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Glaucoma
Published in Mary E. Shaw, Agnes Lee, Ophthalmic Nursing, 2018
Selective laser trabeculoplasty (SLT). SLT differs from conventional argon laser in that it protects the trabecular meshwork against thermal or coagulative effects by selectively targeting only the pigmented cells and preserving surrounding tissue.
Ophthalmology
Published in Janesh K Gupta, Core Clinical Cases in Surgery and Surgical Specialties, 2014
Specific nutritional supplements are therefore indicated in advanced ARMD. The patient should also be advised to stop smoking. Arrangements for the provision of low visual aids (large-print material, optical aids and non-optical aids) and rehabilitation should be remembered. Medical treatment: in most cases, primary open-angle glaucoma is successfully treated with antiglaucoma eyedrops.Laser treatment: laser trabeculoplasty is sometimes used in the treatment of glaucoma. Laser treatment is performed for diabetic maculopathy, if there is clinically significant macular oedema.Surgical treatment: glaucoma filtration surgery (trabeculectomy) (Figure 3.3) or a glaucoma drainage device may become necessary if medical treatment is ineffective or not well tolerated. Visually significant cataract is treated by phacoemulsification and intraocular lens implant.
Laser Surgery in the Treatment of Glaucoma
Published in Neil T. Choplin, Carlo E. Traverso, Atlas of Glaucoma, 2014
Introduced originally by Wise and Witter (1979), argon laser trabeculoplasty (ALT) is a frequently performed glaucoma procedure with good long-term follow-up. A variety of lasers have been used to perform trabeculoplasty. The most commonly used is the argon laser. In using this laser, operator macular photic stress may be reduced by using the argon green only rather than both the blue and green. In addition, the use of a contact lens with a metal halide coating will reduce the hazards of reflected light. The Ritch trabeculoplasty lens (Figure 15.16), has two different angles on its mirrors: 64° for the superior angle and 59° for the inferior angle. In addition, a planoconvex button is positioned over each mirror, which provides 1.4x magnification. This reduces a 50 μm spot to 35 μm and doubles irradiance. A standard one- or two-mirror lens without a planoconvex condensing lens has an angle of 62° and produces a 54 μm spot from the original 50 μm beam, which also slightly decreases irradiance (Figure 15.17). If a one-mirror lens is used, the patient is asked to move the eye in the direction of the treating mirror to accommodate the slight variance in filtering angle anatomy. Tilting the lens will introduce astigmatic error, creating an oval beam and altered irradiance (energy per surface area).
Management of open‐angle glaucoma by primary eye‐care practitioners: toward a personalised medicine approach
Published in Clinical and Experimental Optometry, 2021
Jack Phu, Ashish Agar, Henrietta Wang, Katherine Masselos, Michael Kalloniatis
A recent clinical trial (LiGHT) provided compelling evidence for selective laser trabeculoplasty as primary therapy for patients with open‐angle glaucoma and ocular hypertension, with an ability to achieve intraocular pressure reduction targets with a large proportion of patients being effectively medication‐free.181 Prior to this large clinical trial, numerous others have reported on the effectiveness of selective laser trabeculoplasty as a first‐line therapy for open‐angle glaucoma.182–185 Importantly, the patients included in the LiGHT trial had a mean intraocular pressure of around 24-mmHg. This central tendency statistic does not reflect the diverse range of pressures of patients with glaucoma, especially in ethnically diverse populations where baseline pressures may be lower.186 As noted above, these patients tend to have an excellent intraocular pressure response to selective laser trabeculoplasty and therefore it is perhaps unsurprising that the overall achieved target pressure reduction was impressive. Nonetheless, the results of the LiGHT trial have revitalised considerations for laser as first‐line therapy, which may reduce the need for topical therapy and its disadvantages of requiring patient compliance and medication‐related adverse effects.
Ocular therapeutics: from special interest to standard care
Published in Clinical and Experimental Optometry, 2021
This special issue is complemented by some useful articles highlighting areas where practice is evolving. 2020 will be remembered as the year of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) global pandemic. With governments around the world attempting to change the behaviour of their citizens to minimise the risk of virus transmission, this issue includes a timely update to the Infection Control Guidelines for Optometrists and how practitioners are expected to contribute to the prevention of infection transmission as part of their clinical practice. Hart et al.15 Dang et al.16 summarise existing evidence for use of povidone iodine for adenovirus in the eye. Phu et al. provide a contemporary perspective on the somewhat dated National Health and Medical Research Council clinical care guidelines for glaucoma and propose a new management paradigm for early-stage primary open-angle glaucoma favouring an individualised, preservative-free and/or selective laser trabeculoplasty therapy over the more traditional approach.17
Cost-effectiveness analysis of iStent trabecular micro-bypass stent for patients with open-angle glaucoma in Colombia
Published in Current Medical Research and Opinion, 2019
Jaime E. Ordóñez, Angélica Ordóñez, Urpy M. Osorio
A proven treatment to reduce glaucoma risk progression is to decrease intraocular pressure (IOP) through topical medications. Among the most commonly used are prostaglandin analogs, β-adrenergic agonists, carbonic anhydrase inhibitors, α-adrenergic agonists, and miotic agonists, such as pilocarpine9. Although monotherapy is the most usual strategy at the beginning of the disease, as the severity of glaucoma increases, different combinations of these medications are used. The main problem faced by patients, besides polypharmacy secondary effects, is non-compliance to medication and their insufficient ability to apply them, which affects clinical effectiveness. Surgical procedures such as selective laser trabeculoplasty have shown good clinical outcomes. Recent use of a trabecular micro-bypass stent by means of minimally invasive glaucoma surgery (MIGS) has shown great outcomes.