At the 2025 American Academy of Ophthalmology (AAO) annual meeting, glaucoma expert Dr. Joel S. Schuman, MD, FACS, of Wills Eye Hospital, shared exciting updates on laser therapies for glaucoma. His presentation focused on new innovations in selective laser trabeculoplasty (SLT) and laser cyclophotocoagulation—technologies that are becoming safer, faster, and more comfortable for patients.

These advances are reshaping how doctors treat glaucoma, with SLT increasingly being used as a first-line therapy instead of starting with daily eye drops.

The Evolution of Laser Treatments for Glaucoma

For many years, glaucoma care relied on three main laser treatments:

• Laser iridectomy – used for certain types of angle-closure glaucoma.
• Laser trabeculoplasty – used to lower eye pressure in open-angle glaucoma.
• Laser cyclophotocoagulation – used to reduce fluid production in advanced or difficult-to-control cases.

While all these remain useful, Dr. Schuman explained that laser trabeculoplasty is currently where the most innovation is happening—especially with the growing adoption of selective laser trabeculoplasty (SLT).

From SLT to DSLT: A New Non-Contact Approach

Traditional SLT requires a gonio lens to be placed directly on the eye so the ophthalmologist can visualize and target the trabecular meshwork—the part of the eye that drains fluid and regulates intraocular pressure (IOP).

Dr. Schuman described this technique:

“You need to have a lens sitting on the eye called a gonio lens that allows the person who’s treating to actually see the drainage tissue of the eye and target that with the laser.”

Now, a new version of this technology—called Direct Selective Laser Trabeculoplasty (DSLT)—is changing the process entirely.

“With DSLT,” Dr. Schuman explained, “there is no lens on the eye. The device captures the eye, fixes on it, and treats 360° automatically without anything touching the eye except for light.”

What This Means for Patients

• No physical contact with the eye, reducing discomfort and risk of infection.
• Faster treatment time and less time in the clinic.
• A bit more post-procedure irritation, and slightly less pressure-lowering effect compared to traditional SLT—but overall, greater comfort and convenience.

Dr. Schuman described DSLT as a meaningful step forward for both patients and physicians, improving comfort and procedural efficiency.

SLT as a First-Line Treatment

For more than a century, eye drops have been the standard first-line therapy for glaucoma. But according to Dr. Schuman and recent studies, including the LiGHT Trial, laser therapy is proving to be just as effective, and often better tolerated.

“For most types of open-angle glaucoma, SLT is the first option that I go to,” he said.

He explained that SLT effectively lowers eye pressure without the burden of daily medication, and it can delay or eliminate the need for drops in many patients.

However, some people still prefer to start with drops, and that’s okay. “Those patients get treated with drops, which has been our first-line treatment for over 100 years,” Dr. Schuman said, “but the data show and my clinical experience is that SLT is a better first-line option.”

When SLT Isn’t the Right Choice

While SLT and DSLT are excellent options for open-angle glaucoma, Dr. Schuman cautioned that they are not appropriate for all patients.

They are generally not recommended for:

• Inflammatory glaucomas
• Angle-closure glaucoma
• Neovascular glaucoma (caused by abnormal blood vessel growth)

“For those types of glaucomas, you’re better choosing a different kind of treatment,” he said, such as medication or incisional surgery.

Dr. Schuman emphasized that accurate diagnosis is key. Misidentifying the type of glaucoma can lead to the wrong treatment, and even make things worse.

“It’s important to do a good clinical examination and make your decision about therapy based on the patient’s actual problem,” he noted.

Why These Updates Matter

Laser therapy is moving from an alternative option to a front-line strategy in glaucoma care. The advantages are clear:

• No need for daily drops (for many patients)
• Fewer side effects than some medications
• High safety and effectiveness
• Newer versions like DSLT make the experience even easier

These innovations are part of a broader trend in glaucoma treatment—toward less invasive, more patient-friendly care that can help preserve vision and quality of life.

* Ophthalmology Times (October 19, 2025). “AAO 2025: Glaucoma laser surgery with Joel S. Schuman, MD, FACS”. ophthalmologytimes.com

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