Thomas W. Samuelson, MD, shares clinical perspectives on DSLT, SLT, and glaucoma management

Thomas W. Samuelson, MD, sat down with Sheryl Stevenson, executive editor of Ophthalmology Times, to discuss recent advancements in ophthalmic laser technology, such as direct selective laser trabeculoplasty (DSLT) (Voyager; Alcon). As an attending surgeon and founding partner of Minnesota Eye Consultants in Minneapolis, Samuelson has been involved in DSLT since its early development, even prior to FDA approval when it was known as the Belkin laser.

DSLT differs from conventional SLT by delivering laser energy directly through the perilimbal tissue, rather than reflecting off a gonio prism before traversing the full thickness of the cornea. This direct approach allows the laser to pass through only the outer third of the eye wall, reaching the trabecular meshwork with improved efficiency. Additionally, DSLT utilizes eye-tracking technology (SureTrac), which identifies the limbus and generates a proposed treatment profile that the surgeon reviews before initiating the procedure. In just over 2 seconds, 120 pulses are delivered circumferentially, eliminating the need for a contact lens, which is required in conventional SLT.

Discussing patient response, Samuelson emphasized that laser treatment is now his primary recommendation for lowering IOP, given the robust 6-year data from the LiGHT trial. He explained that laser therapy demonstrated superior outcomes compared with eye drops, reducing the need for secondary surgical interventions and cataract surgeries while maintaining up to 70% of patients medication-free at 6 years. This shift also helps mitigate issues related to poor adherence and ocular surface disease associated with topical therapy.

Regarding clinical scenarios favoring DSLT over SLT, Samuelson referenced the GLAUrious trial, which found DSLT to be substantially equivalent to SLT, leading to FDA approval. While he has fully transitioned to DSLT in select offices, he acknowledges that certain rare cases might necessitate conventional SLT if the registration fails. However, thus far, he has encountered no such instances, reinforcing DSLT’s role as a patient-friendly and surgeon-friendly innovation in glaucoma management.