2RT laser trabeculoplasty vs selective laser trabeculoplasty : a prospective randomised clinical pilot study

This project endeavours to establish whether treatment with a new laser (a retinal regeneration or 2RT laser), is as, or is more effective than an selective laser trabeculoplasty (or SLT) laser at for treating glaucoma. The SLT laser procedure is routinely used to treat glaucoma in a painless outpatient procedure. Our research will compare the more recent 2RT Laser with an older SLT laser but will be used in an identical manner to an selective laser trabeculoplasty procedure. The treatment is a simple outpatient procedure which delivers nanosecond laser pulses of 532nm green laser light to the trabecular meshwork sufficient to trigger a cascade of cell destruction, replacement and trabecular meshwork remodelling; the end result leading to increased outflow for the intraocular fluid and eventual decrease in intraocular pressure to safer levels. In practice with the SLT laser this light intensity is carefully titrated for each individual patient dependant on the individual level of pigmentation of the trabecular meshwork. The treatment model assumes a good level of uniformity of light intensity across the treatment spot. In practice this uniformity is not easy to achieve but fortunately due to the net like structure of the meshwork this tissue tolerates the lack of ideal uniformity quite well. Recent advances made, principally in the development of the 2RT laser which is designed for treating more sensitive planar tissue structures being that of the retina, result in the ability to generate a far more uniform controlled beam intensity profile. Patients in both groups (2RT and SLT lasers) will undergo exactly the same procedure. This involves 2 sessions of laser one week apart as per routine practice. No further laser procedures are required unless the patient has not had a satisfactory outcome. Further laser can be performed if necessary. This decision will be determined by the principle investigator. The patient will be asked to come for a pre-laser treatment visit for measurements. The first of two laser treatments will be given at that time. Prior to the treatment, eye drops are administered to prepare the eye and provide mild anaesthesia. Then, gentle pulses of light are delivered through a specially designed microscope (SLT laser). The entire process takes just a few minutes. When it’s complete, the physician may treat the eye with anti-inflammatory eye drops. A second laser treatment will be applied to the same eye around a week later. The effect of the laser on your eye pressure will be measured a month following the treatment as per routine follow up procedures.