Laser Treatment

At VisionFirst Surgey, we offer bulk billing services for laser treatment including Selective Laser Trabeculoplasty (SLT), peripheral iridotomy and capsulotomy.

Selective Laser Trabeculoplasty (SLT)

What is Selective Laser Trabeculoplasty?

Selective Laser Trabeculoplasty, or SLT for short, is a specific type of laser procedure that is used to lower the intraocular pressure in the eye. It has been widely used for over two decades and is an effective treatment for certain type of glaucoma.

How does SLT work?

SLT users a low energy ‘cold’ laser to stimulate selective pigment cells in the natural drainage canal in the eye (called the trabecular meshwork).

The laser is different to other conventional lasers, as it does not thermally burn tissue, but rather promote the body’s natural cellular activity.

The goal of SLT therapy is to reduce the intraocular pressure in the eye.

When is SLT necessary?

SLT is most effective for those diagnosed with ocular hypertension, primary or secondary open angle glaucoma.
SLT may be advised for situations where the eye pressure is still elevated despite the use of eye drops or other medications.

Patients who have trouble putting in drops or forgetting to use their drops may also be good candidates for the procedure.

Your doctor will determine whether you are suitable for the SLT procedure.

How effective is the SLT procedure?

80% Patients respond well to the laser procedure, with most candidates having a drop in their eye pressure a few weeks after the laser therapy.

The treatment can last several years, but will wear off over time. SLT can be performed again, but may not generally work as well as the very first time.

What can I expect during the SLT procedure?

Your ophthalmologist will in stila numbing drop in your eye and rest a contact lens on the front surface of the eye. This helps focus the laser.

You may see a series of bright lights similar to a photographer’s flash. The procedure is usually quick and can take approximately 2-5 minutes. SLT therapy may be done over two separate sessions.

In general, there are no activity restrictions following the laser treatment, although you should have someone drive you home after the procedure.

If you have issues after the procedure if is advised to speak to your treating ophthalmologist.

What are the risks of the procedure?

Patients are usually very tolerable of the SLT procedure, and the laser therapy has very small risk profile.

The most common side effect can be mild inflammation after the procedure. This is easily treatable with anti-inflammatory drops and rarely causes problems.

In a small amount of people, the pressure in the eye can rise after the procedure. This is usually manageable with eye drops and typically lasts less than 24 hours.

Overall, SLT is very safe and has even less side effects compared to traditional glaucoma eye drops.

Laser Peripheral Iridotomy (LPI)

What is a laser peripheral iridotomy?

Laser peripheral iridotomy is a laser procedure that makes a small opening in the iris (the colored part of the eye). The procedure aims to improve the drainage canal in the eye and prevent acute angle closure.

When is it necessary?

Typically, there are two situations where a laser iridotomy may be required.

A laser iridotomy is necessary when the fluid drainage system of the eye is completely blocked. A muscle behind the iris constantly produces a fluid called aqueous, which then drains through a sponge-like drain system called the trabecular meshwork. Blocking this system causes the pressure in the eye to rise, which can permanently damage the optic nerve and result in vision loss. This process is called acute angle-closure attack, which is a medical emergency.

A laser iridotomy creates a new route for fluid to flow from behind the iris to the outflow drainage system of the eye.  Prevention of angle-closure glaucoma is also an indicator for a laser iridotomy. Some individuals may have a natural tendency to be at risk of angle-closure due to the shape of their eye. A laser iridotomy may be advised to reduce the risk of an attack occurring in future.

What are the symptoms of an acute angle-closure attack?

Not all people with angle-closure glaucoma experience an attack. When angle-closure glaucoma develops slowly, there are no obvious symptoms. However, your doctor may recognise your risk for angle-closure glaucoma before you experience any symptoms.

Symptoms of an angle-closure glaucoma attack are:

  • Headache or eye pain
  • Blurred vision
  • Haloes around lights
  • Red eye
  • Nausea and vomiting.

If pressure is not relieved within a few hours, there may be permanent vision loss.

What are the risk factors for angle-closure glaucoma

The major risk factors for angle-closure include;

  • Age
  • Family history of glaucoma
  • Being very long-sighted
  • Asian ethnicity

How do I prevent an angle-closure attack?

An eye at risk for angle-closure glaucoma can be detected as part of a routine eye exam. Using a mirrored lens, your Ophthalmologist can see if the trabecular meshwork is in danger of being blocked.  A laser iridotomy may be recommended to prevent an angle-closure glaucoma attack.

What can I expect from a laser iridotomy?

A laser iridotomy is usually a quick procedure performed in the clinic on a machine similar to a slit lamp microscope.

Your Ophthalmologist will give you eye drops to numb your eye and place a contact lens on your eye to precisely focus the laser.  A laser iridotomy only takes a few minutes.  You may see a bright light like a photographer’s flash.

In general, there are no activity restrictions following the laser treatment, although you should have someone drive you home after the procedure.

The opening made by an iridotomy is about the size of a pinhead.  The opening is so small, you are unable to see it with the naked eye. The laser opening is also usually performed at the top of the iris, so it is covered by the upper eyelid.

What are the risks?

Loss of vision after laser iridotomy is extremely rare. The main risks of the laser procedure are:

  • The iris may be difficult to penetrate, requiring more than one treatment.
  • A blood vessel in the iris may bleed.
  • Glare may very occasionally occur as extra light can enter the eye through this small laser opening.
  • Intraocular pressure spikes