Argon Laser Trabeculoplasty (ALT)

Laser surgery has become increasingly popular as an intermediate step between drugs and traditional glaucoma surgery. The most common type of laser surgery performed for open-angle glaucoma is called Argon Laser Trabeculoplasty (ALT). The objective of the surgery is to help fluid drain out of the eye, reducing excess intra-ocular pressure that can cause damage to the optic nerve and loss of vision. While in some instances ALT may lower the pressure enough to eliminate some or all eyedrops, in other cases, one may need to continue taking glaucoma medications even after ALT in order to keep the pressure controlled.

Although ALT has tradititionally been performed  most often after first trying to control intra-ocular pressure with medications, recent landmark studies on glaucoma patients suggest that visual damage form glaucoma may be decreased when laser or surgical intervention occurs early rather than late.  These studies also suggest that these procedures may lower intraocular pressure more  effectively  and for a longer period when performed earlier in the course of the disease rather than after the eyes have been "pickled" for years with glaucoma drops.  For these reasons ALT is being used earlier in the course of glaucoma treatment, sometimes even as initial treatment for some patients who are adverse to the use of drops for whatever reason.

ALT is for those: 

• who have been diagnosed with glaucoma and possibly even ocular hypertension
• whose doctor has determined that ALT is appropriate for controlling their intra-ocular pressure
• for patients who prefer laser control of pressure rather than continued daily use of eyedrops for the rest of their lives, whether due to medication side effects or medication costs
• patients who are unable to faithfully use their eyedrops whether due to physical inabilities such as arthritis, or lack of mental capacity to remember the drops

What to expect on procedure day:

Your treatment will be performed in a specially equipped laser room. It does not require a surgery center. Once you have been checked in and settled comfortably, drops will be used to numb your eye; no injections or needles are used. When your eye is completely numb, an eyelid holder will be placed between your eyelids to keep you from blinking during the procedure.

Your doctor will hold up a special lens to your eye as the laser beam is aimed at the lens and reflected onto the special drainage area inside the eye called the trabecular meshwork. You may see flashes of bright green or red light, but you will not feel any pain during the procedure.  Your doctor will make 50-100 evenly-paced laser applications in 10-15 minutes. This will be done in one or two treatment sessions. The laser beam will cause some areas of your eye's drainage system to shrink, resulting in adjacent areas stretching open to permit the fluid to drain faster.

Your eye pressure will be checked shortly after your procedure and drops may be prescribed to alleviate any soreness or swelling inside your eye. You should relax for the rest of the day. Follow-up visits are necessary to monitor your eye pressure. While it may take a few weeks to see the full pressure-lowering effect of this procedure, during which time you may have to continue taking your medication, many patients are eventually able to discontinue at least some of their medications. Most patients resume normal activities within a few days.

Realistic expectations:

The pressure lowering effect of ALT may wear off over time. Two years after ALT surgery, the  pressure from glaucoma increases again in more than half of all patients.  If this occurs ,ALT may be able to be repeated.  Serious complications with ALT are extremely rare, but like any surgical procedure, it does have some risks. You will be given additional information about the procedure that will allow you to make an informed decision about whether to proceed. Be sure you have all your questions answered to your satisfaction.

If you would like more information about this procedure you can make an appointment or contact the office for additional information.