Types of Glaucoma Lasers

There are many different types of glaucoma, but as a medical doctor and eye specialist, I will assess the glaucoma and determine the appropriate type of laser, and need for the procedure. Many of these procedures can be done in the office, and with minimal discomfort. The good news is that most people with glaucoma will never need glaucoma lasers. The simplest glaucoma procedure is a laser peripheral iridotomy (LPI). The procedure is done for people with narrow angle glaucoma. Narrow angle glaucoma is when there is not much space between the iris (colored part of the eye) and the cornea (the clear window where contact lenses rest). This can be done for acute glaucoma when there is a rapid pressure rise that can involve nausea, and severe pain, or for chronic angle closure glaucoma which is where that space narrows with time. The laser procedure involves making an opening in the iris so the fluid in the eye can drain out more successfully. If you need this procedure, you will come into the office and have several different drops to numb and constrict the pupil. A contact lens is placed on the eye to better focus the light, and then the laser will be used to make the opening. The procedure usually only takes a few minutes and there can be some tenderness. The eye will also be blurry for at least several hours. Sometimes the eye needs to be treated several times to complete the opening. Overall, the procedure is low risk, but there can be some bleeding inside the eye, and some risk for the pressure to go up (but usually for just a short time). The patient will take steroid drops and continue their glaucoma drops, and usually be checked a few days later. The next major type of laser is an SLT. The SLT involves treating some pigment in the area called the trabecular meshwork. This is where the fluid from inside the eye goes to drain out, and it can become clogged leading to an elevation of intraocular pressure. The laser preferentially is absorbed by pigment that causes the meshwork to function more appropriately. Just like the LPI, a contact lens is placed on the eye, and the laser is used to make several different spots in that drainage area. The pupil is usually also constricted and steroid drops are usually given after the procedure. The main risks of this procedure are that it does not work, and rarely, there can be a spike in the pressure. There is also a procedure called an argon laser trabeculoplasty (ALT) that is similar in efficacy to the SLT. These are the main glaucoma lasers that are performed although there are several others that are used in rarer circumstances. Please contact our office for a glaucoma evaluation at 512-686-1224.