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Laser trabeculoplasty is performed as an additional measure to lower the intraocular pressure in patients with open-angle glaucoma. It can also be performed in a closed-angle glaucoma patient with a patent iridotomy. This procedure is relatively safe and is gaining popularity. This activity outlines and highlights the role of the interprofessional team in evaluating and treating patients who undergo laser trabeculoplasty. Objectives: Evaluate the treatment considerations for patients with glaucoma. Assess the presentation of a patient with glaucoma who would be a candidate for laser trabeculoplasty. Identify the common indications and contraindications for laser trabeculoplasty. Access free multiple choice questions on this topic.

Glaucoma is defined to be a progressive optic neuropathy that can lead to irreversible blindness. There are various known risk factors for glaucoma. However, intraocular pressure (IOP) appears to be the only known modifiable risk factor for control of the onset and progression of optic neuropathy.[1] Besides the medical and surgical therapy for glaucoma, laser treatment has received considerable attention as an effective modality in recent times. Laser trabeculoplasty commonly practiced are argon laser trabeculoplasty (ALT) and selective laser trabeculoplasty (SLT) to increase aqueous humor outflow and thus lower intraocular pressure.[2] Wise and Witter described the first protocol for ALT in 1979. They demonstrated the safety and efficacy of ALT in a group of patients with open-angle glaucoma (OAG). ALT's safety and long-term efficacy were studied in the glaucoma laser trial. In the glaucoma laser trial, eyes receiving 360° ALT were compared with medical monotherapy with a follow-up period of  2.5 to 5.5 years, concluding that trabeculoplasty was as efficacious as medical therapy in reducing intraocular pressure. However, ALT did not become primary therapy in patients with primary open-angle glaucoma (POAG) because of reduced efficacy over time, so it was used as an adjunctive therapy. Laser trabeculoplasty gained popularity with SLT. SLT uses a Q-switched frequency-doubled Nd: YAG laser in the trabecular meshwork, which appears less destructive than ALT. However, it has been noticed that both ALT and SLT are equally efficacious in reducing intraocular pressure in OAG.

The complications that can manifest with laser trabeculoplasty are as follows: IOP rise - the most common complication in patients undergoing laser trabeculoplasty. The frequency of IOP spikes can be reduced by two-thirds using prophylactic alpha-adrenergic agonists about 30-60 minutes before the procedure.[9] A severe and frequent IOP rise occurs with: The use of higher energy levels, 360° angle treatments, Posterior placement of laser beam, Heavy pigmentation of the angle A low aqueous outflow facility. These IOP spikes are usually transient, occur in the first hour, and resolve with medical treatment. However, in cases with sustained IOP rise, surgical management is needed.[10] Low-grade iritis Formation of PAS Corneal edema- occurs due to HSV reactivation. The inflammatory cascade following laser therapy reactivates the virus. Hyphema

Glaucoma leads to irreversible damage to the optic nerve, thus vision, which can adversely impact a person's life personally and socially. Hence, an interprofessional approach should be adopted to identify, treat, and delay glaucoma progression. The clinician should carefully examine to uncover early signs of glaucoma. If found, appropriate steps should be adopted. A physician in the periphery should refer the patient to a higher center for management. Patient counseling plays an important role. A combined effort by the treating doctor, nurses, and pharmacist should explain the necessity of seeking early treatment. The importance of medication compliance should also be presented. Family members of a patient diagnosed with glaucoma should be encouraged to get themselves screened. Patients undergoing laser procedures should understand the importance of the procedure and any potential complications. Any misconception regarding the laser procedure should be clarified, and the patient should receive an explanation regarding the safety and efficacy of the procedure. An interprofessional approach is key to addressing the global burden of glaucoma. There should be cooperation at each level to prevent the attack by glaucoma.