Selective Laser Trabeculoplasty and the Evolving Glaucoma Paradigm.

The rapid and extensive expansion of therapeutic options for glaucoma management provides both the opportunity and the resources necessary to broadly reconsider our 150+ year topical medications-first approach. Although topical medications are safe and efficacious, their effectiveness is limited by less-than-ideal adherence. The reasons why patients do not take their medications as prescribed have been extensively studied and are both complex-having many facets-and complicated-having no simple solution. Novel therapies, including sustained-release medication platforms, selective laser trabeculoplasty (SLT), and minimally invasive glaucoma surgery, present opportunities to bypass topical medications and absolve patients of the responsibility for self-dosing of topical therapy. Because poor adherence increases the risk of glaucoma progression, moving away from topical therapy offers the potential for better long-term outcomes. In this article, we will review the strengths and limitations of topical medical therapy and propose that-based on new and emerging data-the paradigm shift to primary SLT is both entirely appropriate for the vast majority of patients and long overdue. We will also describe our conversations with patients about SLT, with the goal of facilitating readers' integration of primary SLT into their clinical practices. FINANCIAL DISCLOSURE(S): Proprietary or commercial disclosure may be found in the Footnotes and Disclosures at the end of this article.