SECO 2023: Lasers in optometry: The next frontier

Nate Lighthizer, OD, gives key highlights on his presentation, "Lasers in Optometry: The Next Frontier," which he presented during SECO 2023 in Atlanta, Georgia.

Editor's note: This transcript has been edited for clarity.

Lighthizer:

My name is Dr. Nate Lighthizer. I'm an optometrist at the NSU Oklahoma College of Optometry in Tahlequah, Oklahoma. I am talking on, "Lasers in optometry: The next frontier," here at SECO in Atlanta.

It is going to be an overview of the laser procedures that optometrists are doing currently across the 10 states where ODs are allowed to do those procedures. Those main procedures are YAG capsulotomy, laser peripheral iridotomy, and selective laser trabeculoplasty (SLT).

We also may talk about laser floater removal which also known as YAG vitreolysis. It's a procedure that not many ODs are doing and not in all of those states. But I'm going to leave it up to the audience today. We're going to vote on alright, here's our 4 main laser procedures: capsulotomy, iridotomy, SLT and laser floater removal. And it'll be interesting to see which one they want to talk about.

If it's like past audiences, we'll probably going to talk about YAG capsulotomy and SLT. YAG caps is the number one laser that optometrists are doing across Oklahoma, Kentucky, Louisiana, Alaska, Arkansas, among others—those 10 states—and it is probably the most rewarding laser procedure that we do. Patients come in and obviously their vision is down from this cloudy membrane in the months to years following cataract surgery, their vision is 20/25, 20/30, 20/40, whatever it is, and a quick in office procedure that takes a matter of 1 to 5 minutes depending on the case. We do a little touch up YAG laser, [it] clears out that cloudy membrane, and patients notice almost immediate improvement.

In this lecture today we will talk about the preop things to do, the postop things to manage, and most importantly procedural techniques. How do you do this procedure? Where do you focus? What are the energy settings? What's the offset? Things like that. And we will cover this through a video grand rounds of 4, 5, 6 videos being covered for YAG capsulotomy. So I'm sure we'll cover YAG cap during this lecture.

Also likely we'll cover selective laser trabeculoplasty or SLT. It is a laser that's done for open angle glaucoma. It has gained a lot of steam over the course of the last 5 to 10 years as more and more literature comes out that says SLT is a first line treatment option.

We've got wonderful eyedrops, but we've also got a wonderful laser that has been shown time and time again to be equivalent to prostaglandins for initial therapy in glaucoma, while obviously having the benefit of easing that burden of compliance, cost, the convenience of having a one-time laser that lasts typically 2 to 6 years, and is repeatable, versus a drop in the eye every single day that patients can struggle with.

So we're going to cover the LiGHT (Laser in Glaucoma and Ocular Hypertension) data. The LiGHT study, or the LiGHT trial, was released in 2019, and it showed that 75-80% of patients that had an SLT first-line remain drop-free 3 years later. We're also going to cover—they just released the 6 year LiGHT data, and it showed that 70% of patients that had an SLT as their first line treatment, were drop-free 6 years later. So to be able to tell patients, if we choose this SLT, there's about a 70% chance that we can keep you off of drops for the next 6 years is certainly something that can be very beneficial for patients. Most importantly, that study showed that 27% of patients on drops progressed over those 6 years, versus 19.5% of patients that had a laser.

What's the ultimate goal in glaucoma? To prevent progression, to prevent vision loss—patients were more likely to progress on drops versus the laser, and that likely goes back to the compliance. So we'll also talk about preoperatively, postoperatively what you can expect, potential complications. And we will cover 3 or 4 or 5 videos on how to do SLT. So should be an exciting couple of hours on, "Lasers in optometry: The next frontier."

I hope [attendees] can take away that this is something that is part of optometry. It's part of the DNA of optometry now. It's an in office procedure, it is not done in the OR; it can be done in a surgical suite, but this is very much an office based procedure that 1000s of optometrists are doing across the country in the 10 states that allow that. So I hope they realize and it demystifies this is a procedure that should be done sooner in terms of SLT, and it can be done by optometry.

Just remember, SLT earlier in the course of therapy, capsulotomy—one of the most rewarding procedures we do helping patients improve their vision—both very very rewarding.