By Jeffrey B. Minkovitz, M.D.
If you or someone you love has been diagnosed with glaucoma, chances are the first thing the doctor prescribed was eye drops — one or more bottles, every day, indefinitely. But research suggests there may be a better first step: a quick, painless laser procedure called Selective Laser Trabeculoplasty, or SLT.
What is Glaucoma — and why does it matter?
Glaucoma is a leading cause of irreversible blindness worldwide. It damages the optic nerve, usually because of elevated pressure inside the eye. The only proven way to slow the disease is to lower that pressure. For decades, the standard approach has been prescription eye drops. They work — but often cause redness, stinging, and irritation, must be used consistently for life, and can be expensive. Studies show many patients stop using their drops, and missed doses mean uncontrolled pressure and disease progression.
Enter SLT
SLT is a brief outpatient laser procedure — typically under five minutes — that gently stimulates the eye’s natural drainage system to lower pressure. No incision, minimal discomfort, and patients return to normal activities the same day.
The Evidence: The LiGHT Trial
The landmark Laser in Glaucoma and Ocular Hypertension (LiGHT) Trial, published in The Lancet in 2019, randomly assigned patients to either SLT or eye drops. After three years, 74 percent of SLT patients remained completely drop-free with well-controlled pressures. The SLT group had fewer cases of disease progression and required zero glaucoma surgeries, compared to eleven in the drops group — and SLT was more cost-effective.
Six-year follow-up data reinforced these results: nearly 70 percent of SLT-treated eyes maintained target pressures without drops or surgery, while the drops group experienced more disease progression and more surgeries. A 2025 re-analysis confirmed SLT better preserved patients’ visual fields over six years.
Already on drops? SLT may still be an option
SLT isn’t just for new diagnoses. A 2025 study in JAMA Ophthalmology found that patients who switched from drops to SLT — even when their drops were working — had remarkable results: over 60 percent became completely drop-free, and among those on just one drop, 84 percent no longer needed medication. SLT can also be added alongside drops that aren’t fully controlling pressure. Either way, it can mean fewer bottles, fewer side effects, less hassle, and lower costs — with outcomes as good or better.
The tide is turning
Despite the impressive 2019 results, U.S. adoption was initially slow — drops had been the default for decades and many doctors preferred to wait for longer-term data. But the evidence has become hard to ignore. The UK’s National Institute for Health and Care Excellence now recommends SLT as the preferred first treatment, and a recent survey found roughly two-thirds of U.S. glaucoma specialists now prefer SLT.
What this means for you
Whether you are newly diagnosed or have been using eye drops for years — even if they seem to be working — ask your eye doctor whether SLT might be right for you. Why juggle daily drops, monthly refills, and ongoing side effects when a five-minute procedure could deliver the same or better results? Not every patient is a candidate, but for many, this simple laser offers a simpler, less costly, and more effective path to preserving vision.For further information or to schedule an appointment please call 302-652-3353 or visit www.eyephysicians.com.
Bio
Dr. Jeffrey Minkovitz specializes in corneal, cataract, and refractive surgery. A partner at Eye Physicians and Surgeons, P.A. since 1996, he is also on the staff of Christiana Care and the Center for Advanced Surgical Arts, where he serves on the medical advisory board. After graduating magna cum laude from Harvard University, he received his medical degree from the University of Massachusetts Medical School. He was also named Top Doc in ophthalmology by Delaware Today Magazine for six consecutive years.
Dr. Minkovitz is known for numerous Delaware “firsts,” including PRK laser vision correction, NearVision CK, and newer, less invasive techniques for corneal transplantation including DSEAK, DMEK and DALK. Together with his Center for Advanced Surgical Arts partner and co-founder, Dr. Minkovitz introduced laser cataract surgery to Wilmington, Delaware in 2012. In 2016, he founded Laser Vision Delaware, LLC, once again raising the bar and bringing a newer, faster and more accurate refractive laser to Delaware.
Ophthalmology piqued his interest early on in medical school, as the specialty offers an appealing combination of surgical and medical care, advanced technology, and in particular the joy of being able to impact lives through restoring and enhancing vision. Dr. Minkovitz also enjoys the ability to follow and really get to know his large cohort of patients.
