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Glaucoma Laser Treatment: Argon Laser Trabeculoplasty (ALT)
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Teresa C. Chen, MD
Massachusetts Eye and Ear Infirmary, Harvard Medical School
December 31, 1969

When is ALT indicated?
Laser trabeculoplasty is generally recommended for patients with open angle glaucoma that continues to progress despite use of medications. Although less common, laser trabeculoplasty may also be recommended prior to trying medical treatment. These decisions vary depending on the type of glaucoma, the stage of glaucoma, as well as other factors.

What is ALT?
ALT attempts to facilitate drainage of fluid FROM the eye and thereby lower intraocular pressure. In open angle glaucoma, the normal drainage site of the eye (the trabecular meshwork) does not function normally. The trabecular meshwork encircles the iris (the colored part of the eye). When fluid has a difficult time leaving the eye, the pressure increases and can cause loss of vision. During ALT (Argon laser trabeculoplasty), an Argon laser beam is directed at the trabecular meshwork. If the laser is successful, changes occur in the trabecular meshwork that enable it to drain fluid more effectively.

Figure 1

What should I expect if I have laser trabeculoplasty?
The procedure is an outpatient procedure that can usually be done in the eye doctor's office. You are seated at a slit lamp with your forehead resting against a headpiece and your chin resting in a chinrest. After some eye drops are put in the eye in ORDER to numb the eye, a lens will be placed on your eye. This will prevent you FROM blinking and will also minimize your eye movements. The lens also helps to direct the laser light INTO your eye. The laser, which is attached to the slit lamp equipment, is then directed INTO the eye. The procedure usually takes a few minutes. Most people experience minimal discomfort during the procedure. After the laser, you may experience some irritation in the eye and some blurry vision, but this is largely resolved after a day or two. You will usually have your eye pressure checked one hour after the laser procedure. You are then usually seen the day after the laser procedure and then the following week. The number and frequency of visits after the laser is variable and depends on your type of glaucoma and on the judgment of your doctor. Most people will need to be on an eye DROP four times a day for one week to help the eye heal FROM the laser. This new eye DROP is taken in addition to your regular glaucoma drops. Since usually only half of the trabecular meshwork is treated at one time, you may need another laser procedure if the pressure is not sufficiently lowered.

Will the laser treatment cure my glaucoma?

Can I stop my glaucoma eye drops after the laser?
Since it takes a few weeks to determine the full effect of the laser treatment, you will need to be on the same glaucoma eye drops in the immediate period after the laser treatment. Sometimes it is possible to decrease the number of glaucoma eye drops that you are on. Even if you are on the same glaucoma medications after the laser treatment, the laser is still successful if your pressure is lower. The need for eye drops long-term varies greatly and is determined by your type of glaucoma and the rate it is progressing.

What are some risks of laser surgery?
All laser procedures have some risks. Laser treatment is not done unless the benefits outweigh the risks. Risks include, but are not limited to, inflammation, eye pressure elevations, and even vision loss. In general, serious risks are not common, however, you may want to discuss the benefits and risks with your doctor should you have any further questions. In general, loss of vision after a laser treatment is usually FROM progression of the glaucoma disease and not FROM the laser per se. Sometimes the laser procedure needs to be repeated.

Does this laser procedure work for everyone?

Are there any other laser options to lower the eye pressure after I've already had 2 ALT's?
A new laser has recently been FDA approved and is called SLT (selective laser trabeculoplasty). This uses a Nd:YAG type laser instead of an Argon laser. It can be used in patients with glaucoma that have already received a full treatment of ALT. It can also be used in patients who have never had ALT before.
Figure 1
