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Introducing the Rapid SLT – Four Views are Better Than One

Volk’s Rapid SLT lens cuts down Selective Laser Trabeculoplasty (SLT) procedure time by almost 50% and minimizes the need for lens rotation. The Rapid SLT is the newest addition to the laser lens family from Volk Optical. Specially designed for Selective Laser Trabeculoplasty (SLT), this innovative lens incorporates four total internal reflective surfaces instead of just one – which has been the industry standard – until now. The large reflective surfaces provide four amazing and simultaneous views of the trabecular meshwork and iridocorneal angle.

SLT has emerged as a widely accepted treatment choice for addressing increased Intraocular Pressure (IOP) in patients with glaucoma. Using a Q-switched, frequency doubled, 532 nm Nd:YAG laser, SLT is considered to be less disruptive than Argon Laser Trabeculoplasty (ALT). This technique ‘selectively’ targets pigmented cells that have a greater ability to absorb the laser than the surrounding structures, thereby being considered a relatively safer procedure.

Until now, special laser lenses with a contact element and a single reflective element to facilitate viewing the trabecular meshwork were used as the standard in this procedure. However, these types of lenses require rotation on the patient’s eye to view and target the entire trabecular meshwork. This procedure is often cumbersome for doctors as they must balance rotating the lens while simultaneously stabilizing the lens firmly on the cornea. For patients, this method increases discomfort due to the time the lens remains on the eye, as well as the rotation, which induces blink reflex in many patients.

Efficient Procedure, Lesser Strain

With four spectacular views available through the Rapid SLT (Figure 2), doctors can carry out the SLT procedure with just a minimal one-time adjustment of the lens, resulting in reduced procedure time by almost 50%. The number of laser spots targeted on the eye is also reduced owing to a clear, high resolution, 360° view of the angle.

“This lens is very comfortable for both doctor and patient and provides excellent resolution imaging. After the first round of laser, I only need to rotate it just about one and a half clock hours to complete the SLT procedure,” says Douglas Ripkin, MD; glaucoma and anterior segment specialist at the Cole Eye Institute, Cleveland Clinic.

This enhances patient comfort owing to a quicker procedure and reduced lens rotation. The 1.0x image magnification provides an optimally intuitive view of the angle, while the 1.0x laser magnification helps keep the laser spot profile accurate. “I also use this lens for quick dynamic gonioscopy to examine the angle because of its contact design,” adds Ripkin.

Nathan Lighthizer, O.D., F.A.A.O, the Assistant Dean of Clinical Care Service and Director of Continuing Education at the Oklahoma College of Optometry highlights the functional convenience provided by the four views of the Rapid SLT. “The Rapid SLT lens has been a tremendous addition to our clinic and specifically for SLT procedures in our patients with glaucoma. The new lens has allowed us to reduce our SLT times significantly. The four mirrors of the Rapid SLT lens drastically diminish the need to rotate the lens while performing the SLT procedure, making the procedure more efficient, while at the same time also helping to reduce glare and bubble formation during the procedure which can limit views of the anterior chamber angle anatomy. From the very experienced doctors who have done thousands of procedures, to the students and resident doctors who are early in their experience with SLT, all have commented on the great views achieved with the Rapid SLT lens and the efficiency that it brings to the procedure. It has now become our lens of choice for SLT procedures,” states Lighthizer.

An Easy Transition For O.D.s

According to John McCall Jr., O.D., who collaborated on the design of the rapid SLT, not only does the Rapid SLT speed up the procedure time but also results in more efficient laser spot placement. “What I found, as well as my partners have, is that we use about 25% fewer laser shots with the Rapid SLT. That is 25% lesser millijoules fired into the eye than we used to before, making the procedure safer,” says McCall.

He also highlights the importance of the smaller contact design element of the lens, “With this flange, it is easy on the patient while providing adequate suction through the whole procedure. It is also easier to get off of the eye.”

This feature is particularly beneficial when treating patients with small palpebral fissures or flaccid eyelids who are more prone to blinking the lens off the eye.

Overall, starting with the application of lens on the patient’s eye, through administering the laser, to removing the lens off the eye, the Rapid SLT enhances ease of use at each step of the treatment.

The prevalence of glaucoma continues to increase, bringing an increased need for timely intervention. The Rapid SLT enables an easy transition from diagnosis to treatment for O.D.s, thanks to the nearly 360° view of the angle, analogous to the four mirror gonioscopy technique mastered by every O.D. The Rapid SLT’s views enable better-informed diagnosis and treatment. For O.D.s traveling to licensed states for treatment days, the reduced procedure time translates directly to an ability to treat more patients with each visit.

Conclusion

As evidenced by the images provided by Vadym Pecherii, Ophthalmologist and laser surgeon at the Zinitsa Ophthalmic Center, Ukraine (Figures 2 & 3), the Rapid SLT is a prime example of Volk’s dedication to high resolution imaging. He describes the lens as providing a comprehensive look into the angle from an overall four-view examination, to being able to notice minuscule details with the slit lamp setting at 40x magnification. Volk’s promise of unmatched imaging quality combined with enhanced ease of use, increased patient comfort, and reduced procedure time makes the Rapid SLT a lens every glaucoma specialist will look forward to adding to their collection!

John A. McCall, Jr., OD
Crockett Eye Clinic
A past President of the American Optometric Association, McCall specializes in general optometry and laser treatments for glaucoma management.






Nathan R. Lighthizer, OD, F.A.A.O
Oklahoma College of Optometry
Lighthizer serves as the Assistant Dean of Clinical Care Services and the Chief of Specialty Care Clinic among other roles.






Douglas Ripkin, MD
Cole Eye Institute, Cleveland Clinic
Ripkin specializes in the care of advanced glaucoma including
bypass and MIGS shunt devices, glaucoma laser surgery and cataract surgery.







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