Transforming Glaucoma Management: Next-Generation Laser Technology for Everyday Clinical Practice

Sponsored by Alcon

Why the Next Evolution of Glaucoma Care Has Arrived

For decades, topical medications have been the default first-line treatment for glaucoma. However, the well-recognized challenges of daily eye drops, including poor adherence, ocular surface disease, and long-term treatment, have fueled a significant transformation in glaucoma therapy.^1-5 As a result, glaucoma management has undergone a fundamental shift towards laser-based solutions.

Why Laser-First Therapy Is Changing Glaucoma Practice

At the European Glaucoma Society (EGS) meeting in 2026, Prof. Gus Gazzard explained why Selective Laser Trabeculoplasty (SLT) is the ideal first-line therapy.^6-8

SLT Outcomes Supported by Clinical Evidence

The Landmark LiGHT Trial has demonstrated that:

• Nearly 70% of eyes treated with SLT first (with six years of follow-up) remained drop-free without glaucoma surgery.⁹
• Disease progression occurred less frequently in eyes treated with SLT than those initially managed with medications (26.8% vs. 19.6%, respectively; P 0.006).⁹
• Fewer trabeculectomies and phacoemulsifications were required in patients who underwent SLT than in those treated with eye drops (trabeculectomy: 13 [2.4%] vs. 32 [5.8%], P < 0.001; phacoemulsification: 57 vs. 95, P = 0.03).⁹

Moreover, there are now multiple studies from the UK, Sweden, China, and other healthcare settings, which demonstrate robust treatment effect and significant disease control with SLT as the primary therapy.^10-12 He stressed that these studies consistently demonstrate that SLT can provide long-term disease control without medications,¹³ with only occasional retreatment required in many patients.^14,15

Prof. Gazzard emphasized that these benefits are seen when SLT is introduced early in the disease course.¹⁶

International Guidelines Now Reflect the Evidence

The accumulating clinical evidence has rapidly influenced international practice guidelines. The American Academy of Ophthalmology, the European Glaucoma Society, and the UK's NICE guidelines all recognize SLT as an appropriate first-line treatment, with NICE now recommending laser-first treatment for newly diagnosed patients whenever appropriate.^6-8

Barriers to Widespread SLT Adoption

Yet despite this strong evidence, conventional SLT has not become routine practice since its launch in 1995. Traditionally, SLT requires gonioscopy, corneal contact, topical anesthesia and operator experience. Accurate visualisation of the drainage angle can be technically demanding, limiting widespread adoption of SLT despite its proven efficacy, safety, and durability. In addition, while some patients tolerate SLT very well, others don't tolerate it at all.¹³

Voyager^TM DSLT: Enabling the Next Era of Accessible Laser-First Glaucoma Care

Unlike SLT, which requires a gonioscopy lens for visualization and treatment delivery, the Voyager Direct Selective Laser Trabeculoplasty (DSLT) system uses automated image guidance to deliver laser energy translimbally through the limbus.^13,17 This noncontact approach enables targeted treatment of the trabecular meshwork while eliminating the need for gonioscopy.

The average estimated total energy delivered to the TM was lower for DSLT than for SLT. (21.7 mJ in DSLT group compared to 28.5 mJ for SLT group) while completing treatment in approximately 2 to 3 seconds, creating an efficient and patient-centered treatment experience*.^7,13 By eliminating the need for a gonio contact lens and slit-lamp positioning, DSLT streamlines the treatment process for physicians and staff while also designed for patient comfort.^13,17 The result is a simplified procedure that can optimize practice efficiency and enhance patient satisfaction.^13,17

*96% satisfaction rate

"The goal is to deliver exactly the same therapeutic laser energy [as the SLT] to the trabecular meshwork, but in a different way," Professor Gazzard explained.

Voyager DSLT Clinical Trial Results: GLAUrious Trial

The multicentre GLAUrious trial compared Voyager DSLT and conventional SLT in 192 patients with open-angle glaucoma or ocular hypertension.¹⁸

• Comparable efficacy at 6 months: DSLT achieved a 20.6% (5.5 mmHg) washout IOP reduction versus 23.6% (6.2 mmHg) with conventional SLT.^13,17
• Durable results at 12 months: Both groups maintained similar medicated IOP reductions (~3.2 mmHg), with comparable proportions of medication-free patients.^13,17

The Voyager DSLT is an effective treatment option within the modern glaucoma pathway, particularly where improving access to laser therapy is a priority. It provides:

• Overall clinical efficiency and performance¹⁹
• Sustained pressure reduction¹³
• Favorable safety profile¹³

With growing evidence, evolving international guidelines, and innovations designed to simplify treatment delivery, glaucoma care is entering a new era. Today, the question is no longer whether to offer laser-first therapy, but how to make SLT the practical choice for everyday glaucoma practice. Voyager DSLT is designed with that goal in mind.

Voyager™ Direct Selective Laser Trabeculoplasty (DSLT) redefines how laser treatment is delivered.

©2026 Alcon Inc. 08/26 IMG-DLT-2600016

References

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2. Schwartz GF, Quigley HA. Adherence and persistence with glaucoma therapy. Surv Ophthalmol. 2008 Nov;53(Suppl1):S57-S68. doi: 10.1016/j.survophthal.2008.08.002. PMID: 19038625.
3. Yu AL, Weise S, Welge-Lussen U. Intensity of side effects of topical glaucoma medication and its influence on adherence behavior in patients with glaucoma. Clin Ophthalmol. 2014 Jun 28;8:1221-1226. doi: 10.2147/OPTH.S62494. PMID: 25061268; PMCID: PMC4085302.
4. Bhagat P, Savalia P, Nayi S. A study of the effect of glaucoma and its management on the quality of life of patients. BJKines-NJBAS. 2020;12(1):1-8.
5. Nordmann JP, Auzanneau N, Ricard S, Berdeaux G. Vision related quality of life and topical glaucoma treatment side effects. Health Qual Life Outcomes. 2003;1:75.
6. Glaucoma: Diagnosis and management: Guidance. NICE. January 26, 2022. Accessed June 10, 2024. https://www.nice.org.uk/guidance/ng81/chapter/recommendations.
7. Takusagawa HL, Hoguet A, Sit AJ, et al. Selective laser trabeculoplasty for the treatment of glaucoma. Ophthalmology. 2024;131(1):37-47. doi:10.1016/j.ophtha.2023.07.029.
8. Spaeth GL. European Glaucoma Society Terminology and Guidelines for Glaucoma, 5th Edition. Br J Ophthalmol. 2021;105(Suppl 1):1-169. doi:10.1136/bjophthalmol-2021-egsguidelines.
9. Gazzard G, Konstantakopoulou E, Garway-Heath D, et al. Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial: Six-Year Results of Primary Selective Laser Trabeculoplasty versus Eye Drops for the Treatment of Glaucoma and Ocular Hypertension. Ophthalmology. 2023;130(2):139-51.
10. Dahlgren T, Ayala M, Zetterberg M. Optimal Performance of Selective Laser Trabeculoplasty: Results from the Swedish Optimal SLT Multicenter Randomized Controlled Trial. Ophthalmol Glaucoma. 2024;7(2):105-15.
11. Philippin H, Matayan E, Knoll K, et al. Selective laser trabeculoplasty versus 0.5% timolol eye drops for the treatment of glaucoma in Tanzania: a randomized controlled trial. Lancet Glob Health. 2021;9(11):e1589-99.
12. Yang Y, Jiang Y, Huang S, et al. Laser in Glaucoma and Ocular Hypertension Trial (LIGHT) in China - A Randomized Controlled Trial: Design and Baseline Characteristics. Am J Ophthalmol. 2021;230:143-50.
13. GLAUrious Study - Clinical Study Report (CSR). CA-RP-01-006, Rev. 01; 2022.
14. Khawaja AP, Campbell JH, Kirby N, et al. Real-World Outcomes of Selective Laser Trabeculoplasty in the United Kingdom. Ophthalmology. 2020;127(6):748-757.
15. Khouri AS, Lari HB, Berezina TL, Maltzman B, Fechtner RD. Long term efficacy of repeat selective laser trabeculoplasty. J Ophthalmic Vis Res. 2014;9(4):444-448.
16. Montesano G, Crabb DP, Garway-Heath D, et al. Six-Year Rate of Visual Field Progression in the Laser in Glaucoma and Ocular Hypertension. Ophthalmology. 2026;133(2):169-77.
17. Belkin Vision Eagle Device User Guide, EU. Rev. 7.2; 2024.
18. Gazzard G, Congdon N, Azuara-Blanco A, et al. Randomized Noninferiority Trial of Direct Selective Laser Trabeculoplasty in Open-Angle Glaucoma and Ocular Hypertension: GLAUrious Study. Ophthalmology. 2025;132(10):1091-1104.
19. Alcon data on file, 2026. REF-29887