Leon W. Herndon Jr., MD participated in a recent discussion with the American Academy of Ophthalmology's EyeNet Magazine titled “An Early Look at the New DSLT Technology.,” exploring the clinical potential of Direct Selective Laser Trabeculoplasty (DSLT)—a new, non-contact laser treatment for glaucoma. Herndon joined Ruth D. Williams, MD and Brian E. Flowers, MD in a roundtable discussion to evaluate the benefits, limitations, and future implications of DSLT in glaucoma care.
“The main benefit of DSLT is that you don’t have to use a goniolens to perform the procedure, and it’s more efficient than SLT,” Dr. Herndon explained.
While DSLT offers a streamlined, external approach, Herndon raised important clinical considerations—particularly the inability to adjust laser energy based on angle pigmentation, a key customization available in traditional Selective Laser Trabeculoplasty (SLT).
He also emphasized that DSLT does not eliminate the need for gonioscopy, a critical diagnostic skill in glaucoma management and minimally invasive glaucoma surgery (MIGS). Herndon noted that while DSLT simplifies the procedure itself, preoperative gonioscopy remains essential to ensure appropriate patient selection.
“Although it’s true that surgeons don’t have to perform gonioscopy during the procedure, it still is incumbent upon us to do a gonioscopy preoperatively to make sure that the angle is open and that these are appropriate patients,” he said.
Herndon also reflected on the impact of the LiGHT trial, which demonstrated that SLT is more effective and cost-efficient than medication as a first-line treatment for glaucoma. He shared that he had already adopted SLT as a primary therapy well before the trial’s publication, and the findings have only reinforced that approach.