Non-Contact Laser Therapy for Glaucoma: A Review of Direct Selective Laser Trabeculoplasty

Glaucoma is a chronic, progressive optic neuropathy characterized by the degeneration of retinal ganglion cells. It is one of the leading causes of blindness worldwide, with elevated intraocular pressure (IOP) being the most significant modifiable risk factor. The objective of this paper is to assess the effectiveness of Direct Selective Laser Trabeculoplasty (DSLT) in the management of glaucoma and OHT based on analysis of available literature. Topical hypotensive medications are the preferred first-line therapy for both newly diagnosed open angle glaucoma (OAG) and ocular hypertension (OHT) over other treatment modalities for most patients. Medical glaucoma management, despite proven efficacy, is limited by issues of patient adherence, quality-of-life decrease, side effects, and ocular surface disease (OSD). Selective Laser Trabeculoplasty (SLT) has emerged as a safe, effective, and repeatable alternative to medical therapy for patients with open-angle glaucoma (OAG) and ocular hypertension (OHT). Direct Selective Laser Trabeculoplasty (DSLT) is a novel, non-contact laser treatment that delivers energy transsclerally to the trabecular meshwork (TM) without the use of a gonioscope. In recent studies, DSLT has demonstrated comparable efficacy to conventional SLT, including the multicenter randomized GLAUrious trial. It reduces IOP by 18-27%, often enabling reduction in or discontinuation of hypotensive topical medications. The non-contact, automated nature of DSLT simplifies the procedure, enhances patient comfort, and may expand access to laser therapy across diverse clinical settings. In conclusion, DSLT represents an innovative advancement in laser therapy for glaucoma, combining the clinical benefits of SLT with enhanced procedural efficiency and safety. Further long-term studies are needed to validate its durability, but existing evidence supports its use as a first-line or adjunctive treatment for OAG and OHT.