Laser Trabeculoplasty Perceptions and Practice Patterns of Canadian Ophthalmologists

Abstract

A bstract Aim To describe the current practice patterns and perceptions of Canadian ophthalmologists using laser trabeculoplasty (LTP). Materials and methods A cross-sectional survey of 124 members of the Canadian Ophthalmological Society (COS) who perform LTP was conducted. Descriptive statistics and Chi-square comparative analyses were performed on anonymous self-reported survey data. Results Of the 124 respondents, 34 (27.4%) completed a glaucoma fellowship. Use of selective laser trabeculoplasty (SLT) (94.4%) was preferred over argon laser trabeculoplasty (ALT) (5.6%). The most frequently cited reasons for SLT preference was less damage to trabecular meshwork (30.7%), availability (16.2%), and repeatability (16.2%). In all, 47.6% of the respondents performed LTP concurrently with medical treatment, 33.9% used it after medical treatment, and 17.7% used it as first-line treatment. Majority (87.1%) of the respondents believed that SLT is effective when repeated. In suitable patients, 41.9% of the respondents stated on average they repeat SLT once, 26.6% twice, and 19.4% greater than 2 times, respectively. Of those who repeat SLT on patients, 80.7% found repeat SLT treatments have good outcomes for patients. In all, 105 (84.7%) ophthalmologists responded they would benefit from an LTP practice guideline. Significantly more ophthalmologists without glaucoma fellowships perceived they would benefit from a practice guideline ( p value <0.001). Conclusion This survey provides valuable practical information on how LTP is used in the treatment of glaucoma in Canada. Clinical significance The findings may serve as a baseline survey to trend future practices. How to cite this article Lee EY, Farrokhyar F, Sogbesan E. Laser Trabeculoplasty Perceptions and Practice Patterns of Canadian Ophthalmologists. J Curr Glaucoma Pract 2020;14(3):81–86.

A Review of Selective Laser Trabeculoplasty: “The Hype Is Real”

“…Another glimpse into real-world practice can be provided by a survey study by Canadian ophthalmologists on laser trabeculoplasty. A total of 87.1% of the participants thought of SLT as a repeatable procedure, mostly one or two repetitions [109]. In a retrospective study by Ansari, in the first year, 11% needed re-treatment; this increased to 40% at 5, and 58% at 10 years.…”

A Proposal for the Use of a Fixed Low-Energy Selective Laser Trabeculoplasty for Open Angle Glaucoma

“…Thus using lower energy may mitigate irreversible tissue damage and acute side effects. The success of IOP lowering on repeat SLT treatments would seem to indicate the inherent safety of this procedure 7,8,13,32–42 …”

“…The success of IOP lowering on repeat SLT treatments would seem to indicate the inherent safety of this procedure. 7,8,13,[32][33][34][35][36][37][38][39][40][41][42] The IOP reduction is likely to be determined by the fluence associated with nanosecond SLT pulses. However, the fluence for different commercially available SLT lasers can vary by a factor of 2 or more.…”