Selective laser trabeculoplasty (SLT) has been recognised for years as a complementary treatment for glaucoma – but new studies show that it can also be used as a first-line treatment.
In 2025, international specialist societies published updated guidelines that open up new prospects for patients with glaucoma. In this article, as an ophthalmologist, I explain the key findings and what this means in practice.
SLT is a minimally invasive laser procedure that specifically stimulates pigment cells in the trabecular meshwork (part of the anterior chamber angle and the main drainage pathway for the eye’s aqueous humour) – without damaging surrounding tissue.
This improves the drainage of aqueous humour, thereby reducing intraocular pressure.
The treatment takes just a few minutes, is carried out on an outpatient basis and is painless. Anaesthesia is not usually required.
SLT differs from older laser therapies in that it acts selectively on pigmented cells only. This means: no thermal damage, no scarring and good repeatability if required.
The procedure uses extremely short laser pulses in the nanosecond range – precise and gentle at the same time.
At Bányai Augenheilkunde, we have been using SLT successfully for many years – particularly for patients who cannot tolerate eye drops or as a complement to drug therapy.
An international long-term study involving over 1,000 participants shows that SLT can be just as effective – and in some cases even more effective – than traditional eye drop therapy when open-angle glaucoma is first diagnosed.
Furthermore, SLT is associated with fewer side effects, in particular no irritation caused by preservatives. The key findings:
The study also highlights the importance of early intervention: patients who receive SLT at an early stage are less likely to require additional medication or invasive procedures in the long term.
Based on this evidence, the European Glaucoma Society (EGS) now recommends SLT as a potential first-line treatment – particularly for mild to moderate forms of glaucoma.
Below is a concise overview of the patient groups for whom initial SLT (selective laser trabeculoplasty) is particularly worth considering, including the reasons why this procedure may be a good choice as a first-line treatment in these cases.
| Patient group In cases of newly diagnosed open-angle glaucoma In cases of intolerance to eye drops In cases of poor adherence to treatment or difficulties with application In cases of increased risk of surface complications (e.g. Sicca syndrome) Where occupational requirements necessitate a drop-free treatment (e.g. shift work, impaired fine motor skills) | Why SLT is a sensible option For newly diagnosed open-angle glaucoma No side effects from preservatives No risk from missed or incorrectly administered eye drops Gentle, non-irritating form of treatment Ease of daily life and improved quality of life |
Younger patients also often benefit from SLT, as the effect remains stable for many years and eye drops can be avoided altogether. This means: less hassle in daily life, no preservatives and no difficulties with administration.
At Bányai Augenheilkunde, we assess on a case-by-case basis whether SLT is appropriate right from the start – taking into account quality of life, career and personal circumstances.
SLT is generally well tolerated. In rare cases, a temporary rise in pressure or mild inflammation may occur after treatment.
These are usually easily managed and subside within a few days. However, the procedure is only suitable for patients with an open-angle eye – SLT cannot be used in cases of narrow-angle or chronic angle-closure glaucoma.
A thorough preliminary examination by an ophthalmologist, including gonioscopy and imaging techniques, is essential.
At Bányai Augenheilkunde, the decision on whether to proceed is based on state-of-the-art diagnostics, tailored individually to the condition of the optic nerve and the eye’s structure.
The latest evidence from 2025 clearly shows that SLT is not just an option for later on, but can be beneficial right from the start of glaucoma treatment. It is gentle, effective and particularly well tolerated, offering many people with glaucoma the chance of a drop-free initial treatment.
Whether SLT is suitable for you as a first-line treatment depends on your individual diagnosis. In addition to SLT, other modern procedures are also available today: medication, combination eye drops, pressure-lowering surgery such as trabeculectomy or canaloplasty, as well as cataract surgery with a pressure-lowering effect.
The choice of treatment is made on an individual basis and based on modern diagnostic methods. Seek a personal consultation – Bányai Augenheilkunde supports you with state-of-the-art diagnostics, extensive experience and a personalised treatment plan.
Yes – recent studies show comparable reductions in eye pressure with fewer side effects.
For many patients, several years – a repeat treatment is possible.
In many cases, yes, particularly if there is a medical indication.
Often, yes – particularly in the early stages. In more advanced cases, a combination of treatments may be advisable.
No – it is painless and is carried out on an outpatient basis without anaesthesia.
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