Dr. Stephen Sullivan, founder and CEO of Eye Health Vision Centers in North Dartmouth, announced this week that Selective Laser Trabeculoplasty, the latest advancement in the treatment of chronic open angle glaucoma, is now available at their Dartmouth office. SLT (Selective Laser Trabeculoplasty) represents perhaps the single most dramatic advancement in glaucoma treatment in the past 25 years. The opportunity is now available to offer glaucoma patients a painless, repeatable treatment that can be performed in the office in just a few minutes with the potential of immediate and long-lasting results. It is now possible to employ laser earlier in the course of glaucoma and in many cases as the initial treatment as opposed to the use of drops. Additionally, those who have been treated in the past with the traditional argon laser can now be retreated for additional pressure lowering results.

What is Glaucoma?
Glaucoma, the second leading cause of irreversible blindness in the world, is a condition where the pressure within the eye is too high and results in irreversible damage to the optic nerve and ultimately irreversible vision loss. The basic mechanism of glaucoma involves the obstruction of the fluid channels that normally allow the aqueous humor (the fluid within the eye that nourishes the lens and cornea) to exit from the eye. As a result of age and/or heredity, the aqueous fluid exit channels are clogged" and the pressure within the eye increases. This elevated pressure damages the optic nerve and causes irreversible vision loss. The dangerous reality of glaucoma is that the patient can neither feel the elevated pressure nor recognize the loss of peripheral vision that occurs early in the disease. As a result, without yearly check-ups, careful monitoring and appropriate treatment, patients afflicted with glaucoma can experience progressive vision loss, and ultimately, if not treated, become completely blind.

Is Glaucoma curable?

NarrowAngle Glaucoma (NAG) is a less common type of glaucoma. Although it is curable by laser iridotomy, it is imperative that these patients continue to be monitored, as many of them will also, eventually, develop open angle glaucoma. No drops are used in treating this type of glaucoma. Laser iridotomy, a 60-second procedure is employed to cure narrow angle glaucoma. This procedure has been available for 25 years and can be performed using either the Argon or theYAG laser.

Open Angle Glaucoma (OAG - by far the most common type of glaucoma) is controllable, but not curable. It is a chronic (i.e., forever) and progressive (i.e., it gets worse with age) condition. As such, it must be monitored regularly and retreated throughout life. The new SLT laser, unlike the traditional Argon laser, allows for re-treatment in the future as the glaucoma progresses with age.

How is Open Angle Glaucoma (OAG) treated?
When the pressure in the eye is too high it can be reduced by either decreasing the amount of fluid that enters the eye or by helping the fluid leave the eye. It is much like fixing a sink that is overflowing: you can either turn down the faucet or open up the drain.

SLT can be used to treat essentially any patient with open angle glaucoma.

TRADITIONAL GLAUCOMA TREATMENT
OPTIONS INCLUDE:

1. Drops - which can either reduce fluid production
   (e.g., Timoptic &Alphagan) or increase fluid out-flow
   (e.g., Xalatan, Lumigan, Trusopt
2. Surgery - which increases fluid out-flow
3. Lasers
   (e.g., Argon, ECP and now SLT) – which increase fluid out-flow

1. Cost - usually $50-$200/month ($600-$2400/year) or sometimes even more
2. Compliance - it's not easy having to remember to use eye drops on a daily basis forever
3. Local side effects - with time many patients will develop red eyes or irritated skin from the chronic use of eye drops. The use of multiple drops increases the likelihood of allergic reactions.
4. Systemic side effects - many of the glaucoma drops have systemic side effects.

Because of these disadvantages, many patients are inclined to "cut-back" on their drops to either save money or reduce irritation or other undesirable side effects. Many patients just simply forget. All of these reasons are understandable, but they are dangerous to the patient's visual well-being, and can result in irreversible vision loss.

II. SURGERY: Glaucoma surgery has been available for over 50 years, but has been reserved as a last resort in patients who are still losing vision despite the use of multiple drops and laser treatments. Glaucoma surgery though successful and often necessary carries a higher risk than the use of either drops or laser.

III. LASERS: 33 years ago the argon laser was introduced, and since that time has remained the mainstay of open angle glaucoma laser treatment. It works by causing microscopic scarring (thermal damage) of few of the honeycombed-like aqueous fluid drains which results in the stretching and opening of adjacent honeycombed drainage channels. Argon laser treatment (ALT) can generally be performed only twice over a number of years: each time treating ½ of the drainage area (trabecular meshwork) which encircles the front of the eye and is located along the base of the iris. Remember that glaucoma is chronic and progressive. As such, the 2nd treatment comes not because the first treated failed, but because, with time, the glaucoma itself becomes worse, more difficult to control, and requires further treatment.

The New SLT Laser
Although developed several years ago, the SLT laser has been fine- tuned and improved during the last two years. The SLT laser, unlike the ALT, produces essentially no apparent scarring to the honeycombed fluid drainage (trabecular meshwork) system. It works by selectively breaking up intracellular pigment which causes the honeycombed drainage framework to swell and become obstructed. (Remember that it is this obstruction of the microscopic drainage meshwork that causes the elevated pressure characteristic of open angle glaucoma in the first place.) In essence the SLT laser widens and opens the drainage "pores" which have become narrowed and obstructed with age.

The SLT laser is considered very safe and because it is not associated with permanent scarring of the draining system, it will be replacing the argon laser procedure (ALT) as the primary treatment modality for open angle glaucoma. Unlike its argon laser predecessor, the SLT can be used to treat essentially any patient with open angle glaucoma (OAG): i.e.,

• newly diagnosed glaucoma patients as an alternative to first starting treatment with eye drops
• existing glaucoma patients who are using one or more eye drops as a way of decreasing or eliminating the need for drops
• long-standing chronic glaucoma patients who have already had one or two argon laser (ALT) treatments and thus cannot have any more ALT treatments

There are only two other facilities in the area capable of providing the SLT laser technology: one in Providence and the other at the Massachusetts Eye and Ear Infirmary in Boston. Appointments with Dr. Sullivan for evaluation as to appropriateness of SLT treatment may be scheduled by calling his office at 508-994-1400 or 508-823-5536.