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Optometric Management

Article | 2026 SECO

Managing Glaucoma With SLT

Mitch Ibach, OD, FAAO, made the case for SLT, DSLT, and patient quality of life at SECO 2026.

By: Sarah Fackler, managing editor, Optometric Management
Optometric Management February 28, 2026 Vol 61, Issue January-February 2026

In his SECO 2026 presentation, Mitch Ibach, OD, FAAO, of Vance Thompson Vision, reviewed where selective laser trabeculoplasty (SLT) fits today for patients in the glaucoma treatment paradigm, as well as emerging technologies in direct SLT (DSLT).

Along with lowering intraocular pressure (IOP) as the central strategy in glaucoma management, the primary goals of glaucoma treatment are to preserve not only visual acuity (VA) and visual fields (VF), but also quality of life, Dr. Ibach said. He cited evidence from the Los Angeles Latino Eye Study that vision-related quality of life scores worsen with both monocular and binocular visual field loss, and that more severe VF loss is associated with increased mental health concerns.1

Considering studies such as the LiGHT trial2 and the COAST trial,3 as well as data from Melamed et al,4 SLT is useful in open-angle glaucoma and secondary glaucomas, including pseudoexfoliation glaucoma and pigmentary dispersion glaucoma, Dr. Ibach said. It can also be used as a first-line treatment option in both phakic and pseudophakic patients, but Dr. Ibach avoids it when patients present with cataract, corneal edema, or low IOP.

Dr. Ibach’s preoperative considerations include:

  • Scheduling SLT same-day or 2 to 4 weeks after glaucoma evaluation,

  • Standard VA and IOP exam components,

  • Gonioscopy to assess angle structure and pigmentation,

  • Preference for undilated treatment, and

  • 360º treatment in 1 or both eyes.

Postoperative management has evolved, Dr. Ibach reported. In his practice, in-office postlaser brimonidine is no longer being used, and postlaser steroids or NSAIDs are no longer routine. IOP checks should be performed at 8 to 12 weeks and clinicians should get new visual field and OCT baselines at 3 to 6 months after surgery, he said. Clinicians may also find that 1 topical glaucoma medication (eg, prostaglandin analog) may be discontinued postoperatively.

DSLT differs from conventional SLT in that it is noncontact, delivers 120 automated shots to the limbal area, requires less than 3.5 seconds per eye, and may be performed by optometrists in several states. The GLAUrious trial, which compared SLT and DSLT, found minimal differences in mean mm Hg IOP change from baseline and screening.5

From patient experiences, Dr. Ibach described DSLT as “extraordinarily efficient,” though he noted an efficacy trade-off to conventional SLT. Among his other lessons learned, he said optometrists can help patients by vocalizing the process and stabilizing their heads. DSLT can also be done undilated, he said, and follow-up can be extended to 8 to 12 weeks.

Describing patient experiences further, Dr. Ibach described a study of glaucoma treatment preferences, which reported that 55% of patients preferred drops over drug delivery systems, but 6.3% chose intraocular surgery over medications.6 He also cited Market Scope data from Q4 2024 that showed increasing optometric confidence in SLT.7

"Being more interventional in glaucoma management with the use of SLT allows a treatment modality that lessens the treatment burden for many patients,” Dr. Ibach told Optometric Management. “Using SLT to theoretically clean out and reinvigorate our patients’ natural drainage pathway via the trabecular meshwork filters aqueous through the eye’s conventional pathway. This aqueous flow brings nutrients and provides force to keep this pathway open."

References:

  1. Varma R, Paz SH, Azen SP, et al. The Los Angeles Latino eye study: design, methods, and baseline data. Ophthalmology. 2004;111(6):1121-31. doi:10.1016/j.ophtha.2004.02.001. PMID: 15177962.

  2. Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Selective laser trabeculoplasty versus eye drops for first-line treatment of ocular hypertension and glaucoma (LiGHT): a multicenter randomized controlled trial. Lancet. 2019;393(10180):1505-1516. doi:10.1016/S0140-6736(18)32213-X

  3. Gandolfi SA, Ungaro N, Varano L, Saccà S. Low power selective laser trabeculoplasty (SLT) repeated yearly as primary treatment in open angle glaucoma(s): long term comparison with conventional SLT and ALT. Abstract presented at: Association for Research in Vision and Ophthalmology Annual Meeting; May 1, 2018; Honolulu, HI.

  4. Melamed, S, Simon, G, Levkovitch-Verbin, H. Selective laser trabeculoplasty as primary treatment for open-angle glaucoma. Arch Ophthalmol. 2003:957-960 https://iovs.arvojournals.org/article.aspx?articleid=2691317

  5. Belkin Vision. GLAUrious long-term follow-up study of glaucoma laser treatment. August 8, 2023. Protocol serial number: CA-PL-01-010, CPMS 57059, IRAS 329958. Accessed February 17, 2026. https://doi.org/10.1186/ISRCTN96782911

  6. SooHoo JR, Golas L, Marando CM, et al. Glaucoma patient treatment preferences. Ophthalmology. 2026;123(7):1621-1622. doi:10.1016/j.ophtha.2016.01.018

  7. Market Scope. Ophthalmic market trends: US glaucoma edition. 2024. Accessed February 16, 2026. https://www.market-scope.com/pages/reports/492/ophthalmic-market-trends-us-glaucoma-edition-q4-2024