye Hospital, Gujarat, India
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| Open-angle glaucoma patients who are on one- or two-drug treatment regimes are ideal candidates for SLT. But even in patients where the angle is narrow, with at least half of the spot size falling in the angle, I have obtained good results. In the case of very narrow angles, laser iridotomy prior to SLT usually gives at least a 180-degree area of treatment. |
| If patients must travel from far-flung areas and your clinic is not easily accessible, previous anti-glaucoma medications need to be continued until the entire SLT procedure is completed. |
| Approximately 30 minutes prior to treatment, instil 4 percent Pilocarpine to constrict the pupil and to open the angle as much as possible. |
| Apply 360-degree SLT treatment split over two 180-degree sessions, scheduled three days apart. Consider applying the treatment in two separate quadrants per 180-degree angle; e.g., 3 o’clock to 6 o’clock and then 9 o’clock to 6 o’clock. |
| For patients with highly pigmented angles (as is the case with most of my patients), apply approximately 14 shots per quadrant with an initial energy setting of 0.6 mJ. If small champagne bubbles are visible, titrate energy down to as low as 0.4 mJ or even 0.3 mJ. If no bubbles are visible, titration of energy may go up to 0.8 mJ. The goal should be to achieve champagne bubbles with at least 10 percent of the total shots delivered. Generally, younger eyes require less energy than older ones. |
| Prescribing steroids or anti-inflammatory drugs after SLT is not required. |
| Often following SLT, patients believe that their glaucoma is cured, and that they don’t need to attend follow-up visits. It is necessary to educate each patient that they must attend these follow-up visits as scheduled by their ophthalmologist. |
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CLINICAL TIPS - PRASHANT N. VASA
