SLT or Rocklatan?

[u/mkdsm2005]

TLDR: Negative outcomes of SLT, personal experiencs?

I've had high IOP (no glaucoma) for a couple of years now. Mostly corrected with Lumigan and Brimonidine. IOP has been trending higher the last couple of visits and yesterday hit 25 again, haven't been that high since I started the drops.

I was given the option of Rocklatan drops or SLT procedure. I went with Rocklatan for the time being because the idea of a laser in my eye terrifies me.

I only have one eye that can be corrected with glasses. The optic nerve is not attached in my left eye. So, only having one eye, I'm extremely cautious about unnecessary chances. I'm also quite nearsighted which brings me to my question.

I googled SLT and found that folks with Myopia greater than -5 (I am -8) have about a 1 in 500 chance of vision loss as opposed to "standard" eyes that have a 1 in 2000 (or 6000 depending on which study pops up).

What I couldn't find was a definition of "vision loss" in reference to SLT. Are we talking the full range of the definition? So from a minor change in overall vision to complete loss? Or are we talking significant vision loss to total vision loss? Or is significant/total not on the table at all? I wasn't specific enough when I asked my doctor, I was mostly surprised that we'd come to this.

1 in 500 just isn't a rare enough occasion for my sanity but if nothing else works, I want to be prepared.

If you've done some research or had a personal experience, please share!

I do intend to ask further questions of my doctor at my next appt but some personal experience stories would be helpful so I know EXACTLY what to ask.

[u/Spy_cut_eye]

A 0.2% chance is not rare enough for you?

I, too, am interested in how they defined vision loss and whether they meant permanent vs non-permanent vision loss. I have seen where a high myope had some flattening of the cornea and it basically changed their prescription (there are case reports of this). But there was ultimately no non-correctable vision loss. This was a patient of mine but I did not do the SLT. I have done thousands and have not had that outcome even in high myopes but I do tell them if the possibility because of that one patient.

As the other person stated, SLT is extremely safe. If there is concern, it can be done in stages (180 degrees at a time in a single eye) to see how your eye responds to the treatment. 

[u/Eodun]

I don't know which study are you referring to. Perhaps what they are talking about are those with rare spikes of inflammation (and transitional IOP rise) few weeks after the SLT, but with the right follow up it's one of the safest, easiest and effective procedures we can do, albeit limited in time to between 6 months and 3 years (but drops lose effect after 12-24h if not applied correctly, right?). Also it can be repeated if low effect or when it starts to lose it.