Selective Laser Trabeculoplasty
Selective Laser Trabeculoplasty (SLT)
Author: Aanya Roy
Purpose: SLT is a laser procedure used to treat open-angle glaucoma by lowering intraocular pressure (IOP). It targets the trabecular meshwork—the drainage system of the eye—to improve outflow of aqueous humor without damaging surrounding tissue.
When SLT is Needed:
- Patients with primary or secondary open-angle glaucoma
- Those having difficulty managing daily eye drop regimens
- When medications cause side effects
- As a first-line treatment for newly diagnosed glaucoma
When additional pressure reduction is needed after medication or other treatments
Procedure:
Setting: In-office, outpatient procedure
Time: About 5–10 minutes
Laser Used: Frequency-doubled Nd:YAG laser
Function: Targets pigmented cells in the trabecular meshwork to stimulate better fluid drainage without harming nearby tissue
Steps:
- Numbing drops are applied to the eye
- Patient places head in laser machine’s headrest
- A special contact lens with gel is placed on the eye to focus the laser
- The doctor aims the laser pulses at the trabecular meshwork (typically 50–100 laser spots around 180° to 360° of the angle)
- Patient may hear clicking sounds and see flashes of light
- The contact lens is removed and the eye is rinsed
- Eye pressure is checked 30–60 minutes after the procedure
- The doctor may prescribe anti-inflammatory drops (NSAIDs or steroids) for a few days
What to Expect After SLT
Mild irritation or blurry vision may occur
Most patients resume normal activities within a day
Follow-up exams are important to monitor eye pressure
Full results may take 1–3 months
Pressure reduction can last 1–5 years; repeatable if needed
Benefits
Non-invasive, no incisions or implants
Repeatable if needed
No systemic side effects
Quick recovery, minimal aftercare
Can reduce or eliminate need for eye drops
Proven 20–30% IOP reduction in most patients
Risks (Rare)
Mild inflammation, redness, or discomfort
Temporary IOP spike (usually resolves on its own)
Dryness
Rare: persistent IOP elevation or no significant effect
Citations:
A. Francis, Brian. “Selective Laser Trabeculoplasty (SLT)—Glaucoma Research Foundation.” Glaucoma Research Foundation, 11 Oct. 2023, glaucoma.org/treatment/laser/slt.
AAO OTAC Glaucoma Panel, and Hoskins Center for Quality Eye Care. “Selective Laser Trabeculoplasty for the Treatment of Glaucoma OTA.” American Academy of Ophthalmology, American Academy of Ophthalmology, 13 Sept. 2023, https://www.aao.org/education/ophthalmic-technology-assessment/new-ophthalmictechnologyassessment-6.
“Laser Surgery – Glaucoma Research Foundation.” Glaucoma Research Foundation, 11 Oct. 2023, glaucoma.org/treatment/laser.
Realini, Tony. “Why Selective Laser Trabeculoplasty Should Be a First-Line Treatment.” American Academy of Ophthalmology, Mar. 2024, www.aao.org/education/annual-meeting-video/why-selective-laser-trabeculoplasty-first-line.
Zheng, Cindy. “Selective Laser Trabeculoplasty as Primary Glaucoma Therapy – Glaucoma Research Foundation.” Glaucoma Research Foundation, 10 Jan. 2024, glaucoma.org/articles/selective-laser-trabeculoplasty-as-primary-glaucoma-therapy.
“Lasers – Texoma.” Texoma, Texoma Retina and Glaucoma, 20 Oct. 2022, texomaretina.com/lasers/.
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