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Editorial
August 1999

Reaffirming the Role of the Laser in Glaucoma Management

Arch Ophthalmol. 1999;117(8):1075-1076. doi:10.1001/archopht.117.8.1075

FOR 2 DECADES, LASERS have played an important role in the management of patients with glaucoma. However, the roles of laser trabeculoplasty and laser cycloablation have been deemphasized in recent years. The Moorfield study, which randomized patients with newly diagnosed glaucoma to initial surgery, laser trabeculoplasty, or medication, suggested that initial surgery lowered intraocular pressure (IOP) and preserved visual field better than the other 2 initial approaches in a predominantly white population.1 The success of filtration surgery with adjunctive use of antifibrotic agents reassured surgeons that extremely low IOPs would be achieved. The advent of new medications for glaucoma has tempted other clinicians to give more medications rather than proceed with any other intervention. The appropriate balance lies somewhere between the 2 extremes. On the other end of the spectrum, the development of a variety of glaucoma filtration devices has provided clinicians with an alternative to cycloablative procedures. Because of this, patients with poor vision who underwent prior procedures and subsequent implantation of a glaucoma filtration device might have fared just as well if a laser cycloablation procedure had been performed. Have we, as clinicians who care for patients with glaucoma, become more invasive in our approach? In this editorial, I seek to provide an argument to reconsider the use of laser in clinical practice based on recent studies in the literature.

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