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Lasers are important therapy in glaucoma. They are a pivotal point in treatment between medical and surgical care. Over the last 10 years a new laser has emerged as the usual laser treatment: Selective laser trabeculoplasty (SLT). SLT works as well as the older laser used: argon laser trabeculoplasty (ALT). However SLT has many theoretical benefits over ALT including causing less damage to the tissue it affects. One of the potential patient centered benefits of this laser is that it may be repeatable. It is even possible that the old laser ALT may be useable after an SLT treatment. This study aims to uncover whether repeat laser is possible after SLT and if so which laser is more effective (ALT vs SLT). The potential of repeating laser therapies may delay surgical treatment and its complications. Also understanding which laser to use will help eye doctors know how to treat their patients at this point of the disease.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Argon laser trabeculoplasty | Active Comparator | Up to the year 2005, the vast majority of ophthalmologists used Argon laser trabeculoplasty (ALT) as the mode of laser therapy. ALT is effective but its most significant problem is that its effectiveness decreases with re-treatment since the tissue it targets (the trabecular meshwork) is changed by the laser rendering repeat treatments less effective. |
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| selective laser trabeculoplasty | Active Comparator | Post 2005, a newer mode of laser therapy, selective laser trabeculoplasty (SLT) has emerged as the standard of care laser. There are many potential advantages to SLT but to date these advantages are only theoretical. The most important potential clinical advantage of SLT is that it causes less damage to the tissue it targets. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Argon laser trabeculoplasty | Procedure | With Argon laser trabeculoplasty (ALT), thermal energy is used directed towards the Trabecular Meshwork (the site of aqueous drainage from the eye),which causes focal scarring of trabecular meshwork, thus enable fluid drainage more effectively. However, this procedure may not be repeatable since it causes too much damage to the trabecular meshwork. |
| Measure | Description | Time Frame |
|---|---|---|
| Intraocular Pressure | IOP difference between baseline and 12 month post-laser. | 12 months post operatively |
| Measure | Description | Time Frame |
|---|---|---|
| To compare the IOP lowering effect between the groups at other postoperative visits | IOP difference between baseline, 1hr, 1 wk, and 1, 3, 6 and 12 mon post-laser. | 12 months |
| To compare the visual acuity between the groups at all visits. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| William G Hodge, MD, PhD | Lawson Research Institute, Univ. of Western Ontario | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Rockyview General Hospital, University of Calgary | Calgary | Alberta | T3E 7M8 | Canada | ||
| Royal Alexandra Hospital, University of Alberta |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 35943114 | Derived | Rolim-de-Moura CR, Paranhos A Jr, Loutfi M, Burton D, Wormald R, Evans JR. Laser trabeculoplasty for open-angle glaucoma and ocular hypertension. Cochrane Database Syst Rev. 2022 Aug 9;8(8):CD003919. doi: 10.1002/14651858.CD003919.pub3. | |
| 30278197 | Derived | Hutnik C, Crichton A, Ford B, Nicolela M, Shuba L, Birt C, Sogbesan E, Damji KF, Dorey M, Saheb H, Klar N, Guo H, Hodge W. Selective Laser Trabeculoplasty versus Argon Laser Trabeculoplasty in Glaucoma Patients Treated Previously with 360 degrees Selective Laser Trabeculoplasty: A Randomized, Single-Blind, Equivalence Clinical Trial. Ophthalmology. 2019 Feb;126(2):223-232. doi: 10.1016/j.ophtha.2018.09.037. Epub 2018 Sep 29. |
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| ID | Term |
|---|---|
| D005901 | Glaucoma |
| ID | Term |
|---|---|
| D009798 | Ocular Hypertension |
| D005128 | Eye Diseases |
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| Selective laser trabeculoplasty | Procedure | Selective laser trabeculoplasty is a relatively newer technology that uses a Nd:YAG laser to target specific cells within the trabecular meshwork. SLT does not cause coagulative damage to the trabecular meshwork, and thus has the advantage of being repeatable. |
|
VA difference between baseline, 1hr, 1 wk, and 1, 3, 6 and 12 mon post-laser.
| 12 months |
| To compare the trabecular meshwork pigmentation between the groups at all visits. | 12 months |
| To compare any adverse events between the two groups at all visits. | 12 months |
| SLT repeatability of long term follow up in glaucoma patients | The follow up time has been extended two more years. Patients will be followed up Q6 months. | 36 months after initial enrollment of the primary study |
| Edmonton |
| Alberta |
| T5H 3V9 |
| Canada |
| Eye Care Centre, Dalhousie University | Halifax | Nova Scotia | B3H2R1 | Canada |
| McMaser University, St. Joseph's Healthcare Hamilton, CAHS Regional Eye Institute | Hamilton | Ontario | L8G 5E4 | Canada |
| Ivey Eye Institute, St. Joseph's Hospital, Western University | London | Ontario | N6A 4V2 | Canada |
| Sunnybrook Health Sciences Centre, University of Toronto | Toronto | Ontario | M4N 3M5 | Canada |
| McGill University, Dept. of Ophthalmology, Royal Victoria Hospital, | Montreal | Quebec | H3A 1A1 | Canada |