At The Retina Clinic London, we continue to expand the range of glaucoma treatments available to our patients.
One of the latest additions is Direct Selective Laser Trabeculoplasty (DSLT), a non-contact form of laser treatment designed to reduce pressure inside the eye in selected patients with open-angle glaucoma or ocular hypertension.
DSLT builds on the established principles of selective laser trabeculoplasty, while using automated imaging and eye-tracking technology to deliver treatment in a different way.
Why lowering eye pressure matters
Glaucoma is a condition in which the optic nerve can become progressively damaged over time.
For many patients, reducing intraocular pressure, or IOP, is an important part of managing the risk of further damage.
Treatment may include eye drops, laser treatment, surgery, or a combination of approaches. At The Retina Clinic London, treatment decisions are based on a detailed assessment of the individual eye rather than a single standard pathway.
Reducing the burden of eye drops
Eye drops remain an important part of glaucoma treatment, but some patients require more than one medication each day. Over time, this can make treatment more complicated and place a considerable burden on the patient.
One of the potential benefits of laser treatment is the opportunity to reduce reliance on daily medication.
In the pivotal clinical study of DSLT, 62% of participants treated with DSLT were medication-free at 12 months.
This does not mean that every patient will be able to stop their drops, or that the effect will necessarily be permanent. Some patients may still need medication after treatment, while others may be able to reduce the number of drops they use for a period of time.
Even a temporary reduction can be valuable. Using fewer medications can simplify a patient’s daily treatment routine and reduce the practical burden associated with taking several eye drops every day.
The aim is not simply to remove medication, but to achieve appropriate control of intraocular pressure using the treatment strategy that is most suitable for the individual patient.
What is DSLT?
Direct Selective Laser Trabeculoplasty is a form of laser treatment that targets the eye’s natural drainage system.
The aim is to improve the outflow of fluid from the eye and reduce intraocular pressure.
What makes DSLT different is the way the laser is delivered.
Unlike conventional selective laser trabeculoplasty, DSLT does not require a treatment lens to be placed directly onto the eye. Instead, digital imaging, automated targeting and eye-tracking technology are used to identify the treatment area and deliver the laser through the limbus, where the clear cornea meets the white of the eye.
This means treatment is:
- non-contact
- automated
- image-guided
- eye-tracked
- designed to be delivered efficiently and precisely
The underlying principle remains selective laser trabeculoplasty. DSLT changes the way that treatment is delivered.
What does the clinical evidence show?
DSLT has been studied in the multicentre randomised GLAUrious clinical trial, which compared DSLT with conventional selective laser trabeculoplasty in patients with open-angle glaucoma or ocular hypertension.
Both treatments reduced intraocular pressure.
At six months, the average reduction in eye pressure was 5.5 mmHg following DSLT, compared with 6.2 mmHg following conventional SLT.
The predefined six-month statistical analysis did not establish non-inferiority of DSLT compared with conventional SLT. This does not mean that DSLT was shown to be inferior.
At 12 months, the average reduction in intraocular pressure was 3.2 mmHg in both groups, and the exploratory 12-month analysis met its statistical criterion for non-inferiority.
The study also reported broadly similar safety profiles between the two treatment groups.
Together with the finding that 62% of DSLT participants were medication-free at 12 months, these results demonstrate the potential role of DSLT both in lowering intraocular pressure and, for some patients, reducing reliance on daily glaucoma medication.
A different treatment experience
For patients, one of the main differences with DSLT is that it is non-contact.
Conventional selective laser trabeculoplasty requires a specialised lens to be placed on the eye so that the drainage angle can be visualised and treated manually.
DSLT uses digital imaging, automated targeting and eye tracking instead.
For suitable patients, this offers a different way of receiving selective laser treatment while retaining the same underlying objective: reducing intraocular pressure and helping to manage glaucoma over the longer term.
Is DSLT suitable for everyone?
No single glaucoma treatment is right for every patient.
The current evidence for DSLT relates principally to patients with open-angle glaucoma and ocular hypertension.
Whether DSLT, conventional laser, eye drops, surgery or another approach may be appropriate depends on several factors, including:
- the type and stage of glaucoma
- the level of intraocular pressure
- the anatomy of the eye
- previous treatment
- the number of medications currently required
- response to existing treatment
- the patient’s wider clinical circumstances
A detailed specialist assessment is therefore essential before deciding on treatment.
DSLT at The Retina Clinic London
At The Retina Clinic London, DSLT forms part of a broader specialist glaucoma service.
Patients undergo a detailed ophthalmic assessment so that their diagnosis, level of risk, current medication and treatment options can be considered together.
For some patients, the priority may be to achieve additional pressure reduction. For others, it may be possible to maintain appropriate pressure control while reducing the number of eye drops they need to use.
Where DSLT is appropriate, it can be incorporated into a personalised treatment plan alongside other medical, laser or surgical options.
Our aim is not simply to offer another technology, but to give patients greater choice and create a glaucoma treatment pathway tailored to the individual eye and the individual patient.
For further information about glaucoma assessment or Direct Selective Laser Trabeculoplasty at The Retina Clinic London, please contact our team.
This article provides general information only. The suitability of DSLT or any other glaucoma treatment requires appropriate clinical assessment.