Considering selective laser trabeculoplasty (SLT) is shown to provide stable IOP control (decreasing the need for anti-glaucoma medications),1-3 and 11 states enable optometrists to perform it, it makes sense to discuss it as an option for patients. I would argue that we’ve all discussed it, but I would also argue that many of our patients who could have benefitted from it, have turned it down due word choice.
Creating a term limit
Up until recently, I referred to SLT as a type of “surgery.”
The oxford dictionary defines “surgery” as “the branch of medical practice that treats injuries, diseases, and deformities by the physical removal, repair, or readjustment of organs and tissues, often involving cutting into the body.” As SLT’s mechanism of action is activating inflammatory pathways such as interleukins, cytokines, and tumor necrosis factor alpha, which allow macrophages to effectively remodel the trabecular meshwork tissue,4 it shouldn’t be referred to as surgery.
What’s more, I’ve found that when patients hear the word “surgery,” their mind automatically thinks of inpatient settings, invasiveness, general anesthesia, a long recovery process, and discomfort. As a result, they opt for the “non-surgical” option. My point: We should create a term limit of sorts on “surgical,” reserving its use for when it meets that Oxford Dictionary definition.
Putting a word to work
The word “procedure,” on the other hand, does not elicit any of the negative emotions associated with “surgery,” in my experience. Therefore, I recently decided to refer to SLT as a “procedure” and not a “surgery.” The result: My patients’ acceptance rate of SLT skyrocketed to around 90%.
Here’s the script I use:
"Studies have shown that this procedure can be used as a first-line treatment, it’s safe, and can decrease your reliance on drops. Additionally, it can be repeated. It involves opening your drainage system to keep your IOP in a healthy range. The entire procedure from start to finish can take as little as 45 minutes with minimal to no restrictions following the procedure."
Words matter
Words are a powerful form of communication. Many times, they elicit memories and emotions in the listener not intended by the speaker.5 These unintentional emotions make the underlying message quite different for the two parties and can stop negotiations and education cold in its tracks. By using the word “procedure” instead of “surgery,” my glaucoma patients are now benefitting from SLT.
References:
1. Gazzard G, Konstantakopoulou E, Garway-Heath D, Garg A, Vickerstaff V, Hunter R, Ambler G, Bunce C, Wormald R, Nathwani N, Barton K, Rubin G, Buszewicz M; LiGHT Trial Study Group. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicentre randomised controlled trial. Lancet. 2019;393(10180):1505-1516. doi: 10.1016/S0140-6736(18)32213-X
2. Gazzard G, Konstantakopoulou E, Garway-Heath D, Garg A, Vickerstaff V, Hunter R, Ambler G, Bunce C, Wormald R, Nathwani N, Barton K, Rubin G, Morris S, Buszewicz M. Selective laser trabeculoplasty versus drops for newly diagnosed ocular hypertension and glaucoma: the LiGHT RCT. Health Technol Assess. 2019;23(31):1-102. doi: 10.3310/hta23310.
3. Zgryźniak A, Przeździecka-Dołyk J, Szaliński M, Turno-Kręcicka A. Selective Laser Trabeculoplasty in the Treatment of Ocular Hypertension and Open-Angle Glaucoma: Clinical Review. J Clin Med. 2021;10(15):3307. (NOTE: see Figure 1 for proposed mechanism of action) doi: 10.3390/jcm10153307
4. Chen YF, Zeng W. Mechanism of selective laser trabeculoplasty: a systemic review. Int J Ophthalmol. 2024;17(5):963-968. doi: 10.18240/ijo.2024.05.22.
5. Richter, M., Eck, J., Straube, T., Miltner, W. H., & Weiss, T. (2010). Do words hurt? Brain activation during the processing of pain-related words. Pain, 148(2), 198–205. https://doi.org/10.1016/j.pain.2009.08.009
