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Laser Therapies Beyond SLT: July 2026 Protocol Innovations · Glaucoma, Vision & Longevity: Supplements & Science

• 0:00
  SPEAKER_00: Laser Therapies Beyond SLT, July 2026 Protocol Innovations.
• 0:04
  SPEAKER_00: Selective laser trabeculoplasty T is a well-known laser treatment that lowers eye pressure by targeting the eye's drainage tissue trabecular meshwork.
• 0:13
  SPEAKER_00: Recent studies, July 2026, have explored new laser approaches and tweaks to SLT for glaucoma and ocular hypertension.
• 0:21
  SPEAKER_00: These include modified SLT methods like non-contact SLT and pulsed lasers, micropulse laser techniques, and canal-focused procedures using either lasers or tiny implants.
• 0:33
  SPEAKER_00: We summarize the latest dosing, energy, retreatment rates, pressure drop results, and safety findings and explain what they mean for patients.
• 0:42
  SPEAKER_00: Modified SLT approaches, direct SLT and micropulse LT.
• 0:46
  SPEAKER_00: Researchers continue to refine SLT itself.
• 0:50
  SPEAKER_00: For example, a new direct SLT system treats the drainage tissue without touching the eye.
• 0:54
  SPEAKER_00: In a large series of 218 eyes, Goldberg et al., 2026, found that 67.0% of eyes reached their target pressure at two months after direct SLT26.
• 1:05
  SPEAKER_00: The average eye pressure fell about 3.4 millimeter her grams, a 15.6% drop from a baseline of 19.7 mmhergrams.
• 1:15
  SPEAKER_00: Importantly, eyes that had never used pressure drops before did even better.
• 1:19
  SPEAKER_00: About 78.4% of these treatment naive eyes hit the pressure goal, versus 63.5% of eyes already on medication, gold 26.
• 1:29
  SPEAKER_00: Side effects were mild.
• 1:31
  SPEAKER_00: Over half of eyes had a small subconjunctival bleed, a tiny bruise on the eye surface, and only 1.8% had a brief pressure spike.
• 1:39
  SPEAKER_00: No serious complications were seen.
• 1:42
  SPEAKER_00: Another line of work uses a pulsed laser for the same 360-degree treatment area of SLT.
• 1:48
  SPEAKER_00: This micropulse, SLT applies many tiny bursts of laser energy to gently stimulate the drainage meshwork.
• 1:54
  SPEAKER_00: In a head-to-head trial, Abramowitz et al.
• 1:57
  SPEAKER_00: 2018 found that one year after treatment, micropulse SLT and standard SLT gave very similar pressure drops.
• 2:04
  SPEAKER_00: About 30 to 37% of eyes in each group had a 3 mm gray drop or 20% reduction in pressure, Abramowitz 2018.
• 2:14
  SPEAKER_00: The big difference was comfort.
• 2:16
  SPEAKER_00: Patients reported significantly less pain during and after the micropulse laser, p equals 0.005, Abramowitz 2018.
• 2:25
  SPEAKER_00: In short, modified SLT methods, whether non-contact or pulsed, appear as effective as standard SLT in lowering pressure, with the advantage of easier delivery and less discomfort, Goldberg 26.
• 2:38
  SPEAKER_00: New micropulse laser treatments, beyond SLT style procedures, micropulse lasers have been applied in other ways.
• 2:45
  SPEAKER_00: One major application is ciliary body cyclophotocoagulation, where laser energy is delivered through the sclera, the white of the eye, to reduce fluid production.
• 2:55
  SPEAKER_00: In a recent retrospective study of 118 eyes with various refractory glaucomas, Top 10 et al.
• 3:01
  SPEAKER_00: 2026 reported dramatic pressure reductions from micropulse transcleral laser.
• 3:07
  SPEAKER_00: After one treatment session, mean intraocular pressure fell by about 46 to 56% across glaucoma types, for example, 46.5% in primary open angle glaucoma, 50.4% in neovascular glaucoma, up to 56.2% in juvenile glaucoma.
• 3:24
  SPEAKER_00: Top 10 2026.
• 3:26
  SPEAKER_00: Overall, the group wide drop was 48.8%.
• 3:29
  SPEAKER_00: Initially, 66.9% of eyes succeeded, reached target IOP after one session, and after allowing repeat treatments, about 75.4% met the goal by 12 months.
• 3:40
  SPEAKER_00: In practice, most patients, 67% needed just one session, while 28% required two and 5% three sessions up to one year, top 10 2026.
• 3:52
  SPEAKER_00: Notably, this powerful pressure lowering came with very few serious side effects.
• 3:57
  SPEAKER_00: No eye developed dangerous chronic low pressure, hypotony, or shrunken eye thysis, complications seen with older cyclodestructive lasers.
• 4:05
  SPEAKER_00: A few mild issues were reported, temporary eye inflammation in three patients, small bleeding in one, and one patient had a transient pupil dilation Top 10 2026.
• 4:16
  SPEAKER_00: In summary, micropulse transcleral therapy can cut IOP roughly in half with a 1 to 2 session protocol, at the cost of mostly minor and temporary effects.
• 4:26
  SPEAKER_00: The dosing used in these studies was high power but pulsed, typically a 2,000 millilit laser with a 31% duty cycle, short on bursts totaling about 160 seconds of delivery around the eye, top 10 to 26.
• 4:40
  SPEAKER_00: This delivered about 70 to 80 joules of energy per session.
• 4:45
  SPEAKER_00: The key is that micropulsing lets the tissue cool between bursts, minimizing collateral damage.
• 4:51
  SPEAKER_00: Canal-based procedures, Exzimer tubeculostomy and canaloplasty, researchers are also targeting the eye's fluid canal, Schlem's canal, with new techniques.
• 5:01
  SPEAKER_00: Eximer laser tubeculostomy, ELT, is one such method.
• 5:05
  SPEAKER_00: A tiny ultraviolet laser makes microscopic holes through the trabecular meshwork into Schlem's canal.
• 5:11
  SPEAKER_00: In a small pilot study, Calab et al.
• 5:15
  SPEAKER_00: patients undergoing cataract surgery plus ELT showed measurable improvement in aqueous outflow.
• 5:21
  SPEAKER_00: Diangiography before and after the procedure found a significant increase in fluid flow, p equal 0.03, across the treated drainage area, Calab 2026.
• 5:31
  SPEAKER_00: This suggests ELT can enhance the natural channels, although large-scale pressure data are still pending.
• 5:37
  SPEAKER_00: Separately, non-laser canal procedures, sometimes grouped here, are showing large pressure drops.
• 5:43
  SPEAKER_00: For instance, an omnicanaloplasty trabeculotomy, a microcatheter device that dilates Schlem's canal and cuts through trabecular meshwork, was studied in 18 patients, Olander et al.
• 5:55
  SPEAKER_00: Baseline mean IOP was 26.1 mm grams.
• 5:59
  SPEAKER_00: After 12 to 24 months, IOP had dropped to about 15.5 mmHg, a 9.7 to 0.6 mm ag reduction, Olander 26, and most patients reduced or stopped their drops.
• 6:11
  SPEAKER_00: In fact, 67% of patients were off-glaucoma medications by 24 months, Olander 2026.
• 6:19
  SPEAKER_00: Adverse events were mostly mild, no eye lost vision or suffered major complications, and only one case of dry eye was thought related to the procedure, Olander20 kicks.
• 6:30
  SPEAKER_00: This demonstrates that opening the canal can yield a 40% pressure reduction, comparable to traditional glaucoma surgery, but with a very favorable safety profile.
• 6:40
  SPEAKER_00: Patient factors and choosing a protocol.
• 6:42
  SPEAKER_00: Eye color pigmentation, SLT and micropulse lasers target pigmented cells in the drainage tissue.
• 6:49
  SPEAKER_00: Evidence suggests micropulse methods work well even in darkly pigmented eyes.
• 6:54
  SPEAKER_00: Animal data show these pulses trigger enzymes that remodel the trabecular meshwork without excessive heat, a Bromwitz 2018.
• 7:02
  SPEAKER_00: In practice, no major differences in efficacy by eye color have been reported.
• 7:06
  SPEAKER_00: All these laser options are intended for open angle glaucoma.
• 7:10
  SPEAKER_00: They are ineffective in eyes with closed or very narrow angles.
• 7:15
  SPEAKER_00: Angle status.
• 7:16
  SPEAKER_00: All the laser treatments above require at least a partially open drainage angle.
• 7:21
  SPEAKER_00: If your angle is closed, the first step is typically a laser peripheral iriotomy or a cataract operation to open the angle.
• 7:28
  SPEAKER_00: The canal-based surgeries are usually done in open angle eyes too, often at the time of cataract surgery.
• 7:35
  SPEAKER_00: Prior therapy, timing matters.
• 7:37
  SPEAKER_00: The direct SLT study found bigger pressure drops in eyes that had never used drops before, Goldberg 26.
• 7:44
  SPEAKER_00: For example, medication Naive Eyes had a 20.2% IOP reduction after two months of DSLT versus 14.2% in eyes already on drops, Goldbergs.
• 7:54
  SPEAKER_00: This suggests earlier use of laser before maximal medications may give a better percentage drop.
• 8:00
  SPEAKER_00: In general, laser trabeculoplasty, any type, can be repeated if needed.
• 8:05
  SPEAKER_00: In the micropulse cyclo series, about one-third of eyes needed a second session to reach target, yielding 75% success by one year, top 10 2026.
• 8:15
  SPEAKER_00: Expected results.
• 8:16
  SPEAKER_00: Based on these studies, patients can expect a moderate IOP drop on average.
• 8:21
  SPEAKER_00: SLT or micropulse trabeculoplasty, 306 degrees treatment, typically reduces pressure by 15 to 25%, helping 30 to 67% of eyes reach their goal with one treatment, Goldberg 2026, Abramowitz 2018.
• 8:35
  SPEAKER_00: Moropulse cyclodestruction often gives 40 to 50% drops and usually requires scheduling one to two sessions, top 10 2026.
• 8:44
  SPEAKER_00: Canal procedures like Omni can cut IOP by 40% as well, Olander 2026.
• 8:50
  SPEAKER_00: However, individual response varies widely.
• 8:53
  SPEAKER_00: If you have high baseline pressure or aggressive glaucoma, a bigger intervention, multiple sessions, cyclo, or combined surgery, may be needed, versus a mild case where single-session SLT suffices.
• 9:05
  SPEAKER_00: Safety profile.
• 9:06
  SPEAKER_00: All these lasers are generally safe when used correctly.
• 9:09
  SPEAKER_00: In the new studies, serious complications were rare.
• 9:12
  SPEAKER_00: SLT, even direct SLT, mainly causes brief redness or tiny bleeds, and pressure spikes were under 2% Goldberg 2026.
• 9:21
  SPEAKER_00: Micropulse lasers spare tissue and caused minimal inflammation.
• 9:25
  SPEAKER_00: In one report, almost no eyes had permanent loss of vision or severe hypotony, TOP10, 2026.
• 9:33
  SPEAKER_00: Canal surgeries like Omni had a few mild events, dry eye, transient inflammation, but no vision loss.
• 9:40
  SPEAKER_00: Overall, these methods are much less evasive than traditional surgery trabeculectomy and typically do not carry high risks of blindness or severe complications.
• 9:49
  SPEAKER_00: Conclusion.
• 9:50
  SPEAKER_00: July 2026 studies show that innovations in glaucoma lasers are yielding more options beyond standard SLT.
• 9:58
  SPEAKER_00: Modified SLT techniques, non-contact devices, or micropulse pulses match SLT's pressure lowering with the promise of quicker treatment and less discomfort, Goldberg Tuoni Thavowitz 2018.
• 10:10
  SPEAKER_00: Micropulse cyclophotocoagulation is proving to be a powerful tool for hard-to-control glaucoma, cutting pressure by nearly half in many eyes, with minimal side effects, Top TAN26.
• 10:22
  SPEAKER_00: And canal-targeted procedures, both laser and microsurgical, are delivering large IOP drops, 10 mm hergrams on average, while reducing the need for medications.
• 10:33
  SPEAKER_00: OLANDR 2026.
• 10:35
  SPEAKER_00: In practice, the choice of protocol will depend on your specific situation.
• 10:40
  SPEAKER_00: For newly diagnosed open-angle glaucoma on no drops, a laser trabeculoplasty, SLT or micropulse, is a reasonable first step.
• 10:48
  SPEAKER_00: If you have higher pressures or more advanced disease, micropulse cyclomethods or combining lasers with surgery may be considered.
• 10:56
  SPEAKER_00: Eye color, angle anatomy, and prior treatments all play a role, but the newest evidence suggests that these laser options work across different patient groups.
• 11:06
  SPEAKER_00: Discuss with your ophthalmologist.
• 11:08
  SPEAKER_00: Together you can weigh the likely IOP reduction and side effects in your case.
• 11:13
  SPEAKER_00: With these advances, patients now have more laser choices than ever to safely manage glaucoma.
• 11:19
  SPEAKER_00: Sources Recent Glaucoma Laser Studies, Goldberg 2026, Abramowitz 2018, Top 102026, Kalab 2020, Olander 2026.
• 11:30
  SPEAKER_00: All links to sources are available in the text version of this article.
• 11:34
  SPEAKER_00: You can find the full article at VisualFieldtest.com.
• 11:37
  SPEAKER_00: Thanks for listening.
• 11:39
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