Introduction to

Introduction to

Why Subthreshold Laser Should Be the Treatment of Choice for Glaucoma Patients?

A typical treatment algorithm for POA-Glaucoma has been pharmacotherapy, Argon laser trabeculoplasty, MIGS, then incisional surgery, with high risk cyclo-destructive techniques preserved for end stage with poor prognosis of visual outcomes.

Subthreshold laser therapy delivers a substantially improved risk profile and SLT is now indicated as a first-line therapy for successful management of POAG and ocular hypertension.

Today’s contemporary treatment algorithm places SLT up front with SubCyclo replacing cyclo-destruction, suitable much earlier in the disease process.

🔍 ZOOM TO VISUALIZE TREATMENTS

graphique-introduction-mobile

LASER TRABECULOPLASTY: FROM ALT TO SLT…

Laser treatment of POAG and ocular hypertension has been used for decades. In the 1990s, the GLT study1 demonstrated equivalence in efficacy between Initial treatment with argon laser trabeculoplasty, (ALT), versus topical medication. However, given its associated risk profile, ALT is not considered a first-line treatment option.

Around the same time Mark A. Latina, M.D. of Tufts University, Boston pioneered the concept of selective laser trabeculoplasty (SLT).

SLT induces a biological response in lowering IOP with equivalent efficacy, but without the thermal damage and irreversible structural changes to the trabecular meshwork, intrinsic with ALT.

Subthreshold laser therapy delivers a substantially improved risk profile and SLT is now indicated as a first-line therapy for successful management of POAG and ocular hypertension2; demonstrating repeatability, while maintaining IOP at or below target over considerable time.3

Clinical References

1 The Glaucoma Laser Trial Research Group. Am J Ophthalmol. 1995;20(6):718-731.

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 multicentre randomised controlled trial. Lancet. 2019, Mar 9;393(10180):1505-16.

3 Ophthalmology. 2020 Apr;127(4):467-476.

LASER CYCLOPHOTOCOAGULATION:
From Cyclodestruction to SubCyclo

Cyclodestruction has been a treatment option for refractory glaucoma since the 1930’s with Cyclocryotherapy among the first techniques used to partially destroy the ciliary process.

Laser Transscleral Cyclophotocoagulation, TSCPC, using a Ruby laser followed, described by Beckman et al., in 1972.

Incremental improvements in technique and technology over time have resulted in diode laser options which are safer and as effective.

Cyclophotocoagulation (ThermoCyclo) using 810nm has been demonstrated as a simple, non-invasive way to treat advanced refractory glaucoma1.

ThermoCyclo relies on continuous delivery of laser energy to destroy the ciliary body, with unavoidable collateral damage to surrounding tissue.

Complications associated with ThermoCyclo include, vision loss, chronic hypotony, sympathetic ophthalmia and phthisis bulbi.

Due the risk profile associated with Thermocyclo it is usually reserved for eyes with the poorest visual prognosis.

Subliminal Cyclophotocoagulation, (SubCyclo), based on the principle of TSCPC, demonstrates similar efficacy with a vastly improved safety profile.

SubCyclo delivers subtle laser pulses interlaced with large periods of laser off time, to avoid accumulation of heat to a destructive level.

The SubCyclo technique stimulates the ciliary body and remodels the uveoscleral pathway inducing a biological response, lowering IOP, without destructive thermal dispersion into surrounding tissue.

Recent studies have shown SubCyclo to be as effective as TSCPC with significantly less risk.  SubCyclo is also REPEATABLE.

SubCyclo is an excellent alternative to medical and surgical treatment options, including MIGS and may be considered earlier in the glaucoma treatment paradigm.2 3 4

Clinical References

1 Bloom PA, Tsai JC, Sharma K, et al. “Cyclodiode.” Trans-scleral diode laser cyclophotocoagulation in the treatment of advanced refractory glaucoma. Ophthalmology.1997;104(9):1508-1519

2 Benhatchi N, Bensmail D, Lachkar Y. Benefits of SubCyclo laser therapy guided by high-frequency ultrasound biomicroscopy in patients with refractory glaucoma. J Glaucoma. 2019;28(6):535-539.

3 Lutic I, Dragne C, Filip M, et al. SubCyclo laser procedure results in patients with glaucoma. Rom J Ophthalmol. 2018;62(4):296- 299.

4 Keilani C, Benhatchi N, Lachkar Y, et al. Comparative effectiveness and tolerance of subliminal subthreshold transscleral cyclophotocoagulation with a duty factor of 25% versus 31.3% for advanced glaucoma. J Glaucoma. 2020;29(2):97-103.

SubCyclo ThermoCyclo

Since 1993, Quantel Medical develops, manufactures and markets innovative medical laser and ultrasound solutions.

World leader in ophthalmology, its lasers and ultrasounds are designed to diagnose and treat the four main causes of blindness: cataracts, glaucoma, diabetic retinopathy and macular degeneration; and also dry eye disease.

Newsletter

"*" indicates required fields

Name*

The information collected through this form is recorded and transmitted to the relevant QUANTEL MEDICAL departments and enables us to send you any reply to a request via the contact form. The legal basis for the processing is consent. The data collected are kept for 3 years in digital format and are only transmitted to QUANTEL MEDICAL’s internal departments as well as to our distributors and subsidiaries. You have a right to access, rectify, contest, limit the processing of and erase data. For more information on the use of your data and your rights resulting from the amended French Data Protection Act and the GDPR, please consult our data protection policy or contact our Data Protection Officer at privacy@lumibird.com.

Country*
Consent
For more informations on how Quantel Medical uses your data, please see our Terms and conditions.
© 2024 Quantel Medical
Share this page by email
Share this page on facebook
Share this page on twitter
Share this page on linkedin