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1st author has no financial interest in the subject matter of this poster.

Ocular Blood Flow Analysis as a Predictive or Response Measure to Decrease in Intraocular Pressure from Selective Laser Trabeculoplasty as Primary or Secondary Treatment of Glaucoma ASCRS 2010. 1st author has no financial interest in the subject matter of this poster.

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1st author has no financial interest in the subject matter of this poster.

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  1. Ocular Blood Flow Analysis as a Predictive or Response Measure to Decrease in Intraocular Pressure from Selective Laser Trabeculoplasty as Primary or Secondary Treatment of Glaucoma ASCRS 2010 1st author has no financial interest in the subject matter of this poster. 2nd and 3rd co-authors have no financial interest in the subject matter of this poster. 4th co-author has independently conducted and financed the clinical research study presented herein and has received honoraria from Ellex Corporation in the last year. Elaine M. Miglino Floral Park Ophthalmology Gigi George Siena College Lawrence F. Jindra, MD Columbia University Winthrop University Hospital Michael Mishali Adelphi University

  2. Introduction • Selective Laser Trabeculoplasty (SLT) uses a Q-Switched frequency-doubled (532 nm), low energy Nd:YAG laser, which targets melanocytes in the trabecular meshwork1,2 . • SLT treatment induces a biologic response in the trabecular meshwork, which involves the release of cytokines that trigger macrophage recruitment and other changes, leading to reduction in intraocular pressure (IOP). • SLT treats the trabecular meshwork without causing thermal nor coagulative damage to surrounding structures. 1. Latina MA, et al. Selective targeting of trabecular meshwork cells: in vitro studies of pulsed and CW laser interactions. Exp Eye Res. 1995;60:359-372. 2. Latina MA, et al. Q-switched 532-nm Nd:YAG laser trabeculoplasty (selective laser trabeculoplasty): a multicenter, pilot, clinical study. Ophthalmology. 1998;105:2082-2090.

  3. Purpose • To investigate the relationship of Ocular Blood Flow (OBF) analysis, as a predictive or response measure, to decrease in IOP after treatment with SLT, as primary or secondary therapy, in patients with glaucoma.

  4. Methods • Retrospective chart review was performed on 73 and 52 eyes, respectively, of those treated as primary or secondary therapy, from a continuous case series of 3034 eyes treated with SLT over 7.5 years. • OBF Analysis, as measured by dynamic pneumoplethysmography, was divided into three categories – for male patients (</= 9.0: low, > 9.0 but < 24.0: normal, >/= 24.0: high) and for female patients (</= 10.5: low, > 10.5 but < 29.0: normal, >/= 29.0: high) - for primary and secondary groups. • Four subgroups (primary & secondary / male & female) were established to examine the relationship between pre-op OBF value and post-op decrease in IOP and to examine the relationship between OBF value and time after treatment with SLT.

  5. Results • When analyzed as a function of IOP decrease, pre-op OBF values were not significant predictors for post-op IOP decrease after treatment with SLT in all four subgroups (male/female and primary/ secondary) (p > 0.05). • When comparing the relationship between OBF values and time after treatment with SLT, these data indicate no significant relationship between OBF values and IOP (primary: R = 0.03; secondary: R = 0.07).

  6. Primary PatientsPre-op OBF vs Post-op IOP Results are not significant with p > 0.05

  7. Secondary PatientsPre-op OBF vs Post-op IOP Results are not significant with p > 0.05

  8. Primary Patients OBF vs Time Before and After SLT Results are not significant with R2= 0.0009 and R = 0.03

  9. Secondary PatientsOBF vs Time Before and After SLT Results are not significant with R2= 0.0051 and R = 0.07

  10. Discussion • The Glaucoma Laser Trial • Established efficacy of laser trabeculoplasty in lowering IOP in previously untreated glaucoma patients1. • The Ocular Hypertensive Treatment Study and • Early Manifest Glaucoma Trial • Established efficacy of early and effective treatment to preserve long-term visual function in glaucoma patients2,3. • Our findings build on these and suggest pre-op OBF value was not a significant predictor of post-op IOP decrease in patients treated with SLT for glaucoma (p>0.05). • Our findings suggest, as primary or secondary therapy, SLT treatment did not significantly lower OBF in patients with glaucoma (R<<0.90). • Further study with controlled clinical trials is indicated. 1. The GLT Research Group. GLT. Ophthalmology. 1990;97:1403-1413. 2. Kass MA, et al. OHTS. Arch Ophthalmol. 2002;120:701-713. 3. Heijl A, et al. EMGT. Arch Ophthalmol. 2002;120:1268-1279.

  11. Conclusion • In this series of over 3,000 eyes followed for more than 7 years: • For Selective Laser Trabeculoplasty (SLT) as primary (initial) or secondary (adjunctive) therapy, for both males and females, pre-op Ocular Blood Flow (OBF) value was NOT a significant predictor of post-op decrease in intraocular pressure (IOP). • For Selective Laser Trabeculoplasty (SLT) as primary (initial) or secondary (adjunctive) therapy, for both males and females, there was NO significant change in Ocular Blood Flow (OBF) value as a response measure after treatment with SLT.

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