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Key Points

• The Laser in Glaucoma and Ocular Hypertension (LiGHT) study group offers the latest data on the impact of a single treatment of scanning laser trabeculoplasty (SLT) as opposed to the ongoing use of topical hypotensive drugs for the management of glaucoma and ocular hypertension.
• The LiGHT study has found that the use ‘of selective laser trabeculoplasty as the first-line treatment resulted in a significant reduction in the cost of surgery and medication for ocular hypertension and OAG, with an overall cost saving to the NHS of £451 per patient in specialist ophthalmology costs; for every patient given selective laser trabeculoplasty first instead of eye drops the cost savings are greater than the cost of selective laser trabeculoplasty for two additional patients, or equal to the cost of five additional ophthalmology specialist appointments.’
• SLT involves the circumferential application of around 100 laser burns to the trabecular meshwork via a 1-mirror gonioscopy lens. This increases the trabecular outflow of aqueous and subsequently lowers intraocular pressure.
• The procedure for SLT may be summarised as follows:
• Patients will arrive at the clinic and have their visual acuity measured by the nursing team, as well as having drops administered to help lower their intraocular pressure (IOP) and constrict the pupils. 
• A detailed consent process is essential to ensure patients are fully informed about the treatment procedure, the intended benefits of SLT as well as any risks. Once patients have consented to the procedure, they will be taken to the laser room. 
• The laser procedure takes just a few minutes per eye. 
• After the laser therapy has been delivered, further ocular hypotensive drops are administered. 
• The IOP will then be checked an hour later and any spike in IOP dealt with before being allowed home.
• Follow-up is usually recommended after 6 weeks from procedure.
• SLT may be undertaken by suitably qualified and experienced hospital optometrists under the authority of a consultant ophthalmologist. A move to look at its use in the community setting by similarly qualified optometrists is under way.