Glaucoma PhysicianThings You Didn’t Know About SLT

More than 20 experienced glaucoma surgeons reveal that SLT remains dramatically underutilized despite evidence supporting first-line use, with most physicians reporting only 10% of their patients receive SLT as initial therapy, even as nearly all say they would choose it for their own eyes.

Clinical Considerations

• Treatment-naive eyes can achieve 50% to 55% IOP reductions with primary SLT, far exceeding the commonly cited 25% to 30% benchmark.
• Repeat SLT works regardless of initial response, with 67% of eyes maintaining target IOP at 18 months after a second treatment per LiGHT trial data.
• Non-vitreoretinal pathology aside, SLT serves as an underrecognized ocular surface rescue strategy, reducing drop burden and restoring tear film health in patients with prostaglandin-related toxicity.
• Postprocedure steroid (prednisolone acetate 1%) outperformed topical NSAIDs in a 2025 RCT, reversing earlier recommendations favoring ketorolac.

Practice Applications

• Offer primary SLT before topical therapy to treatment-naive patients with OHTN or POAG.
• Reframe SLT counseling around quality-of-life benefits and medication reduction, not IOP numbers alone.
• Repeat SLT in apparent nonresponders; underdosing, not true failure, is the likely cause.
• Treat both eyes same-day when indicated: the staffing and patient time savings outweigh the 50% fee reduction.

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