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SLT laser treatment – a gentler approach to glaucoma care

Glaucoma is one of the leading causes of sight loss, but with the latest treatments, it’s possible to manage the condition drop-free, says eye surgeon Mfazo Hove, founder of Blue Fin Vision®

As we get older, many of us become used to the idea of reading glasses, routine eye checks and the occasional change in prescription. What we’re less prepared for is being told we have glaucoma and that we may need daily eye drops, possibly for life.

Glaucoma, sometimes called the “silent thief of sight”, often has no obvious symptoms to begin with. Yet it’s one of the leading causes of irreversible sight loss in the UK. The good news is that treatment has come a long way, and for some people it may now be possible to manage glaucoma with fewer – and in some cases no – drops.

Here, consultant ophthalmic surgeon Mr Mfazo Hove explains what glaucoma is, why drops can be challenging for some people, and how a gentle laser treatment called SLT is becoming part of modern glaucoma care.

What is glaucoma and who does it affect?

“Glaucoma is essentially a pressure problem inside the eye,” explains Mr Hove. “A clear fluid is produced inside the eye all the time, and it normally drains away through a delicate meshwork. If that drainage becomes less efficient, pressure can build up and start to affect the optic nerve at the back of the eye.”

This usually happens slowly and without pain. Many people don’t notice any change in their vision in the early stages, which is why routine checks are so important.

“Glaucoma becomes more common with age, especially over 40,” says Mr Hove. “A family history, short-sightedness, higher eye pressure and certain medical conditions can all increase the risk. But the key message is: you may not feel anything. Your optician or eye specialist will often be the first to pick it up.”

How is glaucoma usually treated?

The most common first step in treating glaucoma is daily eye drops to lower pressure.

“For many patients, drops work very well,” says Mr Hove. “They remain a cornerstone of glaucoma treatment and can be extremely effective at protecting the optic nerve when used regularly.”

However, they’re not always straightforward to live with long-term. Common challenges include:

> Forgetting doses, especially with busy routines
> Stinging or burning when the drops go in
> Redness or irritation around the eyes
> Sensitivity to preservatives in long-term medications
> The emotional weight of being told you may need drops for life

“Some people cope very well,” he says. “Others tell me they feel ‘medicated’ every day for a condition they can’t see or feel. That’s why we’re increasingly looking at ways to tailor treatment. For some that’s a different type of drop, for others it may be a laser procedure or surgery.”

What is SLT and where does it fit in?

SLT stands for Selective Laser Trabeculoplasty, a long name for a relatively simple concept.

“Think of it as a way of helping the eye’s natural drainage system work better,” explains Mr Hove. “Rather than adding more medication, we use a very low-energy laser to lightly stimulate the tissue that drains the fluid. That stimulation encourages the channels to work more efficiently, so pressure can come down.”

Key points about SLT:
> It’s an outpatient procedure. You go home the same day
> The laser application itself takes just a few minutes
> Most people find it painless, with only mild discomfort at most
> There is no cutting, no burning and no removal of tissue
> The treatment can often be repeated if the effect wears off over time

“For some patients, SLT can reduce or remove the need for daily drops,” says Mr Hove. “For others, it works alongside medication to help keep pressures controlled. It’s one of several tools we now have to personalise glaucoma care.”

Who might be offered SLT?

SLT is usually considered in the context of an individual’s overall eye health, pressures and lifestyle. According to Mr Hove, it may be discussed for:

> People newly diagnosed with certain types of glaucoma or ocular hypertension
> Patients already using drops who find them difficult to tolerate or remember
> Those who have developed sensitivity to preservatives
> People whose pressure is still a little high despite treatment

“SLT won’t be right for everyone, and it doesn’t ‘cure’ glaucoma,” he stresses. “But in the right setting, it can be a very useful option. The important thing is that patients know these choices exist and can have a balanced conversation with their eye care team.”

In the UK, SLT may be available through hospital eye services as well as privately, depending on local pathways.

Does SLT replace the need for regular eye checks?

Short answer: no. “Even if SLT works very well for you, glaucoma still needs ongoing monitoring,” says Mr Hove. “We’ll want to check your eye pressure, your optic nerve and your visual field at regular intervals, whatever treatment you’re on.”

The aim is to stabilise the condition and keep your sight safe in the long term. That’s why follow-up is just as important as the initial choice of drops, laser or surgery.

Looking after your eyes if you’re worried about glaucoma

While lifestyle changes can’t replace medical treatment, they can support overall eye health and help you feel more in control.

Mr Hove suggests the following simple steps:

1. Keep up with routine eye tests
“Even if your vision seems fine, go for regular eye checks,” he says. “Your optician can pick up early changes before you notice anything yourself.”

2. Move your body regularly
Moderate exercise like walking, swimming or gentle cycling can support healthy blood flow and overall circulation, which is beneficial for the eyes as well as the rest of the body.

3. Look after your blood pressure and general health
High blood pressure, diabetes and sleep apnoea can all affect eye health. “Working with your GP to manage these well is an important part of protecting your sight,” says Mr Hove.

4. Eat for your eyes
Colourful fruits and vegetables, leafy greens, nuts and seeds provide antioxidants that support the delicate tissues at the back of the eye. Omega-3s from oily fish, walnuts and chia seeds can also play a role.

5. Don’t ignore changes
If you notice blurred vision, haloes around lights, eye pain or a sudden change in how you see, seek urgent advice. “It may not be glaucoma,” he says, “but it’s always better to get checked.”

The bottom line: gentler glaucoma care is becoming possible

Being told you have glaucoma can feel unsettling, especially when it’s described as a lifelong condition. But as Mr Hove is keen to emphasise, there is real reason for reassurance.

“Glaucoma is one of those areas where early diagnosis and modern treatment make a huge difference,” he says. “We now have a range of options, including laser treatments like SLT, which allow us, in many cases, to manage the condition in a way that fits better with someone’s life.”

For some people, that may mean fewer bottles on the bathroom shelf; for others it simply means feeling more confident that there is a plan in place.

“If you’ve been told you have glaucoma or high eye pressure, it doesn’t have to be a story of decline,” says Mr Hove. “With regular monitoring and the right combination of treatments, glaucoma care can be calm, controlled and compatible with an active, independent life.”

If you’re concerned about your eye health or struggling with your current glaucoma treatment, speak to your optician or GP and ask about your options. The earlier you start the conversation, the more scope there is to tailor care to you.

About the expert

Mr Mfazo Hove MBChB MD FRCOphth CertLRS is lead consultant ophthalmic surgeon and founder of Blue Fin Vision®, a consultant-led eye clinic with locations across London and the South East. Having performed over 50,000 eye procedures, he is known for combining advanced surgical expertise with clear, compassionate communication, helping patients feel informed and at ease about their eye health.