ARGON LASER TRABECULOPLASTY (ALT)

In this treatment, the laser is used to make multiple microscopic burns in the outflow filter of the eye. This improves the escape of fluid from the eye into its normal drainage system and thereby lowers the intraocular pressure.

In glaucoma, ALT is usually used as a second-line treatment when eye drops have not provided sufficient effect on their own or were not well tolerated due to side effects. ALT is often also used as a first-line treatment, and the regular use of eye drops added if the result is not good enough.

What are the potential risks?

ALT is very safe. In the vast majority of patients, no side effects are encountered. Vision should return to normal a few hours after ALT.

The main risk is that the pressure may rise initially following the treatment. To prevent this the ophthalmologist uses additional drops to lower the pressure. Very rarely the pressure may rise and remain elevated, requiring long-term increased medication or even glaucoma surgery. Occasionally an eye may react by becoming inflamed (iritis). Steroid drops are commonly prescribed for a few days following laser treatment to prevent this. Should it occur, these drops may need to be increased or continued for longer until the iritis settles.

What is involved?

Laser therapy is performed at the specialist's rooms as a day procedure. Each treatment takes only a few minutes to perform but your visit takes over an hour while we give preparatory eye drops and check for side effects after the treatment. ALT is divided into two treatment sessions per eye. Eye drops are required both before and after the procedure. ALT is virtually painless, so it does not require any anaesthetic other than eye drops. A special contact lens is placed on the eye to hold the lids open and focus the laser.

The treatments do not involve the visual part of the eye, so apart from initial blurring for a few hours, vision quickly returns to normal. Due to the temporary blurring, however, it is advisable to arrange for transport home and not to drive immediately afterwards.

How successful is it?

Laser trabeculoplasty lowers the intraocular pressure in the majority of patients, but the magnitude of the reduction varies greatly between individuals and is impossible to predict. Around 75% of patients will achieve lowering of pressure, while in the remainder pressures are unchanged. If successful, laser therapy can be applied a second time should pressure rise again, though with smaller chance of success.

The duration of effect is also unpredictable, but ranges from months to many years (up to 10 years). Even if pressure is controlled, this is not a cure. Glaucoma is a lifelong attack on the vision, and patients need to attend an ophthalmologist regularly, indefinitely.

INSTRUCTIONS FOR ALT

ALT usually takes 2 treatments of about 10 minutes each for each eye, 1-3 weeks apart.

The treatment is done on a microscope similar to that on which you are routinely examined in the office. For a few minutes after the treatment the vision is blurred and it takes several hours to fully recover. Each treatment involves 50 to 60 "shots". It is rare to experience pain, though some discomfort is common, but if you just say "STOP" the doctor can literally stop in one second.

MEDICATION BEFORE, DURING AND AFTER LASER TREATMENT

It is important to CONTINUE YOUR USUAL GLAUCOMA MEDICATIONS unless specifically told otherwise.

The most important serious side effect of ALT is a sudden pressure rise an hour or two after ALT. In order to lessen the potential for this doctor will instil drops into the eye before and after laser treatment. These drops may make the pupil small for 4 hours and may produce a mild ache in the forehead.

If you are allergic to sulphur drugs you must tell us because you should not receive "Trusopt."

AFTER ALT:

Your doctor will advise you if you need to use Flarex. If you do use one FLAREX drop every ONE to TWO hours for that day and the next day. Place the leftovers in the fridge in case they are needed again.
If you have any pain then take two Panadol on one occasion only. If that is inadequate then you must contact the doctor.

The eye may be red for 1-2 days. If the vision does not mostly recover within a few hours OR if the vision recovers and then goes blurry, you must contact the doctor immediately.