What's new in laser treatment for glaucoma?

PURPOSE OF REVIEW This review highlights recently published studies on prevailing and newer laser therapies in glaucoma and critically evaluates their roles in the treatment algorithm. RECENT FINDINGS Recently published studies suggest a role for selective laser trabeculoplasty (SLT) as initial therapy for open-angle glaucoma and ocular hypertension and have demonstrated efficacy in other glaucoma subtypes. Novel laser applications (micropulse diode laser trabeculoplasty, titanium sapphire laser trabeculoplasty and excimer laser trabeculotomy) have shown favorable early results. Endoscopic and transscleral cyclophotocoagulation (ECP, TCP) are generally reserved for refractory glaucomas, although some recent studies report its use in patients with good visual acuity. The effectiveness of laser iridotomy with or without iridoplasty for long-term prevention of primary angle closure glaucoma is undetermined. Laser goniopuncture is an important adjunct to nonpenetrating surgery, but wide adoption of the procedure is lacking. SUMMARY The use of lasers in glaucoma continues to evolve, with a trend towards primary and earlier intervention. SLT is assuming an expanded role in the treatment of additional subtypes of glaucoma, whereas ECP and TCP are generally reserved for refractory glaucomas. Newer laser modalities show promise as alternatives and adjuncts to topical medications and nonpenetrating surgery. Additional research is needed to better define their safety and efficacy.