ALT or NOT

[Opii]

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Can anyone tell me why some OD clinicians are in favor for SLT, ALT early and others are not? Some prefer to suggest to add another glaucoma drug instead. I was on one rotation which was very much in favor of it then I went to my next one where the preceptors were very much against it? I'm confused.

 

[VA Hopeful Dr]

Can anyone tell me why some OD clinicians are in favor for SLT, ALT early and others are not? Some prefer to suggest to add another glaucoma drug instead. I was on one rotation which was very much in favor of it then I went to my next one where the preceptors were very much against it? I'm confused.

Even laser surgery has its risks while drops tend to be faily benign. Why risk complications if drops are working (I've seen patients on 3-4 different drops and only when those fail is surgery an option, ODs and MDs both practicing this way).

Why send your patient off to an MD when the drops you can give them are working just fine?

On the other hand, surgery can often get patients off of many of their drops. Take a Medicaid patient with diabetes, glaucoma and high cholesterol. Here in SC, medicaid provides 4 drugs a month. If you have a patient like this, do you want them to have to choose which drugs to take and which not to? Instead, medicaid can pay for the surgery and they might not even need their drops for awhile.

 

[r_salis]

Also, in a patient with sketchy compliance, surgery might be the best option to preserve vision. (You want to be sure that they'll at least show up to their f/u appointments after the surgery, though.)

 

[Opii]

Thanks for the replies, these are all good points to think about when you have one patient. I was looking for a set formula but one should rather look at the whole picture such as Medicaid, compliance, etc. to make a proper decision. Thanks.

 

[Ben Chudner]

Also, in a patient with sketchy compliance, surgery might be the best option to preserve vision. (You want to be sure that they'll at least show up to their f/u appointments after the surgery, though.)

I am not sure why an OD would favor one option over another for every patient. I agree with the above posts in that every patient is different. For some, ALT or SLT early makes sense while for others drops may be best. I don't like to have set rules that apply to everyone.

 

[Opii]

I am not sure why an OD would favor one option over another for every patient. I agree with the above posts in that every patient is different. For some, ALT or SLT early makes sense while for others drops may be best. I don't like to have set rules that apply to everyone.

Yea, that's why I was confussed. There is one preceptor that I have that is dead set against it for every patient. He practically flipped out when I suggested the possibility. The patient was on his second glaucoma medication, his IOPs didn't go down, and his compliance was questionable. The other preceptors in this site just go with the flow and avoid the subject on SLT, ALT all together. But the above posts are more open minded towards the individual patient's need. I think the more modern approach is to go with what that individual needs too. I just wanted to see what others thought.
Thanks.

 

[posner]

Most professional opinions are dictated by training. The American model of glaucoma management differs from that in Europe and other countries. In the US we tend to go with drops first(unless there are obvious issues of cost, compliance, etc) whereas in Europe laser is often the initial treatment. I tailor my approach to the patient. There are clearly patients for which laser is the best option, and many others who can be effectively managed with one or more eyedrops. Laser is not the end all... We have many patients we have done SLT/ALT with who are still on drops post operatively. It is nice when laser does work as intended, but it is not always the case.

Posner

 

[Opii]

Thanks😀